SLP Toolkit Podcast, Episode 19, Transcript
How's it going?
I've decided I'm never going to complain it's cold in Arizona ever again.
Yeah, exactly. Can you tell everybody where you were this weekend?
I was in Minnesota, which I-- not to hate on anybody living in Minnesota, I just can't imagine ever actually living there.
Yeah. What was the temperature?
Because it was negative 10 degrees and on Tuesday it's going to be negative-- well the low will be something like negative 30 or 45 or something with like a wind chill of negative 75. And I don't feel like my body was ever designed to be in such temperatures.
I don't think anybody's is unless you're covered, like literally layered in clothing. That's so insane.
So I loved visiting and it was super fun to visit because we went one time in the summer and there were lots of bugs. And so I decided I will take the snow and the cold over the bugs and humidity. But--
Well, I'm glad you're back. It was about 70 here, so.
Okay. So I will never complain ever again when it gets down to like 35 here, not going to happen.
Well I'm glad you're back. And I'm glad you're here today because I am really excited about this episode. I will preface by saying I'm also a little nervous about this episode.
Well, only in the sense of this is a topic that got a lot of buzz recently. I think we started seeing a lot about this in the fall. And so our friend, Meredith Harold, had reached out and said “Hey, I think this is an important topic and you guys should discuss it, and I've got this amazing researcher friend who I think would be an awesome guest to have on this episode. And so you guys should tackle this topic,” and I was like, all right, we'll do it. And hope--hopefully do it, the justice it deserves, but it's also kind of a hot button topic.
Well, and let's just say what the name of the article was that Meredith wrote. She had written a blog post that said "That One Time a Journal Article on Speech Sounds Broke the SLP internet." So this is all about the quote-unquote "new" SLP speech sound norms.
Yeah, everybody took them to be new norms and we're going to get into it a little bit, but it was that really cute infographic that was put out. And it came from a study done by McLeod and Crowe. And I think it was in early fall of 2018, right? And so this darling infographic got published and it showed all of these sounds which we used to think of as later developing actually much, much earlier, and it caused a lot of controversy. And we're gonna talk about it now.
So we're not going to do this alone. We have invited somebody that actually knows the authors and has worked with them and is a far more well-versed in being able to dissect this research.
And discuss speech sound disorders in general.
So we are super excited to have in the confessional today Kelly Farquharson, who is an associate professor and director at the Children's Literacy And Speech Sound lab, which has the cutest acronym, CLASS, out of FSU, which actually one of my former professors at ASU, Dr. Leonard LaPointe, you work with him, right?
Kelly Farquharson (03:45):
I do work with him.
Love him. So I will let you tell our audience a little bit more about the work that you're doing there at FSU, and then we'll dive into our topic.
Kelly Farquharson (03:53):
That's great. Yeah. So I'm a few doors down from Dr. LaPointe or "Chick" as he's well-known now. So thank you guys so much for inviting me and thanks again to Meredith Harold for kind of spearheading this collaboration. I'm really excited, but like you, I'm also a little nervous for this conversation because this is an article that broke the internet and our colleagues, Sharynne McLeod and Kate Crowe who are the authors of that article, I think didn't have much sense of how big this was going to be and how this was received, particularly in the US. So I'm really excited to be part of the conversation. At Florida State, this is my first academic year here. I was previously a faculty member at Emerson College in Boston. So talking about the difference between a very, very cold winter and a 35 to 40 degree winter and Florida is-- I totally understand that difference. And so I have complained in the past week about it being in the forties and have been reprimanded because that's not winter. So this is my first winter without snow, which is very exciting. But so when I was at Emerson college, I established the CLASS lab, which is the Children's Literacy And Speech Sound lab, and I brought that with me here at Florida State. And the mission of the lab is to help children with speech and language impairments achieve classroom success. And so we particularly focus on kids with speech sound disorders and how they are successful in school and how that relates to their literacy acquisition. And we're interested in kids with speech sound disorders who both do and do not have issues with literacy acquisition because a lot of them present very similar speech sound error profiles, and some of them have issues with literacy and some of them don't. So that's kind of one of the main driving questions behind the work that we do in the lab. But we also do have broader research projects that we work on, really looking more explicitly at how school-based practice happens for kids who have speech and language impairments. And so we have some projects looking at kids with traumatic brain injury and how they receive services in the schools, how children with language impairments or children with dyslexia receive services in the schools. And we're also really interested in best practices. So how we can help support speech pathologists be successful. All of these research articles that tell us what to do and how to do it only really matter if that's feasible within a school-based setting. And so we're really interested too, in helping to support school-based SLPs to make sure that they can advocate for appropriate caseload sizes and work practices. Some of our work looks at job satisfaction and self-efficacy and how those SLP-level factors contribute to child outcomes. So we're really kind of pretty well-rounded, at least I hope to think that, with respect to the way we think about school-based practice for kids with speech and language impairments.
Did this passion come because you practiced in the school?
Kelly Farquharson (06:43):
I did it! Yeah. So after earning my master's degree from Penn State University, I worked in the public schools for about four or five years before I went back for my PhD. And I went to the university of Nebraska in Lincoln and studied with Tiffany Hogan and Jon Bernthal. And yeah, all of my research questions stem back to the kids that I worked with, the teachers that I worked with, my fellow SLP's in the schools at the time. And I've been very lucky to continue a lot of those relationships. But I think about those kids all the time, whenever I think about the results of the study, there's always a "so what?" in the back of my head, even if it was my work to start with. I'm always kind of like, okay, but what's the takeaway here? How is this going to make sense? How does this fit in a huge caseload of an SLP who might be traveling to multiple schools? How does this work? So that's--
When we look at research, we're always like that's great, but how does this apply with me in the real world?
