SLP Toolkit Podcast, Episode 12, Transcript
Well, hi, Lisa!
How are you doing today?
Good. I like how we just mixed it up. And you started this one.
Do you think anyone but you noticed that?
Yeah, I think everybody was like, wait, Sarah usually says hi, Lisa first.
I'm pretty sure you might be the only one that heard, but I'm really excited that, that got you real jazzed to change it up like that.
Yeah, I know. We're just really shaking things up around here.
Well, I'm going to tell you we've really, really shaken it up because we have somebody new in the confessional.
And a dude.
Seriously, that's where it's like, not only do we have a guest live and in person, but, um, he's part of the 3% of SLPs that are not female, right? Is it 3%?
I don't know.
Research says it's 3%, but that statistic was completely made up.
We like to just randomly just throw things in front, like where you just say research says, and everybody just believes that if you just say research says, so research says only 3% of SLPs are male. I believe it.
I don't think it's that small.
What was your grad class like?
I had two.
There you go.
You had two grad classes and you're an SLP?
Two dudes! Two guys in the class out of 50. So I do, I think the number's really small, but anyway, we found one. It's like a unicorn and here he is.
So let's introduce him! This is Doug Cutler.
I know. And it's always amazing that we convince anyone to come and do this with us. Um, but we were really excited Doug agreed to do this because one, we really like him and two he's super smart. And I think this episode is going to be so helpful to a lot of people. So thanks for coming.
I'm happy to be here. I hope it's all that and more.
Yeah, I think it will be. I think it's going to be a treat. So welcome. Doug. Tell us a little bit about yourself.
I am a speech pathologist here in, uh, here in Phoenix, working for public schools, doing assistive technology solely as the AT specialist in the district. We are the largest district in Arizona, so it's, it's huge. And um, it's a little bit different, I think, than, than what most people who are AAC specialists are doing because you, you are working with a large district and a lot of departments, so.
The resources are big, but then sometimes it's almost like the government where even though there are a lot of resources, there are a lot of sometimes red tape involved in, um, because the process—You have processes when you have a district that's so big. Right. So that's actually how we all met. We all met, worked in the same district together. And so we've gotten to work with you on that kind of personal level too, and know your awesomeness, um, from that.
Yeah. And I think like you were saying, because there are districts so large, um, our last podcast we did with ampage on AEC, we really focused on those students with communicate complex communication needs. I thought about it after I listened to it, and I love that episode, and there was a lot of great things shared, but that's just one tiny piece of the puzzle.
Assistive technology is obviously involved in a variety of ways and you do it all.
You're not just working with speech pathologists, right?
No. Um, we work with special educators and aides and parents, um, obviously teachers. But you know, we're also working with other departments and especially in the last few, I don't know how many years, I think one of the things that gets lost and I don't want to get too far in the weeds here because I know, you know, not everyone wants to be an AT specialist or has that inclination, but, um, I think what does get lost is, is the history of AAC and kind of, um, what that looks like now and what that entails. So, you know, we were talking a couple, few years ago, even you had your device company and you had your specific device and this is what it did. And it was solely for voice output and that was it. And, um, you know, it allowed us to be very self-reliant. I could be a speech pathologist with some AAC knowledge and know how to use a voice output device. Um, and maybe, maybe my skill was in how to figure out what voice output device fit in what situation and things like that. Uh, but now, I mean, we're working with tablets and a lot of, uh, well, we're working within a system, as you said, Lisa, where we've got other departments to deal with too. So now we're working with firewalls, we're working with ed tech, we're working with information systems, um, we're working with Internet access. It's become quite different in the last few years, I'd say.
Or even something as simple as how can you get apps on an iPad and how does it belong to a district versus an individual iPad and one user.
Well, heck, when I first set up an iPad, I was doing, I figured, well, I'll get an iPad and we'll get, you know, Prolocal on it and start going here and see what happens. So I set it up, sure, with my iTunes account, why not? That sounds smart. Why not do that? Um, and you know, I got it out there, I was thinking I was doing this great thing and got it out to a student that I'm like, this is gonna work for him. He'll be my test case. We'll see how all this goes. And um, yeah, all of a sudden my emails are all screwy and I'm like, what is going on here?
Then your live photo stream showed up on your iPad and you're like, "oh, I'm fired."
I'm like, "What the heck is going on?" I've got work emails that are going out to people I don't know. But yeah, turns out, sure, you can set up an iPad with your own personal iTunes account and everything else gets linked into it.
Including your Gmail—
I saw a movie about that once.
Oh, man. Things have changed.
You know what? Learning curve though. And I think that's the great thing about, uh, assistive tech and AAC. And I, I heard, you know, I heard you guys talk about it before that you have to get in there and do it. Um, there's, there's no cookbook for it. And I think that's, what's different about AAC and that's what's fun about it.
Yeah. I have always been very interested in it, but it also terrifies me. That's what we talked about on that last podcast is the fear. And I, because we personally have worked together, we just had a really interesting conversation about this last week. Doug is probably one of the nicest people on the planet. Um, if you don't know him, sorry. That sucks for you.
Your loss. Yeah. He's just such a good guy. And I always knew I could call him if I needed anything. And I could, I, I think internally I knew I could probably ask the dumbest question in the world and wouldn't be judged, but because we all have this insecurity that, well, I'm a school-based SL or I'm a speech pathologist, I should know this. And so I never wanted to be found out just how like AAC dumb I was. And so I wasted all of this time on my ego, not calling you. And I'm sad now because I think you could have taught me so many things.
You know, I think it's funny because coming from my perspective, I am terrified to step into your guys' issues and go back into a classroom after doing this for 20 years. It's like, sure, my professors wouldn't want to hear this: I don't know if I'm a speech pathologist anymore. I don't know what I am. If I'm IS, ed tech, if I'm a special educator, um, what I know I'm not really good at anymore is: let's go in and work with an artic kid or some fluency. Like I'd be coming up to people saying, uh, w-what do I do? Where do I start?
