SLP Toolkit Podcast, Episode 21, Transcript

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Sarah: (00:10)

Hi Lisa.

 

Lisa: (00:43)

Hi Sarah.

 

Sarah: (00:44)

Fancy meeting you here.

 

Lisa: (00:45)

Well, it's been awhile since we've been in the podcast room.

 

Sarah: (00:48)

It is, it's true. I am super excited about this one because it is a followup to the controversial one we did. No, it wasn't controversial, but it was hot.

 

Lisa: (01:00)

We got a lot of hate letters. Just kidding.

 

Sarah: (01:04)

Wouldn't that be awesome?

 

Lisa: (01:05)

No, that actually really wouldn't because I'm the one that reads all those.

 

Laurel Bruce : (01:08)

SLP hate mail.

 

Sarah: (01:08)

SLP hate mail. We got no, hate mail. It wasn't controversial, but it was a hot one. We had a lot of people listen and tune in and it was the one on those articulation norms. And when we should start treating some of what we would've considered later developing sounds.

 

Lisa: (01:24)

Well and then I saw in some of the posts that we made, there was a lot of "hell no." Because we had that graphic that said, "can we treat R at age five?" And I think that's where the controversy came in, people were just physically reacting to that idea.

 

Sarah: (01:40)

Exactly. A lot of strong opinions.

 

Lisa: (01:42)

But we do have someone in the confessional with us today that can kind of help us talk about this even a little bit further.

 

Sarah: (01:50)

Yes. Because we had said we were going to unpack it. There was so much in that episode and one of the points that was made was RTI. And we are huge fans of using RTI, especially to treat speech sound and disorders. And so it was one of the areas we wanted to do an entire episode on. And so we thought who better to bring in, to talk about this then our good friend, Laurel Bruce? And she's here in person. Cause she lives in the Valley.

 

Laurel Bruce : (02:20)

That's right. I'm here in the confessional looking around at these amazing walls.

 

Sarah: (02:25)

Yeah. So we're super excited to have you here. And we had met you a couple of years ago. You actually participated in a in person conference. We held and this was one of the things that you talked about there because of your experience with RTI. And so we thought you're the perfect person to bring in, to talk about what does this even look like? So we probably do need to start from the beginning. I don't know how many people are using RTI in the school setting in the area of speech. (inaudible)

 

Lisa: (02:53)

I think there's some controversy, even from administration of what is allowed and what's not when the services are being provided by a special educator. So whether that be the teacher or an SLP, once it gets that specially designed in the instruction, so it's not just instructional assistants or paraprofessionals that are implementing strategies, that was where I always saw a lot of differing opinions from administrators and different districts.

 

Sarah: (03:20)

I worked in two different districts in the same area and one of them was all for it and we had a policy and procedure in place for it. And then I moved to another district and they were like, nope, you can't do that. So let's start with that. First of all let's talk about what RTI is for speech and then what your experience is with setting up a program like that. Is it okay? Can speech pathologist be providing RTI? All of that.

 

Laurel Bruce : (03:46)

Sure. Yeah. So RTI, most people are familiar with it, response to intervention. It also falls under the umbrella of multi tiered systems of support. So you also will sometimes hear it referred to as MTSS.

 

Sarah: (03:58)

Is that a new way of saying RTI? Are they changing it to MTSS or it's--?

 

Laurel Bruce : (04:02)

It's a little bit of an umbrella term that also includes PBIs underneath it. Yeah, so it's kind of an overarching term that's being used. But I still see and hear RTI being used a lot. And so really it's a way-- I think of it, Lisa, like you were saying that sometimes we have these really definitive lines between general education and special education and by extension, the people who provide those services and RTI I kind of envision as this bridge between the two where we can kind of intervene earlier, see how the student's responding, look at the data based on those interventions and make some decisions about if special education is required.

 

Sarah: (04:41)

Yeah. I think it's a brilliant way to get that data because without that data, all we have is when we go to a RED meeting and gather information from various means. Because we're typically not involved in pre-referral processes, there's some probably key data that we're not able to bring to a meeting to make those informed decisions.

 

Lisa: (05:04)

Well, and I think that was part of the district that we both worked in, that it wasn't allowed for awhile. The fear was that if you're at that point where you're trying to get data, then there is a suspected disability. And if there is ever a suspected disability, you have to go into the evaluation process. So you have to have that RED meeting and their thoughts where you could meet for the RED, talk about what your concerns are, decide you need additional data. Part of that additional data could be what the SLP gathers as part of an RTI and that process, but that it wasn't done before the RED. And I never really agreed with that because I said sometimes we don't even have enough data to determine. It's a suspected disability until we do provide some RTI. I need a little bit more information on the student than the teacher can provide me, or that an observation can provide me. So--

 

Sarah: (05:56)

So do we have a definitive--? I mean, I'm going to guess this differs, not only state by state, but district by district.