And I love that we had the opportunity to chat with you a little bit before we actually started recording the episode. And I had told you, I always get a little bit nervous having these conversations with researchers and scientists. Because I do--I think it's my own self perceived feeling that we're on two completely different planets and have two completely different ideas on how this works in the real world. And so I always can appreciate somebody who's experienced what it's truly like to work in the school setting and have that perspective. And then like what you said is you're doing best practice in this research around these topics, but then know that there's this application piece and trying to figure out how you can best support the therapist. This is not an us against them situation. I think unfortunately, that's what we think. Internally, even before I talked to you 20 minutes ago, I had this mentality of, okay, I've seen an article, I've seen some information about what she thinks of speech sound disorders and how those should be treated. I hope that we're not going to have any kind of heated arguments about how this doesn't work in the real world, you know? And so I think this is going to be the perfect discussion to really mix these two ideas of what we should be doing, and then what it really looks like as a practicing clinician.
Kelly Farquharson (08:59):
So let's talk really quickly. I know this was not your study, but the McCloud and Crowe-- these, I'm going to say, quote unquote "new" norms, which we know they're not. But can you talk a little bit about why people thought they were new? And what they really mean for us as clinicians?
Kelly Farquharson (09:18):
Yeah, that's a great question. And I think part of the reason that this work-- which came from two researchers in Australia-- Sharynne McLeod and Kate Crowe. I think one of the reasons that it seemed like these were new norms is because the infographics that came along with these articles that you mentioned, they showed a different graphic than we're used to. And they showed us a different kind of trajectory for achievement of the speech sounds than we had been used to seeing. I think a lot of people are probably familiar with either Sander's norms from 1972 or the Iowa Nebraska norms from 1990. And both show graphics that actually do tell the exact same story as the infographics that came out of the McLeod and Crowe paper. But I think the McLeod and Crowe paper showed us-- I'm looking at it right now on my wall-- showed us a different level of mastery. And I think even though the original studies that the McLeod and Crowe paper is based on, the original studies say the exact same thing. It had been interpreted incorrectly for the past, you know, 1990 was how many decades ago? Unfortunately. So it really is a hard pill to swallow because in many ways it feels like, oh my gosh, we've been doing it wrong. And in some ways, yeah, we have. And I'm not sure exactly where that originated, that the interpretation kind of got off on the wrong foot. But I think that's one of the reasons that these feel like new norms is because they're different from the way that we had been using speech sound norms.
I remember explaining it to parents in meetings and sitting there saying, so here's the age range of typical acquisition of these sounds. So if you even think of something like walking, if an average age of acquisition for walking is say 10 months to 14 months, some kids walk at 10 months, some kids walk at 14 months, that's all considered typical and average. Once they get beyond a certain point, that's when we start to consider that not to be developmentally appropriate, where we would want to provide intervention. But there is kind of that window of when kids can acquire sounds. So you're saying that that is not how we should be interpreting those bar graphs that we see on those kind of traditional norm charts?
Kelly Farquharson (11:40):
Right. Right. And I agree, I think that there is definitely still a developmental window in which it's normal to start using speech sounds, even what we consider later developing speech sounds quite early. But there's still a window of what's normal for typical development. And I'm sure a lot of your listeners have children of their own. I have nieces and nephews. And so my nephew was using an R sound correctly by the age of two. And very, unfortunately he doesn't live near me, so this was not my influence. This was just part of development.
It's just my genetics.
Kelly Farquharson (12:15):
I don't mean to brag, but we do see some of these later developing sounds develop really early in normal development. And I think we forget that because we're so used to saying, oh, we're not going to pick that child up until they're nine. Nine is so late to start thinking about accurate speech sound production. It almost makes me shiver. And I say that also with the caveat of also having already shared that I was a school-based SLP who was probably guilty many times of saying let's wait until they're eight or nine. When we think about those bar charts that we're familiar with, with the bars kind of going horizontally across development with certain speech sounds, one way to really think about that is where the bar starts. About 50% of the kids who were studied already can do that sound with 100% accuracy. So where that bar starts, which if I'm looking at it for the Sanders, that bar starts for the R sound at the age of three. That means that 50% of kids are perfectly producing an R sound. 50% of them by the age of three. And so we're still waiting another five, six years before we say it's disordered, that they can't do it. And so while there's a definitely a window that's developmentally appropriate, it's not a six year window. It's not, it doesn't take six years to develop that sound. And as everyone who's listening, if they have any remote interest in speech sound production knows, R is one of the most challenging sounds to work on. And so, even though it seems counterintuitive in some ways to start working on it earlier, it will be easier to work on it earlier, than it will be to start at the age of nine.
That's a really good point, and I know Lisa wants to talk about this very thing because it is a really, really challenging sound to work on. And so our experience in the schools has kind of a different idea of if these younger students, kindergarten aged, are actually cognitively capable of learning how to produce that sound correctly.
Kelly Farquharson (14:13):
Yes, they absolutely are.
You're saying yes they are.
Kelly Farquharson (14:15):
Oh, absolutely. Absolutely. Sorry-- I was just going to say, that's assuming that there's nothing else happening, right? So that's assuming that there's no cognitive disability. That's assuming that they don't have a major receptive language impairment when following directions is a huge problem. So all of these still have to be taken as a case by case basis, but for the average child who is experiencing difficulties with speech sound production, typically in the absence of other language or cognitive issues, it is absolutely appropriate to start working on this by the age of five.
Well, and Sarah and I were kind of talking about this leading up to having our podcast and just our own clinical experience with different sounds. And I was saying that I personally, with the kids that I've worked with over the years particularly in the school setting, but that with all sounds, I could see working with students earlier and providing an intervention. And with even thinking about the kind of cueing that you can give kids that I feel like I could establish those sounds earlier with the exception of R, and even because it is not a super visual sound requires a lot of instruction, requires a higher cognitive level to even sort of break down the instructions I've given to establish. And when I came up with the way that I worked on it, I remember having one girl that I tried to bring in at first grade, who was a gifted student to just see, well, does it work with younger kids, this method? Didn't. I brought her in again in third grade and she got it the first time we worked on it. So that was just, again, at what point does clinical experience in your work with kids and what you're doing-- I mean, maybe we just need better treatment methods. But R to me because it is not concrete, it's not something like, S, you can see it, you can provide different types of cueing, but R is so complex. That is the one that I think for me personally, I'm having more of that reaction to where should we? Could we? Maybe, but I don't want to pull a kid in for two years and have them say "uh" for two years and then build up that frustration when I could pull them in a couple of years later and get it within a couple of weeks.