I think that's anybody that specializes, though. I think you start to get so focused on that one area that you become an expert in that. And so that happened with somebody else in actually the district that we worked in that was in a specialized role and then kind of transitioned into a more school-based role. And she was like, Lisa, I need to learn how to be an SLP again. So you need to help me because it is, it's a different set of expectations when you're working in a more traditional school-based role and the generalized caseload and all of that. You kind of have to know a little bit about everything versus, um, when you're just focusing on, you know, a lot about your area, but, but you know, a lot about that. So you're able to take that and generalize it to a lot of different students, but it's, it's just a different skill.
It was really powerful when you said that to me, um, when, when you just made that comment. Yeah, because it, it made me realize here you know, that you're not going to be comfortable walking into a school-based SLP's role, and that you've kind of lost maybe, um, some of those skills that you once had because of your new focus made me realize I have got to break down these walls. Like, I don't know why any of us are hesitating to reach out to experts and specialists and get help and know that they in return would be asking us for help if the situation was reversed.
Absolutely. And I think the other thing is that, you know, when you do ask for help, I don't care what the profession is or what the specialty is. Um, I'm walking into your classroom, I'm walking into your realm. Um, I'm walking into your speech room. It's, it's not by all means, uh, my last, the last thing I want to do is walk in and tell someone how to do something, where to do it, that they're doing something wrong, especially, um, you know, if I'm doing my job appropriately, I'm, I'm in there, we're giving knowledge, we figured out a system, some kind of support, whatever. And, uh, and hopefully nothing's, nothing's changed on the surface. Um, and I think that's where, where people get stuck a little bit is that, you know, I've gotta do something different. I've got to do something, you know, out of the box because this kid has AAC or AT or whatever it is. And the reality is, is if we do our job, right, it should be seamless. Um, if, if, if there's something you're noticing, we're, we're on the wrong language system, we're not prompting and cuing appropriately, something—something's gone awry there.
I think that same principle applies. So if you think about like, even us reaching out to you and connecting with you and having that fear, it's kind of that same principle, like even a general education teacher, we're a specialist to them. So imagine if they were nervous to connect with us, to tap into what we know about communication skills and same thing, we would never want to go into a general education classroom and start telling them what they're doing wrong. Everybody has this unique set of skills and this unique perspective on what they're doing. And it really should all be, you know, you pull from that. [Unintelligible]
That's the post we did on Instagram last week. We are all in this together. We really have to break these walls down and start openly communicating and saying, here's where I need help, you know, or here's where I can offer help. Or, you know, we've got to just break those walls down. Cause I do. I think it is a problem in all of our fields. Our sole focus is on the student and that means that we come together and do what's best for students. And, and no one person is, is a stronger member of a team.
I think that may have even served me well to be so engrossed in what I do that it's like, okay, I would definitely need a refresher course or two, or how to get back into an SLP's role. But you know what the other thing is? I don't hide that. Um, when we talk language development and language development relevant to AAC, I throw those questions out there: hey, what do you think? What, where do you think this student is developmentally, cognitively? Um, I throw it out to teachers that way as well. Talk to me about your curriculum. What does it look like? Again, if we do things right, this ought to be a seamless transition, this shouldn't be something where, okay, I'm going to do something different for this one kid that's participating in this, this full classroom. Um, that's not where we're going for.
Yes. That is a huge thing.
I was going to say, and we're going to get into this, I hope, a little bit more later too, but that was also something I learned from you is: this is just their output.
Nothing else is changing. And so when we talk about, you know, doing AAC assessments and writing AAC goals and doing AAC therapy…
There's not AAC time.
It's built into their day. It's not that we just set aside time. And that would be like setting aside time to just communicate or to learn like there is, you know, it has to be built in.
Yeah. So you're saying, if we find the right support for that student, there really shouldn't be this huge learning curve because it should just blend into what they're doing every day, but now has given them access.
And I think what ends up happening is, you know, we, we want to do instinctively. We want to do activities. We want to do like, Oh, I want this student to learn X, Y, or Z. And we're going to do this activity around it. And, you know, especially in a school-based setting, our activities are right there. It's the curriculum, let's work with our teachers to pull stuff out of that curriculum. Now we can pre-teach it in a therapy room if that's what we want to do, something like that. But this notion of teaching them, teaching our students something, you know, completely different off of this tangent, because we think it's right, or it feels good to us, or, you know, I know you guys were talking about colors at one point. We want to know, we really want this kid to learn green, well, so kind of a dumb example, but if he's not learning green anywhere else, that's just one aspect. And we know our kids need so much repetition and our kids need a lot of repetition with AAC. Why not make it something that's relevant to them? Something they can generalize. Something where they're going to get more practice outside of just you.
So, and I think we talked about this with Anne too. So the idea then is whatever it is that we're working on now, we've just included this device or, or whatever support that we're providing with the student. And so where do we start? I think that's everyone's biggest hangup. How do we start? This is new to them. We've introduced this new output device or, or whatever it is. And then, and then what? We model.
Um, modeling's a lost piece of this. Um, but I think, you know, the funny thing is, and I'm going to go a little bit different from, um, what was said on the other podcast with Anne. Um, I think she did an excellent job of talking about what happens in a classroom and things like that. I'm going to support her from the backside of things, because for me, what I'm always looking for are systems, um, and we always talk about those kids that do walk in with communication devices and they have this high-tech device and so forth. Um, you know, when I, when I look at it, I'm looking at it from the perspective of there's 80 schools out there with kids that are, we have kids in preschool, we have kids that are in high school. Um, so everything becomes individualized as far as where that student is, where they're going, where they're at cognitively, the environment they're in, gosh, what teacher they're with, what program they're with, what curriculum they're using. All of that really plays some sort of role in there. So taking your question again, going back to the basics of it, I might be working with a student in a preschool and I'm doing activity boards and printouts, um, looking at specific language, you know, and even incorporating some of those core words. Um, so really it does depend where your students are. And I always go back to Joy Zabala and the SETT framework where we're looking at, she is specifically: Student, Environment, Tasks, and Tools, and it's always been used as, as more of an evaluative framework, but, um, it's also great for ongoing assessments, it just kind of gives—
You know where they're at, to know where you're taking them.