Kelly Farquharson (16:25):
Yeah. I think there's a lot of validity to that. I think our clinical experience is a huge part of evidence-based practice and should definitely not be ignored. I think there's a few things that come to mind. First of all when you're talking about the complexity of that sound, it's absolutely true. Not everyone makes it the exact same way and it's a liquid, right? So if we remember some of the reasons why the phonemes in our language are labeled as such, liquid sounds kind of take the shape, like a liquid, take the shape of what they're around, what sounds are around them. And so just in the same way that you pour water into a round vase versus a square vase, it's going to take that shape. R is a liquid. So it's the way that your tongue produces that sound is going to form around the other sounds in the word. And that's going to totally change depending on the word, right? So depending on the vowels that come before it, or after it. Depending on if it's prevocalic or postvocalic in the word is going to change the way that you make the sound, and not a lot of other constants in our language are that way. And so that's another reason why it's tricky is because we maybe start focusing on ER, but that's not the only R sound, right? There's about 14 different ways you can produce R vocalically. And so I think that makes it really challenging too, and then you add to the fact that there's different tongue positions that can be successful. So a retroflexed R can be as successful as a bunched R. And so you might be training a child to produce a bunched R when their natural tongue position, once they actually achieve it will be retroflexed. And how would you know that? So there's a lot of those kind of messy features around that particular sound that do make it one of the hardest sounds for us to treat. And there's absolutely no way around that. It's also highly sonorant, which means it's kind of vowel-like. So when we rate consonants on how similar they are to vowels, R is one of the sounds that's more sonorant. It's more vowel-like, which also means the vocal track is a little bit more open. It's not as constricted as it is for a stop sound, for instance. And so there's a lot of physiological and acoustic features that relate to how R is produced that contribute to why it's so challenging to produce.
We're gonna need your next paper to be how to teach R to five year olds.
Kelly Farquharson (18:46):
I know, a step-by-step breakdown of that. I absolutely agree. And I think, it's interesting too. I think the other thing that you're talking about with respect to this caseload issue is I think there might be some kids who do need to wait. There might be some kids who aren't getting it until second grade. And at that point they're seven. At that point, we can say, they're definitely past the normal age of acquisition. Let's try it in second grade. I think the important thing though, is that we're not making that decision based on the fact that it's an R sound.
Kelly Farquharson (19:22):
And I shared with you guys a paper that is is going to be coming out in a special issue of Perspectives through the special interest group one, which is language learning and education. And so the title of this paper that I shared with you guys is called, "It might not be ‘just artic’.”--and that's in quotes, “just artic”. The case for the single sound error. And anyone who's ever been to one of my professional development events or has sat through one of my classes at Emerson or Florida State knows that one of my pet peeves in our field is this phrase "just artic." And I find it belittling to the kids that we work with. And I find it belittling to how hard we're working on trying to achieve that sound. You've thought about those kids long and hard, right? You thought they're not cognitively ready. This is a multi step process, and you're not cognitively ready to produce this sound. So you thought a lot about what these kids need to be able to produce that sound. And then as a field, we say, “It's just artic right? It's no big deal. It's just artic.”. It's a huge deal, right? It's not just artic. There's a lot more to it. And if it means that a child is not ready to produce that sound until the age of eight, that's a possibility. And that's a real possibility that we need to consider, but we need to consider it because of how complex it is cognitively for you to explain those steps, as opposed to saying, I'm not worried about that kid, it's just artic it's not that big of a deal.
Right. Oh I love this so much.
Kelly Farquharson (20:47):
And so that's my pet peeve with that phrase is I think it's so-- we think so hard about these kids and we're always trying to do right by them. And so when we're saying "just artic," we're saying we're not working as hard as we could be, because this is just not that big of a deal to treat. And then we're also saying like, well, kid who can't produce this certain sound, what you're having a hard time with in your life is not as big of a deal as what the other kids on my caseload are struggling with. You should see this kid in a wheelchair, who's using an AAC device. What if you were him? Right? And that's not what it's about. It's not about comparing whose impairment is worse. It's not about saying, well, yeah, you can't say R, but at least you can speak, right? That's not what it's about. It's about saying I need to support you. I'm the speech pathologist in this building. And I need to support you so that you have accurate and appropriate communication to be successful in this school. And if that's because you have an R distortion or because you stutter or because you use an AAC device because you have a language impairment, whatever it is, that's my job. And it's not my job to judge how hard this is for you, cause that's something I also don't know, is how hard this is for you to deal with and to work through. And so in the paper that I think is coming out in February I kind of raised some of those points and I think to kind of tie back to what you were saying about the picking up a child, who's just working on R. The idea there is, as long as the decision hasn't been made solely on the basis of it being R--
Or based on just their age.
Kelly Farquharson (22:23):
Yes, exactly! Based on just the fact that they're whatever age and it's one sound and the sound happens to be our, then the decision is I'm not going to pick them up. I would say that's probably the--the wrong way to make that decision. It doesn't mean it's the wrong decision. I would say. It might be the wrong way to make that decision because the other things you might be able to say you might think about is what are the--how's this child performing with some literacy skills, some early literacy skills like phonological awareness? So what do we know about their rhyming ability? What do we know about their knowledge of phonology? So, do they have an awareness of what's happening with respect to speech sounds and their language? Um, if that's also low, then I might say, oh, you might want to think about that. So that's a, that's a point for me and the pick them up, call them if their phonological awareness is great--and you'll be shocked once you start really looking at phonological awareness, how many kids have speech sound errors and really good phonological awareness, that still perplexes me. I don't know exactly how they get it, but a lot of them do. And if that's the case, then that's a point for me and the, maybe we should wait column. Um, so I think there's a lot, there's a lot more to it. If this is an older kid who's--well, not older, but you know, second or third grade, we can start looking at spelling. And so we can start looking at, and not from a perspective of, we're going to do standardized testing for spelling for this child. And we're going to add spelling as an IEP goal, but just asking the teacher “Can you look at a spelling test and see--are you seeing any of the influence of this speech sound production, error in their spelling?”. And if so, that's a point for me in the “pick them up now” column because we're seeing-- (Lisa begins speaking, then stops) No, sorry, go ahead.
No, I was going to say, I think that was a lot of the takeaway from reading the paper with--and thank you again for giving us early access to that--but that, there is a connection of si--even single sound errors. I remember thinking a lot of times, even myself, I remember thinking that if I have really complex kids or kids with apraxia, you know, kids with multiple sound errors, thinking that there is naturally some sort of connection to then reading and writing and literacy, but that, you know, the research actually says that there is a connection, even for kids with single sound ears. So make that a part of your data collectio! And that I think, fortunately, working in a school setting, we have this data available. It doesn't mean that we have to do any testing. We just need to get our hands on that data because, you know, there could be testing that's done at a state or district level that looks at, you know--specifically in Arizona, they do the DIBELS testing. I don't know if that's nationwide, but that we'll look at some of those sort of phonological awareness skills, right? And then, you know, you could get some of that classroom data and--and see what the teacher has seen in the classroom, but we just--we need to know what it is we're looking for and the connections--
Making that consideration beyond just artic.
Kelly Farquharson (25:06):
He just has the “Th” and he’s five so no, we're going to--we'll talk about him in third grade, see you then!
Kelly Farquharson (25:25):
Kelly Farquharson (25:27):
Exactly, I think your point is so valid that, you know, there--there's--there's a lot more here. And I think the other piece of it is that I often, um, I want to be careful to make these recommendations to speech pathologists, especially those who are working in the schools, having--having been there myself, knowing that adding one more thing sometimes feels like it's the straw that breaks the camel's back. You know? You go to a CE workshop and someone says “You know what you should do? You should add this standardized test, which you can conveniently buy at the end of this workshop!”. And so it's--it's--it's when you think there's one more thing to add, you just keep thinking, “Oh my gosh, how can I add one more thing? I'm supposed to do the full self--a Goldman, a language sample, a classroom observation, and I've got 30 minutes and that's if I don't eat lunch today!”. (Agreeal from Sarah) And so there's--it's really hard to make all of that happen. I think that one thing--and this is actually not even really specific to these single sound errors, but really broadly applied to all of the kids who are referred to us--there's so much data available on these kids when they get referred to you, we feel like, okay, we're starting this expedition to--to be the first discoverers of any information on this child. [But] they've been through several classroom teachers! Let's go talk to those people! Right? They've got parents who've been there from day one. Let's talk to those people. Let's see what the school nurse has on file with respect to any illnesses or any--of course, this is all with permission to evaluate with, you know, if there were any failed hearing screenings at any point, if they've had any, you know, chronic issues there is already data available on this child. And so we need to get into a better practice. And while--I will say we, but I really meant this was not something that I did very well. So maybe other people do this really well. But knowing that you can access these--this data, once you have permission to evaluate, talk to the teacher, look at some tests look at some--
Have a discussion at the red ring, move into the existing database. That is where you're talking about all areas of suspected disability. Everything needs to come to the table right at that moment. And so then you will have the information of what, what other exploring you need to do with that student outside of the--the data that's been shown.
But what can be hard though where I think we're people need to really hone their skills is what kinds of questions to ask. So you have access to this too, of knowing that a single sound error could connect into other issues, knowing to ask questions specifically connected to phonological awareness spelling. I think sometimes we know with our older kids connecting into the socio-so-so-social, social-emotional issues that can be impacted. But I know that you linked, even in your paper to kids, as young as preschool can--that there's research connected to that, but they can also be, you know, have negative emotions surrounding--that they can't say their names correctly because yeah, like saying the kid's name was Kate and maybe they can't say Kate, they say Tate. And so they can have negative emotions surrounding that. So, you know, thinking about that, talking to the parents, but that's where I think w you know, it doesn't necessarily mean that you have to dive into a million records to do this, it’s the fact that that we are meeting with the parent we're meeting with the classroom teacher. It’s really--
You really need to take advantage of this opportunity to get this information.
Don't look at it as just a “Well, yeah. Do you understand him? Do you understand him? Okay. Everybody thinks we need to look at the K sound? Okay, great. Let's do this, Let's--let's go ahead and evaluate!”, you know? That is your chance to have your team there and really dig into these issues a little bit more deeply, but it really takes--
(Unintelligible) you are going to have to assess--not assess all those biological skills when the entire team and all of the evidence has probably been brought to the table is showing if this child's doing really well.
And the same thing with language! I know that was one of your recommendations too, is that we might want to do a comprehensive, receptive, and expressive language assessment. But again, if all of the data that in that first initial meeting if that the parents don't have any concerns with language, the teacher doesn't--but I think part of that too involves, we need to make sure that we're looking at that at a comprehensive level that we're asking specific questions. Are there concerns with language? Teachers don't know and what that means, what that means, parents don't necessarily know what that means. So we have to have kind of a battery of questions that we go through that digs into that a little bit deeper, that they could answer, that we could then kind of--does anything Q off our spidey senses of, do we want to dig into that a little more deeply?
Kelly Farquharson (29:39):
Absolutely. I totally agree. And I think it--it does make it really complex. Whenever I've had lots of parents, and unfortunately some teachers, respond to the question of, well, how is his language with a response of, like, well, he speaks English,
I was gonna say--English. Right. You know?