Exactly. Um, and it, it allows you to look at, okay, here's the student, here's where they're at cognitively, whether you're at a baseline assessment or whether this is a reeval. Um, and then, you know, what tasks have changed over time over the years, even over the course of weeks that this kid's being asked to address, but all of that becomes a system. And even, um, you know, I mean, we could go talking about specific communication devices and things like that, but the, the reality is, um, what I'm looking for is: you know, if we've got a kid on, on such and such core word device, how great would it be for them to have started on a paper-based display with some of that same language? So you ease that transition. So I think having those short-term and long-term goals become really, really important. And just having that perspective, it doesn't all have to be written down, but just having an idea.
What helps them, why does the paper device, what helps make that connection for them?
You know, I, we used to be that every kid had to start with paper-based overlays, and there was this progression up through AAC, and that's not necessarily true anymore. But, um, we were just in a preschool classroom working with students. And, um, we took some of the editing software and just printed off the pages that are in what would be a communication device.
Just to show some of those foundational skills readiness for a device.
You know what? What it allowed us to do actually is just give the kids something immediate and that had some structure to it. So, um, you know, as much as I like Boardmaker and things like that, sometimes our teachers, our SLPs are, you know, time-constrained or a little bit intimidated about using it. Maybe they don't have access. Now, some of that editing software is free and you can download that and then just print off a page and be able to implement it right away. If you have a student that does well, you know where you're going. It can also be cut up into individual symbols as well, if you're at a little bit lower level. But I think the other thing that you guys talked about in your other podcasts that was so important, and the part that does remain fairly consistent throughout AAC is core words. You've got your core words right there. Um, they're readily accessible. You don't have to go to another book. You don't have to go to another person. There it is. Print it off, start using it. It's systematic. As the student moves up, you can move up with them.
Yeah, I like that. I like what you said, just get, I think we all hesitate to get started. Cause it's like, I gotta wait for the AAC eval. I need the eval, and then I need this specialist to come in and decide the device and I need to do, and so—We wait, we just wait. Instead, if we could just print that off, get going, try some things. Um, the, the question, I think that comes up a lot too are symbols. And, um, there's such a variety of, of, you know, different types of, um, the images are different. The colors are different.
Or displays are black and white.
The location of buttons are different. Some things are grouped by different ways. What is there, is there an easy answer to this? How do you know which one?
Or how many?
Yeah, exactly. Um, there's really not, but I do go back to still the, the SETT framework and really looking at, okay, here's our student. Here's what they're able to do. Um, cognitively I, you know, I go back to a lot of the testing that you guys, speech pads, have probably already done, and you've, you've done an expressive one-word, you've done a Goldman-Fristoe. Where is this student? And you get a pretty good idea of where they need to be. Um, so I think, you know, a lot of times that stuff gets discounted, like, oh my gosh, we're starting new, we went into AAC. No, that stuff is so supportive of what we're going to end up looking at. And, you know, going into assessment, there is no formal assessment for AAC in there. There's nothing that's going to give you something that's gonna say, all right, I checked this box. This is where this kid is at. I checked this box. This is where this kid is at. He needs to be on a low-tech or this kid needs to be on a high-tech system. Um, there's, there's nothing, that'll give you a brand name. You know what I mean? And I think that's where people get caught up too, is, you know, they, they want this recipe of how to do AAC and that's, that's not really it. I mean, you hate to say it's trial and error. We do have a starting point and you're, you're hoping that the information you've gathered leads you to a right place or, you know, a great starting point. But the reality is those things are going to be tweaked. And if you got an AAC user that's going to be on this for, you know, long-term, it'll be tweaked again and again and again, and it'll never be perfect. Um, but it'll be, it'll be that kid's system.
I think that just gave so many people, like a time to just go [sighs] when you said that, because I do think—we, we think there should be something that's guiding these decisions, you know, like that we just don't know it.
I've been missing something all these years, you know, like I should know which system is the best and which one's more appropriate for the student, but there, there really isn't an answer.
There, there really isn't there's um, you know, there's, there are systems at work. There are, there are, you know, there's trial, there's error. There's, there's what works in this environment versus that environment. If I've got a kid that's going to swim club, I'm not giving him a high-tech device. It doesn't mean he won't use one in his classroom where, you know, that's a more appropriate setting for it, but maybe as a paper backup for the pool.
So that environment piece plays a huge role in it. And, um, and then again, your tasks, you know, what is this kid being able to ask to do? And I think you, you take the students and their abilities, and then you look at the tasks that they're being asked to do. And there has to be some middle ground there somewhere. Yeah.
But that's, what's so cool. I think again, thinking of core words and looking at where we can come in with our lens of what can we do with that kid. So even thinking in a swim that you can laminate that for there, or even having the swim coach with a lanyard and having those symbols laminated on their neck. I mean, there are ways that we think of, um, making this diversified kind of instruction for our students, all of our students all the time. And it's one of those things we do naturally, whether you give yourself credit for it or not. But I think we, we kind of put up this stumbling block when it comes to AAC, that we just sort of say, we can't, we don't know this and this fear creeps in, but you do know this, people. You know language. And so you start with that. You start with what the student knows. You build on those strengths. You figure out this whole, um, system of how they can show and use their language. So you know, more than you think you do, I think, often. Yeah.
And I think there's, there, there are going to be different things that people have different access to also. Districts have different access. Parents have different access. But the, you know, what? We can make it all work. Um, it there's, regardless of what the system is, to a certain extent, you, you still have the basic principles of, of those, those targets that you want to hit and how this kid is supposed to use it or how the student is supposed to use it. But, you know, I think that's the difference is you're not, you're not teaching AAC. You're not teaching the device, you know. You're, you're teaching language, like you said. Your goals should be language goals. They should be, you know, expression goals, um, not touch the button, touch the button as a physical task. It's a skill, but it's not language.
So the big thing is the teams need to really figure out what the current communication strengths and needs are. And from there, they need to develop goals to support those needs. So what would be some, some typical, like kind of language that would support students who are using AAC, that would be more language driven versus student will touch a button.
So I think it goes right back to those goals that you would create for any typical kid that you were working with. Um, I think it goes back to, you know, your, your language delayed kids and the targets you're trying to hit. Um, if you're expecting him to compose sentences that are comprised of grammatical markers, like an appropriate pronoun and so forth, that's what we want with AAC as well. Um, you want that? Alright. Student's going to create a two to three word sentence. Now the, the end of that goal might be given access to his AAC device, but, you know, going into the IEP lingo here, someone should already have a really good idea of that student and a picture of that student before you ever get to your goals. So if in your present levels, you're saying this is a student who's non-verbal, he uses a high-tech communication system with 42 locations. He accesses it with his hands versus like a switch or something like that. Um, you know, I'm going into those goals down the line going, Oh, that's right. I've got a kid who uses an AAC device. This is where he's at. He's able to pick out single nouns here and there, but we really want to use that core word and create a system. How can we get him to do that? Um, just like your students that would only be using one word, and you're looking to expand MLU.
Yeah. I love that. You wrote a blog post for us a while back. I will reshare it on this podcast episode too, because it's one of the number one questions we get is: when are you going to add AAC goals to SLP toolkit?
And so we always answer with, well, here's a blog post we think you should read. Because we're not. Because there's not—the goal, the goal isn't going to change, but it was still targeting speech and language skills, but you may want to add the output of how the student is going to produce that response. That's okay to add to the goal, right. But the goal is not to memorize all 42 buttons on their device.
Yeah. And notice we're not even talking about specific language systems. We're talking about where that student is at and what their language is comprised of. So, you know, I would never, I guess, in a present level you can write what system they have and they're using that.
Because that's present level. That's currently happening.
That's happening right now. Um, your goal's being predictive. Um, we don't know if that device is going to be there. Maybe the kid's doing fantastic and we need to, we needed to just up his device for whatever reason. He is on a super talker. We need to get him up to something that's a little more dynamic than that because his vocabulary has expanded so much.
Or maybe he brings it to a swim lesson and drops it in a pool. Then you're screwed.
So I, that's a good point to make:maybe don't list the device, right. Just say that they're using voice output or, or whatever they're working on.
But then the other piece too, is the special considerations. There is that section and special considerations in your IEP that you list assistive technology. So you would want to put, if that student requires a device, maybe not a specific device, but if they require some sort of communication device in order to access their curriculum, that should be listed there, right?
Totally. And that allows someone like me to look at the present levels. If you told me that he's using, you know, a high-tech device on a 42 location with 42 symbols, basically, um, and he's able to navigate, and he's using, you know, his general MOU is three to five words, something like that. Let's say that device does break. That device has to go back to the company. It's in for repair. Parents need to take care of it, whatever. That allows someone like me to figure out the resources in order to get this student something where he can get back and participate in curriculum. Again, I have a good idea of what we're looking for, what we need to put in place. Um, so it serves that purpose as well to, you know, not just say: oh, well he had a device, uh, we don't, you know, we, we don't know what it was and I, I'm not going to put in something that that's not going to be effective for him.
What if I'm in a school district where I'm one of three SLPs and we don't have huge resources or I inherit an IEP that says something like this. And I go to my sped director. And if they say, well, we don't have funds for that.
You know, there's a couple of different resources. And I know that, um, number one, uh, if it is a device that's made by a manufacturer like Prentke Romich, like Saltillo, someone like that, uh, like Tobii Dynavox, those guys are really supportive and they want the kids to thrive. So, you know what? I would talk to— most of them have local representatives. If they don't have local rep, I'm sure they can put you in touch with someone that, that, that is able to help. Um, the second part is that, you know, and I'm not sure about all states, but I know that in our state, we have a lending library through the state of Arizona that's run by Department of Ed and they allow us access to certain devices. Um, in fact, they have a wide repertoire here of, of devices that are available. Um, so that's another resource where it's like, hey, you can go in. You can go through their loan library and at least borrow something for a month or something like that, just to kind of get things rolling. Um, you know, getting a little in the weeds here. I think it comes down to, you know, we're lucky.
Well, but if it's in the student's IEP though, too, I, that my answer to that too, would be, that's not my problem. Right. We have to figure it out. So unfortunasately you might get some of those responses sometimes, especially when districts are smaller and feel pressure like that. But there are resources that I think sometimes you don't know about like that you just mentioned. So just, I always loved one of Sarah's favorite. Well, a couple of her favorite expressions: be resourceful, be a problem solver. There are a lot of resources out there. So a lot of times there are people at your Department of Ed that might have programs that can kind of point you in the right direction. So check into that. I loved your suggestion of checking in with the companies, because even if they can't directly, they might know of, I mean, they're out doing this kind of public outreach with districts and, and, um.
They may know organizations that have, you know, that, that have charitable, you know, resources where they're donating and things like that. Right?
Yep. Again, being connected, being a specialist within the field, I'm, you know, we're lucky. We haven't necessarily had that problem, but, um, you know, it's, I get it. The first, the first reaction is to just start sweating, probably.