Kelly Farquharson (29:49):
And so great. So then it tells me absolutely nothing, you know? And so I think it is you're--you're right that we need to be very pointed in the kinds of questions that we're asking. We also need to be mindful of the fact that, you know, there's a phonological piece to learning new words, right? So if I say, I want a bat versus I want a pat, I'm saying two very different things. And that is based solely on the voicing of the initial consonant in that word. So there's a phonological piece to learning new vocabulary that--if you do have some deficits in phonological awareness over time, those might manifest as vocabulary deficits too. And so it is important that we're thinking about vocabulary. And even if we're saying, oh, it's fine now, even if we know we're getting that response--that's accurate from both parents and teachers that vocabulary or language syntax are fine right now. We still want to keep in mind that if there's a phonological deficit in some way, that can snowball into bigger issues with decoding, with spelling, and with acquiring new vocabulary. And so it's something that we just want to have our eyes on, because what can also happen is that kindergarten, first grade, second grade teachers will say, he's fine. He's fine. He's fine. He's doing great. [In] third grade you have to read by yourself and answer some questions and write a five paragraph essay--third grade, fourth grade, fifth grade. And all of a sudden we're like, Oh, he can't do this. And now we're saying, oh, he has a language impairment too, when it's quite possible that it was there all along, but we never tested for it. And everyone was saying, it's fine. It's fine. It's fine. Until he actually needs to use those skills for something more complex. And now we think a disorder has popped out of nowhere when really it's been there the whole time, but he's been able to kind of get away with things because he hasn't needed to use those skills as sharply as now, we're asking him to do in third grade, fourth grade, fifth grade. So those are some other things to keep in mind too.
Well. And O-- I will say, I mean the amount of things that I am guilty of doing. First of all, I realized after reading both the blog posts from Meredith and your article, that I just flat out learned some of these things wrong. I misinterpreted what those norms mean. I think the amount of times I must have written in an IEP “These errors are considered developmentally appropriate and therefore will not be targeted at this time”. I probably wrote that so many times over and over and over again. And so I'm thinking about--and this is why I want to say this very clearly, anybody who's listening, who has also done this and who has also not picked up students who might have, have had other implications because we waited so long, we're not picking them up until age eight. And now, you know, this time has gone by, this is not about making anybody feel guilty because I've done it. And so this was just a really powerful aha moment for me of--of I never actually considered all the impact and implications of that decision, because I just thought it's what I was supposed to do.
Kelly Farquharson (32:43):
This is multifaceted, I think too, because if we look in terms of school eligibility, if we look at the criteria for eligibility, it's A) is there any kind of disability present?, B) is there an educational impact as a result of that disability?, and C) is it only correctable with special education? And so those are kind of the three main criteria. So I think particularly when it comes to single sound speech disorders that, you know, sometimes even if it was something like we're in--in my head thinking of something like an R or a lateralized S, to me was very different than something like a TH because even if I felt like, okay, there is an articulation disorder here with that single sound. Does it impact the student? Maybe, maybe not. I mean, they're certainly--yeah. And I don't know if I dug as deep or maybe--I think we did talk about that sometimes spelling, but, you know, I could--could've probably done a better job with that, but then I think I would get hung up on that third criteria of is it only correctable with special education? If I can give the kid a visual or one verbal or one bite your tongue and blow, and I can teach the teacher to do that--because I think of that, you know, one of the beauties we always talk about working in a school setting is that it's not just the burden. You know, you--you are not an Island, it's not just the burden of you as the SLP to work on everything. And so you look at who is the most appropriate person to work on certain things?
Well, something like that could be RTI, right? (Overlapping chatter) And that can be special education.
Right, it could be RT, it could be the teacher supporting that, and you could give exercises to the parent at home. Or I think, again, we go back to the idea of when does it become the burden of a school to work on things versus private therapy.
Kelly Farquharson (34:31):
Mmhm, yeah. And there's a lot to unpack there and what you were just saying. So one thing is--I'll also draw your attention to an article that came out in LSHSS, the language, speech, and hearing services in schools. I can send this to you guys to maybe post on the website or--
(Unintelligible) And some of this content into the actual podcast episode that you can refer to.
Kelly Farquharson (34:51):
So I'll--I'll send this along. So this is an article that I wrote and was--and had a coauthor of Lisa Baldini, who was a student of mine at Emerson. And the purpose of this study was to look at a survey we had conducted. And Lisa had pulled out some of these data for her thesis, her Master's thesis and we want it to look at the kind of variability that we see with respect to thinking about eligibility for services, particularly for kids with speech sound disorders and across the U.S. So we were very lucky in this survey, we had 845 speech pathologists at least click in to the survey and we had 575 complete the survey, we had all 50 States represented. I'll--I'll summarize it to say, it's astonishing--the variability that you see across States and that you see within States. So even there are those three main tenants that you brought up from IDEA, the way those are interpreted within and across States, it could be--it's like, it's three--it's like it's 50 different mandates from 50 different countries.
Yeah, even amongst individual SLPs, working within a district could interpret their district mandates as eligibility.
Well, I’m laughing, I actually was thinking back--I will say there were--there were times I did pick up students earlier than what I had I had interpreted, what I was supposed to do with norms, I had picked them up and I felt like a rebel. I was such a rebel because you know what, I'm just going to ignore what the district told me are my requirements for eligibility and will do right by this kid. Watch this. I love that you're about to explain that that's part of the problem is our interpretation of all of the information.
Kelly Farquharson (36:28):
Speaker 3: (36:28)
But I think the other thing that's important to highlight there is that our interpretation, it's not our fault that we're interpreting it that right way, right? We didn't just arrive as the SLP in that district and say, this is how I'm going to interpret this, right? This comes from above. And so I think some of this message is important for SLPs to hear, of course, but a lot of this needs to be kind of presented in neon lights to school administrators, because that is often the--those are often the individuals who are making these decisions or interpreting the guidelines for either the state level or the district level? And that's another messy piece too, is that there's some States that have state level interpretation and there's some States that have local decision-making. And so, like I just moved from Massachusetts to Florida and Massachusetts is local decision-making, which means the state says here's IDEA, but as an individual district, it's your job as the local education agency to make this decision, you decide how to do it. Which means if you live in Cambridge, you might get services. If you live in Medford, you might not. Right? And those are two towns in Boston or two towns surrounding Boston. Both under the same state guidelines, the same Massachusetts state guidelines, but might get different kinds of services. Um, so that's one problem, right? Because then you have other States like Texas that are state decision-making. Texas also has a really strong Speech and Hearing Association in TSHA that helps to kind of--helps their SLPs, understand the guidelines from the state and puts policies into place. And the data that we got from the SLPs in Texas was unanimous. They all knew exactly what to say. Every single one of them had agreement and consensus on what their eligibility criteria is. Speech pathologists in Massachusetts were all over the place. And this is no--and I was--I was president of the state association in Massachusetts so this is no slam on how state associations operate by contrast. It just tells us what state associations--state associations are capable of doing, depending on the state legislation, right? Massachusetts is local decision-making. So even if ASHA was able to say, here's the policy, here's what we're doing. Local local districts could still say, that's how you could it, but that's not how we're going to do it.
Right? Because even some schools--I think, is it California? [California] might be one where they actually have it in their eligibility that you have to give to standardized test. And they have to be 1.5 standard deviations or below on two different tests or something where I'm like, you know, in Arizona, it's not like that. I think it's more of the localized where they just get the idea and it's just that blanket statement of there has to be a disability. So we, as the clinician can determine, is that disability present? And then the--the team is looking at all of that data as far as disability, plus the educational impact. Plus is it correctable to make that determination for eligibility?
Kelly Farquharson (39:15):
Yeah. And I think there's pros and cons to both sides of it, right? So there's--there's--there's definitely pros behind the speech pathologist being able to make the individual decision for the child, because she's the only person looking at this child and being able to say things like I'm going to do what's best by you. Right? I know that this is what you need. And with this exact same profile was this other kid over here, I'm going to make a different decision because although his speech has the same profile, the rest of him is different, right? He doesn't need this. You do. And there's a lot of beauty and flexibility in that. And it's also nice to have--um, I guess kind of obvious and straightforward guidelines from your state, you know? So there's--
Those make us comfortable.
Kelly Farquharson (39:59):
Most of us are followers, I think by nature, a lot of us. And so I think if I'm not this very clear guideline and then I can't deviate from it, well, then it's just going to make my job easier because that's the argument I'm going to take into the meeting when I say why I won't qualify, you know? And so I think there's some comfort there. I actually had decided though, throughout this entire episode, as--as--as you've been bringing some of this to my bore mind, you know, the front of my mind is I actually am feeling comforted more now by the fact that, um, uh, I am the one who has got more information and almost like, I'm not gonna say forget these guidelines, but I can make a case.
Kelly Farquharson (40:36):
That's exactly right.
And so I'm going to start. I'm not stressed right now by the fact that I should pick up the kids that have the R sound and at five years old and what that means for my caseload. I comforted by the fact that I have the clinical expertise to be able to make decisions on a case by case basis and what's best for my students.
Kelly Farquharson (40:55):
Yup. I absolutely agree. And I think you know what I usually say at the end of some of the workshops that I give is I usually say like some of this is going to be completely overwhelming and it might feel like “Oh my gosh, how am I going to make these changes?” or “How am I going to--this--this might require me buying a new standardized test. That's $500. I can't buy that! What am I going to do?” and I usually say, just start small, start with one kid this school year and don't pick at random, right? So that's not at all--you know what the purpose of this is, but find a kid for whom you could make that case that you could say, you know, I looked at his phonological awareness. I talked to the teacher, I talked to the child himself, and I got some information about--you brought up the social emotional piece. That's huge! And so I've talked to this child who is very aware of his speech sound errors. He's very embarrassed. He doesn't like to speak in class. You know, they're working on reading out loud. He doesn't want to, because of his speech sound alone. Right? So if that's the case, we can make the case there. That is, that is just as important data as a standard score. And that is just as relevant for educational impact as a standard score, perhaps more so. And so for that kid, let's just take a, take a chance. Let's see what happens, pick that child up and see what happens. If you start working on our, at the age of six for that child, are you able to teach the child how to do it and use that as your practice based evidence get some information for yourself about what it looks like?
Speaker 3 (42:18):
Instead of saying, I can't, because they don't know, how are you saying they don't know how, because you've tried it on every single kid that's ever been referred to you and they don't know how to make our, I would beg to differ because I've tried it on a lot of the kids that I've worked with. And I agree, some of them can't do it. A lot of them can. And so I think, you know, you have to adapt the way you explain your instructions might need to change because they're younger or they're, their cognition is different, so you might need to adapt, but you can do that.
Speaker 2 (42:47):
I'm going to add some more tools to our toolbox. Yeah. Things might not be our best way.
Speaker 3 (42:52):
Yeah, that's exactly right. And so I think, yeah, I think these are all really important points. And I think the message, I think, for speech pathologists, is to start small and to see if there's one kid that you can make this case for and try that and just see what happens. And--and it's--that might sound easier said than done. And I'm sure in many cases it is because it could feel like a flood gate situation. You know, if you open--open the flood Gates to one five-year-old who can't say R and now all of a sudden you're going to get a ton of referrals. But again, that's why it's important that you're able to make the case. You have other data beyond his intelligibility to help support the reason for eligibility of services. And all of that is also outlined in IDEA. All of that, that could support educational performance. All of that is outlined in pretty clear language. Now, again, it's, it's different at each state level, but all of that is outlined.
I think oftentimes we overlook the power of RTI. I mean, we would have so much data in just that opportunity alone to make that decision, whether we're going to qualify them for special education or not. I think about that really critical piece.
Kelly Farquharson (43:59):
And I know I've worked with kids that before RTI was really--and I've used RTI a lot so I'd love to talk a little bit more about that, but I've worked with kids before RTI was really a thing in the schools who, you know, they get on your caseload and in six weeks they basically have the sound that you're working on. You're like--you're excited, but there's also--
Kelly Farquharson (44:22):
And so I think we also kind of have this sense of like, I know I could help this kid, but I could help them in six weeks. And an IEP is a year and I'm not doing an IEP for six weeks worth of therapy. So I know there's also that piece of it too, is not that we feel like we shouldn't be helping or not that we feel that we couldn't be helping. It's probably by contrast, we're like, yeah, I could totally fix that kid, but in like six weeks and I don't--I'm not going to do six weeks worth of therapy on an IEP. And so I think RTI is a huge--or any sort of multi-tiered system of support-is a huge resource for us as a speech pathologist. No, it was not the original intention of RTI. And so I get a lot of--my work has also really pushed RTI as well. And I have another article using that same survey data with another thesis student from Emerson, Divia Swaminathan, and that work also looks at the role of caseload size and how SLPs decide to use RTI for speech sound disorders or not. And this could be a great way for us to alleviate some of the caseload issues by providing services to children that we think “Oh, I could stick that in eight weeks flat!”, you know? Then here's eight weeks, do it. And then you don't have that child on your caseload. And yes, it's still another child you'd have to see and find time for and all of that, but--
Yep. But I will say too, like if you're open and, and able to mentor graduate students, this is a great use of using graduate students too, like, you know? Pull them in and teach them how to kind of decipher some of that information and incorporate that into programming and--and I loved using grad students in that.