And freeze. And stand still. Sometimes we just stand still.
And isn't that a barrier in assistive tech, especially that, for some reason, there's still this stigma of like, Oh my God, it costs money. Don't talk about it.
Right, right. We don't want to be responsible for paying for it. If we say the student needs it, but we always have to put the students' needs first. We are supposed to be their advocate.
Yeah. Now one thing I will say is, um, typically the students on my caseload that would have benefited from assisted technology, I saw once a week. I was maybe in the room for an hour. Um, so is that going to cut it, Doug? Is that going to cut it, to get this kid a device? And then I'm going to trust everyone in the room to work on with him, with the rest of the week. And then I'm only going to do my 30 minutes once a week.
Yeah. Uh, no, but I think—
Is that only Sarah's responsibility?
You know what, no, it's, it's a team responsibility. And in fact, that's one of the biggest reasons why I try to get the buy in from our special educators and from our teachers and, and really looking at, you know, curriculum and how this kid is going to access curriculum. That's his practice. Um, for the most part, we may be doing some refining, um, in an individualized setting, but you know, really our curriculum is our stimulus. There are activities. You're going to see the most carry over, the most generalization, when we've got the support of everyone on the team. The other thing is, is again, kind of like we talked about earlier, um, I want our teachers to be involved and I don't want to be giving them...Okay. This kid uses AAC. So we're going to do something completely different here. Here's how we're going to do it. No. Hey, let's talk about your curriculum. What does the day look like? What does his day look like in your classroom? How can we get him more involved? There, now we're on the right track. And I think putting it in a way where we're all on the same team, we're working for you and for the student, tends to get a little bit of that buy-in versus, you know, again, like we talked about in the beginning, someone barging into your room or your speech therapy room and, and saying: hey, this is how it works.
And then you point at them and you say: you suck.
Yeah. That works.
Yeah. That wasn't a helpful approach.
I know, because I do think that's one thing is, um, and I know we talked about this in the last episode, when we talked about AAC too, is, um, I'm not going to be very beneficial to that student using their device to to access whatever activity they're doing if I don't know it. Absolutely. Because I have sat down with students before and I thought we're going to use your device today and participate in the classroom. And so then the, the activities happening and the student's not doing anything with their device. So I'm like, let me model, I'm gonna show you, I'm gonna show you how we do this, but I actually don't know where anything on that device is either. And so then I'm like, huh, how are we going to say this? How are wegoing to say this today? So I'm, what do I do about that?
There's a couple of things. And one is, I know, right? You wanna learn, you're going to pull that kid's voice right away and take his voice.
I'm going to take his voice with me because I better memorize that because I can't model if I don't know how I'm going to say this with the buttons that I have.
You just let the kid figure it out. You just watch. And then when they can't do it, you're like, what's your problem.
I think a huge thing with that is, is, uh, going back to some of that editing software, if you're, you're fortunate, I mean, we're talking about higher tech devices here, and if you're having trouble finding that vocabulary, that's what I'm assuming we're going with. So, um, some of that editing software is just awesome. Like the touch chat app. You can download exactly what that student's device looks like onto your, uh, into your PC, um, and have that available to you. You're able to just scroll through pages. See, now you won't have any individualized information, like what friends or whatever that he put into his device, but you will have that core vocabulary and, and be able to see the actual categories that are in there. I think that's a huge under-utilized, um, tool that that's available to people if they don't know about. PRC has the same thing, uh, even, uh, Dynavox. And you're able to download some of their software as well and see what is on the system.
Yeah. And we know Cough Drop too. Um, we, we had met the, uh, individuals responsible for Cough Drop. He's such a great guy and I love his story, but anyway, uh, I've used his and same thing. I have it on my computer and then I can make the changes and do everything and then update the app, which is awesome.
And I think the great thing about that is that then you're able to take that. Now, imagine printing off those pages. Maybe you don't have a laptop. I don't know. Um, you can print off those pages too and have that in front of you and use it as really low tech modeling. But how great is that?
Yeah. Um, and you have to know these devices you're working with.
You know what? You do. And at the same time, I will say this. When I go into, when I go into a consult, when I go into, you know, student has a device, what do I do with it? Um, the first thing I'm not talking about is programming, Uh, the technical stuff I really do not even purposefully, but I will save it. Um, because the more important thing is: how are we prompting and cueing the student to participate in his environment? And when we're looking at a curricular environment, that tends to be the hard part. Um, you know, going back to one of our preschool examples, it's like how many of our students are constantly asked, what's this, what's this, and it's noun, noun noun. Um, and again, that's just what we're used to, but what if we flip that around? What if we say, tell me about this flamingo, and we talk about pink and we talk about bird and we talk about tall or skinny, or, you know, whatever it is, but that, you know, those—using those descriptive words, I could have described a flamingo. I could have, could describe the ball across the, the classroom if I didn't have that word. But the point being is that those are words that are going to be much more high-frequency, used much more.
Than just flamingo.
Exactly. And so what I'm getting to is that, regardless of what level it's at, if we're prompting and cuing appropriately, we can do this. Um, but it, you know, when we've talked earlier about it being seamless, if I've got someone that's saying, Hey, we need to program this or program that, or, you know, beyond some of those individualized family members and friends and things like that, my gosh, do I need to be programming all that vocabulary? How many times this kid going to see a flamingo? You and I would have in Miami, but the point being is that like most of our students, at least here in Arizona, you're not going to run into a flamingo too often.
And you're going to get more bang for your buck too. I think spending your time modeling this and training like your instructional assistants or para-professionals depending where you're at to use that same sort of cueing. So then when you're not in there, the 30 minutes a week, they're using that same kind of modeling that same language and prompting throughout other lessons.
Honestly, I think in this day and age, it's harder to teach that than it is to teach the technical part or the programming. I'll teach you the technical and the programming part on most of these devices in literally a matter of minutes, but training ourselves to prompt and cue and not just ask for that, that block there, but maybe give me a color, maybe a shape and a size, number of blocks. Wow, that's way more impactful.
Or training other assistants in the room, not to do things for this child though. That's a huge one too.
Process versus product.
How about that. Yeah. We end up with, well, we want this completed art project, but we miss all of those communicative opportunities in there and they don't have to be big things. Um, you know, it, you know, sabotaging the environment still works for an AAC kid, so they can't reach the scissors or reach the glue and they need to ask for, you know, I need, and be able to say this one, that one, uh, the red one, the big one, the small one.
Yeah. So, okay. And that's where I think I needed to shift my mindset a little bit is to focus more on that, because what I would tend to do is —I'm a huge fan of literacy based therapy. And so I would have my book. And so of course, there's gonna be a lot of fringe vocabulary in that book. Right. So these are, there's going to be words. And I'm like, Oh, that word's not in there. So how am I going to work around it? Because I'm not sure how he's going to answer me with this device because that word's not in there. Um, but that's not what I should have. Why was I trying to get those words from him? We should've just been talking about what was happening in the story and checking comprehension of the activity or the story. And, and so I think I needed to shift my mindset.
How many times do we ask a question who is doing something? We expect this proper name. "She is"—what a great carrier phrase. Let's translate that to "he is", "they are", um, "it is" in the case of an animal or something like that, but those types of things are super impactful. Now, you know, is it going to happen overnight too? Cause that's what we get stuck in also is we want to see that immediate gratification, but you know, the students that are using AAC for the most part, and I'm generalizing here, they need that repetition. They need that practice, you know, a carrier phrase once a week. And it changing every day might not be the route to go, but a carrier phrase, a sentence of the day that lasts a week at a time that might be impactful.
That's a great point to make too.
We've talked about that before, about how, just because we get bored with something right, and always want to switch it up? That's for our benefit, not our students. Right? Yeah.
Our kids would love to read the same books over and over again.
Yeah. It was the same, the same movie. Like even, you know, neuro-typical kinds of kids have want to watch the same movie 8,000 times.
Well, and I was just thinking when it was oftentimes happening for me is I was just doing this on the fly and I didn't have enough preparation. And I think this is something that takes a lot of practice. And so I was just sitting here while you're talking and thinking, why didn't I lesson plan that out and really think about how I was going to get the most from whatever the curriculum activity was. What am I going to do to try to support the student and get this device, you know, being used in the activity? I should've mapped that out rather than trying to wing it.
I mean, although I do think even with trial and error, like it's still better for him to see me trying and, and looking, but, but still I could have been more prepared.
You know, I think, it does. There's a lot to that. And I think it's just for, for our comfort level as well, but you know what, we're going to make mistakes in therapy as well. I mean, I can't tell you how many times: Who is that? Oh geez. Like you roll with it. They won't know. But at the same time, I think those were the best learning situations for me was to then, alright, you know, tell me about this picture. What do you see? Things that are, you know, a little bit more general, a little more open-ended um, and then, you know, there's all those supports in between too. I mean, listening to you and talking about lesson planning. When, when I hear lesson planning, I go to like symbol supports and things like that. And, um, you know, they, there is, there's a lot to that and there's a, there's a lot to AAC that I feel like, "oh my gosh, we just can't even cover here". Um, I don't know if you can cover it anywhere.
You're going to write a blog post for us and, um, a book.
You mean a book.
And do a video. And what else?
You know, I think that the best teaching comes from, like, you really have these students that are such individuals and you need, if I had this student to represent this strategy and this student to represent this strategy and eventually we'll bring that all together. And, but that's, that's kind of it. Um, I, again, going back to the same constant that like you're still working on language.
Yeah. You got to shift your mindset a little bit. One thing that I was dying to ask you about for this podcast too, was, um, you get some, we get some backlash sometimes from parents. Um, because I want to just talk about the type of students that are, that can be supported by devices. So again, the last podcast episode we did was very much about our students that are, you know, maybe non-verbal or have very limited verbal output, um, and intellectual disabilities. But this can also be great for students with apraxia, which our whole last episode was about, um, students with maybe severe dysarthria or other things that are causing their inability to communicate verbally with us. Um, but we get backlash sometimes from families when we introduce that as an option, because they want the child to talk.
So how do you handle that?
Um, a lot of times the discussion goes for, uh, immediacy and you, you look at the goals, we look at the short term, we look at the long-term, we have this long-term idea of this student that, yeah, he's going to be verbal and that's fantastic. We're going to work towards that long-term goal. In the meantime, we also need to know that this student is getting what he needs at a curriculum and from social, uh, let's not forget the social aspects that go along with this and being able to interact with other students or other family members even. And so that's typically the way that I will address it is that this is by all means not the be all end all, but this could even be a kickstart, um, for our students that that will develop more verbal language later.
It's almost like when you use something like sign language. The most functional output will always prevail. Absolutely. Whatever is going to work for that student and be most functional is going to overcome.
What we hear a lot of times is that if we incorporate some AAC that a student is not going to talk.
Oh, because, yeah, they're going to just rely on that now. They're not gonna even try and talk anymore. Yeah.