Kelly Farquharson (45:56):
Absolutely. I think that's a great idea and it's a great experience for them because as challenging as speech sound therapy can be, it also can be fairly formulaic? Um, and so there's--there's something that's nice about achieving that success that graduate students can, can really benefit from too, of--of doing some successful therapy in their placements.
Right. There's so much here. I mean, really, we could seriously talk about this for hours, because as we've been talking about all of this, I think there's so many things that--that we need to look at. And one, that is just overall workload caseload, right? That's a--that's a huge problem. It's the--it is the kickback that started the breaking of the internet with this article. Right? It's like, don't tell me, I'm picking up kids at five years old now for R, I don't have room on my caseload for that. And so yes, is caseload a problem? Yes. Is that something that we need to look at, how to help kind of redefine workload in the schools and, and at a district level, state level, all of that? Yes, we do. Then there's this issue with guidelines and the fact that they are all different everywhere and everybody interprets them differently. That's a huge other problem. So there's all these things that yes, can I advocate and be involved in? Yes I could. And I will. I'm not saying I won't, but I think anybody who's listening to this, I don't want you taking away from this, like, “I'm not, you know, I'm not going to go fight, you know, at the district level or state level and it helped make any of these changes. So what does this all actually mean for me?”. And I hope the takeaway really here comes from a place of--use your clinical judgment to do what's best by your kids. That's why we're in this job. And make those decisions case by case basis, and like you said, just start small, you know? Don't--we can't--I think we just look at this whole big, huge thing. Like I--and it would just shut down! I can't do any of it, so I'm just going to shut down. And so I’ll do none of it.
Kelly Farquharson (47:44):
Absolutely. Or okay, advocating? Great. Add that to the list of things I'm going to do.
Kelly Farquharson (47:51):
It just feels like one more thing. I will say, you know, I've done some the Holly Historical and I did a short course at ASHA this past fall. Sharynne McLeod was supposed to be there too, and she contributed remotely. And one of the--one of the pieces of that short course that I contributed was this advocacy worksheet. And it kind of talks about--actually we have scientific evidence to help us support the need for us to advocate. So one piece of that is that we have data that supports that: SLPs with smaller case loads report higher job satisfaction. So--and those SLPs also happened to have more years of experience and were older. So for school districts and here--I'm thinking about really kind of talking to school administrators or special ed directors--the buy-in for speech pathologists there, this recruitment and retention piece is huge from the level of administration. If SLPs who have more years of experience and are older, are the ones who are a higher have higher job satisfaction, then we need to make sure we get them to a place that they're still in your school district and still working for you by the time they have those years of experience and are older, right? Because a lot of times we're seeing this burnout before 30.
And that's terrifying
[Look at] the message boards. They don't want to be an SLP anymore. And it's so sad.
Kelly Farquharson (49:07):
And that's terrifying! And so--and--but part of that--part of what contributes to this better job satisfaction also has to do with caseload size! It is a real scientific fact that has been established. And so I think that's a really powerful piece of evidence that we can say. I mean, it's also--I mean, yes, it is also a no-brainer right? So there's that piece of it too, but it's also really nice when you have data-driven administrators, when you're able to say here's a published peer reviewed research article that found this, you know, and so then you're able to--to use that towards your advocacy efforts. There is data to help support those--those arguments towards better caseload sizes towards using a workload approach instead of a caseload approach. And I think that's what's necessary in order to get to a point where we can make these decisions. We talked a little bit at the beginning before we started about this idea of having, you know, kind of almost front-loading your caseload and having a bunch of the kindergarteners and first graders on your caseload so that they're not on your caseload by the time they're in fourth grade, because what's happening now is we pick them up in third grade and then they're on until eighth grade. Right? And so we see the same thing happening with--with children who have dyslexia. If we don't pick them up until fourth, fourth grade, now we're paying for special education services for that child from fourth grade through 12th grade. Whereas if we pick them up in kindergarten, we might have to support them through special education services until about third grade and then have the skills they need to be successful. There’s a few exceptions of course, and the same thing could be true. Now, I'm not going to say that--that that period of time when you front-loaded, but you still have those--those later grades on your caseload, that's going to be a very challenging year or two, right?Or maybe three, that's going to be hard. And so that getting that over with is, is not an easy task. And so it's very easy to say, here's how you do it because once you have them on your caseload early, you won't have them on your caseload late. But to get there, you have to go through a period of growth where you have kindergartners through sixth graders on your caseload.
It's going to be a little uncomfortable. Yeah.
Get a grad student.
Kelly Farquharson (51:08):
Yes! Yes. I would definitely. I recommend, if there's a university near you, absolutely volunteer to take students because they're--they're always looking for qualified speech pathologist to take students for placements. And it's a--it's a great way for you to also help the new generation. And I think it could also bring some brightness and freshness into your practice if you're feeling that--that burnout, it's nice to talk to somebody who's new to the field and excited about it.
Yeah. And I think Lisa and I talk about this in a lot of different times related to a lot of different areas of our job as school-based SLPs. We are highly passionate about this setting for a variety of reasons, but the burnout is real. But I--we both kind of discovered through this whole process, is it really is a mind shift though. I think that you're unfortunately all too focused on these aspects like caseload and--and all of these other really difficult parts of our job. And then that's where all of our focus goes. And so that's what I--I feel like I have a different perspective now on this topic than I did even an hour ago when we first started this and it's a mind shift. And so instead of having that guard up and that just immediate reaction to, “Nope, I can't do any of this. It's all very unrealistic.”. It--I just needed that mind shift of going back to what matters most and that's our students and giving them some emphasis that they deserve.