And that is completely opposite. Um, as we've been talking about for however long, AAC is not easy. It's not easy for anyone. It's not easy for the student. There's, you know, he's interacting with something that's between him and somebody else as well. It's, uh, it's a longer process, no matter what we do. I mean the goal of, for me as an AT specialist, especially, it's getting a little in the weeds here, but when I'm dealing with someone with physical issues and access issues, the whole goal there is to try to increase speed of communication, right? Well, even with our best communicators who don't have those kinds of barriers, it's still a step slower. Trust me, our kids want to talk. If they could get it out, they will. And they will. Um, you know, we put a, uh, a communication device in front of students who do have verbal language. You will hear them verbalize that vast majority of the time. Um, in fact, we were working with a student the other day. As a group, the students were using a communication device so that all the students were modeling off each other. But we were also looking at this one specific student. All of the other students, the ones that could verbalize, they hit the Apple on a communication device. And they said, Apple. The right flag went up when our student hit the word Apple was totally content with that and sat down. Turns out when you go to ask him about that, he seemed to display some of those apraxic tendencies. And we were getting, um, we were getting motor planning problems and it's like: oh, okay. Here's a kid that, yeah, over the longterm, we'd love to see him using his voice. In the meantime, we need to make sure that he's continuing to learn, access curriculum, and that he's able to express wants and needs.
Yeah. And that's what... I had a really tough case. And I really struggled with, with her. And she was going to be moving on to junior high. Severely dysarthric and had some other things going on too. And so you would help me with her and we got her device and, um, she loved it. And so before I, I, you know, I, I don't think we had, I couldn't really talk to parents because it was almost, I didn't need permission maybe yet, because we were just going to introduce this to her, see what, you know, if this was something that was even a good option for her. And so we had introduced it to her. Well, she loved it. And, and mostly because we had shown her how to create entire dialogues of questions to ask her peers and things that she wanted to say, and she used it to write. And we saw just paragraphs from the student that I had never seen before, because she was using it to write stories and tell us things. And so I'm like blown away, right? This is going to be the greatest thing in the world for her. Um, and she could speak and she did keep speaking. We used her voice. And so anyway, when I finally introduced it to, to the family, um, they, they absolutely said, no, Liz is not, we don't want to do this. She will get lazy. Um, we want her to use her voice. Um, we don't want to rely on this. And so I, we, I even talked to you, I think about: what can I help to say? And so we did, we gave her a lot of information, but then there was a speech pathologist at home also saying, no, she doesn't need it. Um, she, she shouldn't be using this device. And so I don't think she has it any more. And it was a tough one. Cause I even questioned it. She does use her voice. She can talk. She was just, her intelligibility was so low and it was very effortful for her, um, to communicate. So she would do very short responses, even though I knew, I knew we could get more from her. So she was a good candidate. Don't you think back me up on this, Doug?
No, I agree with you. But I think that brings up an awesome point that like one of the biggest things that we see from our students and especially when we're questioning ourselves about that what if. I really look at, and more often than not, it's helpful, but do you see frustration in the student? Do you see times when they, you know, they, they either circum low cued or they just give up or, you know, they're, they're just not happy about where they are. And I think those are the times when it's like, yeah, you know what? Let's explore this. Let's see, let's see what we can do here. Yeah.
Yeah. And if they're wanting to, and she was interested in it and she wanted to use it.
Clearly, like that's what's so sad.
It's pretty amazing. I would've done it. I wouldn't have forced it on her if she didn't find it a helpful resource, but, but she really, she did. It was it, that was a tough case. But you do, you kind of question who are these students that need this, um, this kind of support and, and try to get some buy-in because again, I didn't need just buy-in from the family. I needed buy-in from the whole classroom on, on that.
And it sounds like it was going pretty well. Cause I mean, I know that we were also working with writing and again, talking about another point that gets lost is writing being expressive output. That's part of AAC as well. I mean, we've got students who are using our communication systems to write, um, you know, however you want to do it. Ours happens to be within the Google system, but we've got our students who are writing, saving their messages and then pasting it into Gmail, document, or into Gmail and into Google docs and actually composing written work. So that's what I mean, you know, with AAC being such a gambit and, and this individual could do that and could benefit from that. Well, some of our others, they're not at that level yet, but you know, you look at the scope of where, you know, from a single message, big Mac, all the way up to our students who are doing writing, composing, social media. It's, it's pretty vast.
The student may not be at that level, but I've seen some really clever teachers taking, you know, I even think of one particular teacher that will take her students' messages and compose it for them to make like a classroom book. So, I mean, there's so much that can be done. It's just kind of expanding your scope of what you, what your concept, even is of writing.
What your concept is of expression.
You know who does a lot of awesome stuff with that at a, at a lower level is Caroline Musselwhite. And she's local here. I mean, she's phenomenal talking about like, she's got kids doing poetry with communication devices and also scaffolded over different levels. You know, we, it's easy to talk about our communication devices that have, you know, all of the vocabulary built in and our kids are navigating it and putting it together themselves. Um, but you know, it's, it's a lot tougher, I think, to, to work with our students who are, you know, what do we do with this student in writing who has, you know, four locations on their, on their cheap talk and, and we want them to participate in this activity, and she has great ideas for that. Um, including just fill ins, uh, you know, fill in the blank and then, um, repetitive lines stuff.
Um, she, she does a great job and is an incredible resource, so.
Yeah. I love this so much. I think this just really ties into like getting past that fear, starting somewhere. I love the trial and error. Um, you know, not being afraid to ask for help. Find those supports that are available. Um, I think it's also important. I, like, look back over things in my career and I think that's one area I do beat myself up on probably the most is that I didn't give those supports to children who really needed them and make sure, you know, that there was buy-in and that they were being used. And I think: oh, where are they now? You know? Um, but it's never too late. Right?
Especially now with technology and what's available to us and available at a price that's, you know, when we talk about price, unfortunately with AAC, that's something that comes into play, but stuff has become so much more reasonable. Um, and we, we don't have to break the bank in order to provide access.
It doesn't have to be $10,000 any more.
No, it doesn't. And there's so many great apps out there. Now, I don't, we didn't really talk too much about it, but I didn't, you know, I didn't know, is there something better? I mean, are there things better than others?