I'm just glad Sarah can say her--her F sound, apparently. She said mine shift three times. Very different words.
Kelly Farquharson (52:37):
Well, that wouldn't be too far off either. Sometimes it feels like that.
That same mindset shift--no, mind shift. Mindset shift. No--hat I'm trying to say--hopefully you all got the message!
Well, this has been awesome.
Oh, it's been so good. And I really--I do just think this is kind of like the beginning point.
Kelly Farquharson (52:59):
Even throughout this discussion, I thought of a few other topics that I'd like to have you come back on for us.
Kelly Farquharson (53:05):
I'd love to come back!
Yeah. I think that would be great. And I think, you know, Lisa and I talk about this a lot. We want to get more involved, whether that's just on committees or--or doing things that we can to help be a voice for school-based SLPs. But we talk a lot, nothing's really come from it so, well.
Kelly Farquharson (53:23):
Also, it is--it's one more so it's, it's, that's hard to, you know, but I will say I'll, I'll put another plug in for state associations. If you are interested in getting involved at any level, state associations are always looking for people to serve on committees and that, most of the time, does not require face-to-face--you know, that you have to travel to meetings and stuff--Sometimes that's part of it, but there's a lot of ways to get involved even remotely! And so I think that those are it's--that's a good way to start getting involved to make practice. Especially with issues like this that do have very specific standards at each state level that are different. And so in your state to make the, you know, the biggest bang for your buck is really at your state association level.
Yeah. That was--it's so good. Anything else that you wanted to touch on?
I don't think so!
I actually, as I'm reviewing a lot of this in my mind about what we did discuss, I am always--I'm always afraid when I end up podcast episode that we skated over something really important. And, and then I think well, no, I just missed it because we've been talking a lot about different things, but I know we touched on it really briefly--I think that the big idea here and the message that I wanted to make sure we hit on is the actual impact on and implications of these students. And so I know we touched on that, the impacts of literacy, but I think that's with that driving force, right? That's going to make sure that we really do invest appropriate assessment of the students at an early age. But did we--did we touch on that enough? Did you guys--did we hit that part about what are the implications of these speech sound disorders on a student's learning?
Kelly Farquharson (54:52):
Yeah, I think that's a great point. And I do think that we talked on some of the major issues with respect to their literacy acquisition and how that influence that might influence spelling as well. In fact, for some kids that influences spelling and it doesn't influence decoding, so spelling is actually one of the main players there that we might see some issues. I think for me, the social-emotional piece is huge. We kind of forget the role that we play in helping these kids be successful in school? And that--that--that bleeds out of what their grades look like. Right? It's not just what their grades look like. There's a lot, remember what it was like to be in school? Like there's a lot more to it. And there's--and now think about what it's like, can you imagine having been in school and social media era? It sounds, like, atrocious. And so imagine now there's some social implications of your speech sound impairment and our stuttering or voice disorder or language impairment, any sort of speech and language impairment. I think that's a, that's a huge part of our scope of practice that we often think of the social side of things as reserved for pragmatic disorders or children on the spectrum and that's not the only time that social implications come into play. And so, I think that's another big piece--is that we see over time that can kind of erode their spirit and their self-efficacy and their self awareness. If they have been unwilling to speak out loud in class, because they've been made fun of.
I had like--was pulling a kindergartner to come work with me and there would be a teacher that would pass by and say, “Oh, don't fix her speech. It's so cute!” And I'm like, it's not as cute when she's 16. (Agreeal) And I think we forget is that it's not even just social, emotional, but then when they go on for vocational purposes, job interviews, that sort of thing, you know, it's not, there are these long-term effects if we don't correct it, it's harder to correct early on.
What you just said needs to go into that impact statement about how this is impacting the student's ability to be successful in the classroom.
Kelly Farquharson (56:44):
And that's the case that can be made.
Kelly Farquharson (56:47):
Yep. I think so. I think there's a lot to it. And your point of the vocational outcomes, there is data to support longitudinally that kids who have a history of a speech and language impairment do have--they typically don't go to college and they have more blue collar versus white collar jobs. And--and that a lot of that has to do through qualitative interviews they've had with these individuals, about their history of speech and language impairments. So it's--it has long lasting impacts. And I think anybody who has been bullied, even in a minor sense for not a reason related to speech or language can speak to the fact that it sticks with you. And that is something that we have the power to help change. And that's--that's not something to take lightly. So I think it's a really important point of, of thinking about earlier services for these kids.
And that's why--I'd literally--that could not have ended on a perfect note. That is why all of this matters. And we're not going to get upset when we see that infographic pop up in your face.
Kelly Farquharson (57:38):
That's right. That's right. That's right. I would love to talk more with you guys about, I feel like we opened a bunch of cans of worms and I love to talk about them again. So thanks for inviting me and I'd love to talk to you guys again.
Thank you for, yeah.
Thank you for coming on in and having this conversation with us. I thought it was going to be a lot more uncomfortable than it was!
Kelly Farquharson (57:59):
Well I’m glad to hear that. I mean, I'm glad to hear that, but I don’t know if I’m glad to hear that.
Wait, what did you say?
I want you to say Kelly's last name.
No! Don't make me do that!
(Overlapping protests and attempts, Lisa sounds it out in the chaos)
Did she say it right?
Kelly Farquharson (58:11):
(Overlapping chatter and repeating, insisting they’ve got it)
Kelly Farquharson (58:17):
I show it to my students using phonetic transcription and say this is something challenging, but I'm going to help you get there.
Of course, Kelly Farquharson (mispronouncing) Far-qwor-son.
Yeah, I like it.
Kelly Farquharson (58:29):
Yeah, well, thanks, Kelly.
Kelly Farquharson (58:31):
Yeah. Thank you guys, it was great to talk to you.