You know, from my perspective and that's the other thing is, you know, going back to that STEPP framework that I always go back to, it's like: my environment, the school environment, and the classroom environment, you know, you can have a whole different discussion on a home environment and what's important there. And of course I have to do my plug where yes, of course we're all working together and going towards the same things, but let's be real. That environment dictates something different. Um, and so there's not always something better, but it's how would you use in the environment and for me in this classroom environment when I'm dealing with a whole district? I think I touched on this earlier and maybe didn't explain it terribly well, but, um, I'm looking at systems of supports. Um, I, you know, when we're dealing with hundreds of teachers, um, who have to be trained on communication devices and different language systems, um, when we have speech pathologists that need to be trained, when we have, you know, uh, different types of picture symbols, that's like you were talking about, I'm looking at where is this all coming together, and how do we make it so that I can address a student, uh, from preschool through high school with maybe supports that are going to be effective, not only for the students. I mean, we want to individualize for that student, but also for a teacher? Also for an SLP? I think for you guys to learn two, three, four different language systems, it's not really realistic all the time. Sometimes we're going to have to do it, but if we break it down to core words, if we break it down to, you know, prompting and cueing strategies, that that is one part of the system. For me looking at it across the school district, I want access to that editing software so badly where I can, you know, make printouts on low tech, where I can hide and show buttons and, you know, bring up a 20 location display down to, down to 10 or 15, but then without much programming, be able to pop it back up for the student as their vocabulary expands. I want to be able to move from a 20 location to a 40 location, keeping that same core language and some of that same look to the language system. So I also, when you talk about writing, I need this thing to interact well with our firewalls and what our district does as far as being able to manage all these mobile devices
And copy and paste.
Yeah. Into other docs.
It's so funny that like, you know, th—that environment and that, and what you have in that, that environment really dictates what you can do. Um, and again, it goes back to that it being so individualized. So for me, is there something better? No, there's just something that works.
So I'm saying that—thinking though, just based on what you said, iPad apps could be a great solution, right? Because then you are able to do a lot of what you just said with technology and wifi and interacting the device with other apps. Um, but also they can be customized [unintelligible] um, so like something like Cough Drop, something like Touch Chat, right. Those are great alternatives, Words for Life. Okay.
Um, absolutely. Um, you know.
They're more affordable, too.
And honestly if the state, will buy, um, individuals. They'll buy children the iPad and install an app for them so they can bring it from home.
Yep. And it, it really depends. And it depends on that student too. You know, one of my things is that, you know, if we're dealing with a student that does have more access issues and physical challenges, you know what? That might be a really good opportunity. Not that you can't do it on a, on a tablet, but going to some of those communication device companies and really looking at something that can be customized for this child.
Um, something that has really good built-in scanning features or things like that, or, you know, Eyegaze, which is, you know, one of those things that people— really, that's just a touchy subject right there. But, um, you know what, there's an access method. And so, you know, it does depend, I think for, for some of them.
So many things to think about that way. Yeah. Because I had this too with the visual impairment who was on an iPad and he was doing okay with it. But at some point he was definitely gonna need some kind of, um, oh, I just lost it. The grip that was visual. I mean, that was tactile. The Keycard. Right. So that he could remember where the spaces were and have some like textural reference to where he was.
Or maybe he's a student that eventually'll be on auditory scanning. And those are, you know, I mean, as much as of course, I'm like, Oh, every SLP, wow. Not every SLP needs to know all of this. I just don't think those, the population is there. But gosh, it is great to have those resources knowing it's out there.
Yes. It's just knowing like, hey, the potential is endless. You don't have to know all of this. But knowing that if your student has needs, don't just throw up that barrier of, "I don't know it". Know that there are resources out there and get with people that do know it.
Don't be afraid to ask. Don't be.
Have the discussions.
Cause it is a discussion. I am not, I don't think any of us—.
Yes. We're going to post his phone number on this podcast.
That's a different kind of phone number. But yeah, it's a discussion and it's a team. It's—It's parents, it's the students, it's, you know, the teacher or the SLP with our access kids. We're bringing in OTs. I mean, it, it truly is a discussion. There really shouldn't be like, Oh, I walk in, well, obviously I know what you need here.
Yeah. And I don't even think, I always, I wish I, these are the things I wish I knew sooner, but don't you think of a family and a team would rather hear you say, "I am not an expert in this, but I am going to do whatever I can to help your student, and I am going to figure it out and I'm going to go find the resources and ask the right questions, and we will do this together?" versus "Yep. I got this." And then I put it on the shelf and I actually don't do anything with it because it's scary. And I don't actually want to admit that I'm wrong and I don't want to go call Doug and ask him to help me.
I need some time. Let me make a couple phone calls. I, you know, I, I will check back with you at this point. I, I think, gosh, I think about that with a contractor to even so yeah. That's the way I would want to be treated. And that's the way that I think our families want to hear that we're working for them. Yes. We're supporting them. Right. Um, so yeah. Yeah.
So many good takeaways today. I think this has been a really helpful episode for a lot of reasons. I, again, I forget the theme we didn't even know we were going to have when we did this podcast, which is just that idea of like, we're all learning and it's okay. And you know, we, we can't be expected to know everything, but we just have to start and we have to try and there's help out there. Um, again, we'll give you Doug's phone number. He's the person to call. We hope everybody has a Doug, but I don't think that's the case. I don't think everybody has a Doug.
I don't know.
Yeah, for now. We're just happy that you shared your SLPenis with us.
Lisa has been waiting to say that this entire episode.
And ESS, that's all.
We got it. Lisa thinks she's going to coin the term SLPenis.
Yes. There's not many out there.
I just see graphic tees. Show me your SLPenis.
Will you wear one, Doug?
We can have seven made for the seven male SLPs.
Oh, it's been a pleasure. Thank you so much for coming, Doug. For being brave and stepping into the hot box.
I appreciate it. It was a lot of fun.
Yeah. All right. Let's see you guys.