 

Lisa: (06:03)

And interpretation of the law, I think.

 

Laurel Bruce : (06:05)

And one of the things that's great about RTI is it's a freedom, but within that freedom comes some ambiguous-ness that--

 

Lisa: (06:14)

everybody interprets a little differently.

 

Laurel Bruce : (06:15)

Exactly. And so I think that being able to have some freedom is great, but it also comes with-- you can use that freedom well, or you can use that freedom partly.

 

Sarah: (06:26)

right, right. Yeah. That makes sense. I have to back up for one second, cause I realized I introduced you and said your name, but gave no background information whatsoever. You are a practicing clinician in the valley up until a couple of years ago when you decided to go back to school for your PhD.

 

Laurel Bruce : (06:41)

Yes. Yeah. I am originally a school-based SLP. I worked in the schools for 12 years. And then decided-- I was working in RTI and in that area and just had a lot of research questions that were coming up that I really wanted someone to answer. And I was like, well, maybe I should go see if I can answer some of these.

 

Lisa: (06:59)

I like it.

 

Sarah: (06:59)

That's pretty boss.

 

Laurel Bruce : (07:01)

So I took the plunge.

 

Lisa: (07:03)

She's like, if I got a problem, yo I'll solve it.

 

Sarah: (07:07)

Seriously. That's so cool.

 

Laurel Bruce : (07:09)

So yeah, I'm really enjoying being a PhD student. It's challenging and wonderful all at the same time, but so is being an SLP, right?

 

Lisa: (07:17)

It's just a different layer of growth. I mean, you're just thinking about things in a different way and on the other side.

 

Laurel Bruce : (07:24)

Yeah. My biggest goal as a PhD student and going into academia is to bridge those two sides because--

 

Lisa: (07:33)

we need it.

 

Laurel Bruce : (07:34)

I'm a clinician first. I was a school SLP for 12 years and that's where my heart is. I love school SLPs.

 

Sarah: (07:40)

And your perspective is so unique that you have that to offer. This is what we talked about when we had Meredith with the Informed SLP do an episode with us, is she also had that perspective of being a clinician and seeing that there is that gap there and some lack of communication happening between both clinicians and researchers. So the value you will add to this field I think is just going to be amazing. And you already have contributed so much, and that's why we wanted to bring you in specifically about RTI is because you've done research on this. Before you got actually into that, can you talk to-- what was the district's way that they were able to do this? So I'm going to guess you do need parent permission?

 

Laurel Bruce : (08:19)

Yes. Yeah. So kind of how this came about was we went to a conference that Jennifer Taps Richard presented at, and she had done a lot of work on RTI in her district in California. And she presented this model and I was sitting there with a colleague and we turned to each other and thought we need to do this. We need to see if working with students a little bit younger can really help us make faster progress, easier progress, and not have these kids practicing these errors for so long before they get help. So it was a little bit of a process in order to come to present this to the district. And we started out very small. We went in and we asked if we could develop an RTI team, because one of our biggest concerns with hearing this is that adding RTI onto an already full caseload is just piling on the plate that we already know is overflowing the task.

 

Lisa: (09:20)

And "I don't get credit for this" is what I hear a lot too.

 

Laurel Bruce : (09:22)

Right. Yeah. And so that was our number one priority when we presented this was to try and present it as a team model instead of just more on piling on an SLP's plate. So we presented it as starting with just two schools and doing RTI at a very small level. We each I think were working about a half a day doing it. And we had typical case loads the rest of the week. And it started to have success and kids were moving through faster. And so it grew and grew. And we did this for about six years and we had an RTI team, a small RTI team. And that was another thing that was really great about this is getting the chance to work with kids a little bit younger than is typical on these sounds, but also working with other SLPs in a teamwork model was so beneficial because you could bounce ideas off of each other. And that's something that can be so rare when you're working as an SLP in the schools.

 

Lisa: (10:15)

and the younger piece-- something resonated with me in a presentation that you recently gave a couple of weeks ago about that critical acquisition window there are two you were talking about?

 

Laurel Bruce : (10:27)

Yes. Research from Shriver has talked about there being two windows where speech development is at a faster trajectory. One being from seven to eight and a half. And a lot of times in districts we're qualifying students for speech sound disorders after eight. And so we wanted to take advantage of that second window and see if we could kind of ride that wave of development.

 

Lisa: (10:52)

So what did your data show? I know that you were taking data on everything that was going on with your students when you were piloting this in your district.

 

Laurel Bruce : (10:59)

Yeah. So what the data showed was we kind of had some different subsets of kids. So over the course of six years, we worked with just shy of about 400 kids and 170 kids out of 389 ended up finishing their therapy just on RTI alone. So they didn't end up needing an IEP, they just needed some help. They definitely needed the specialized instruction, but they didn't necessarily need a full blown IEP with all the supports that that brings--

 

Sarah: (11:31)

I'm not a mathematician. Is that about 50%?

 

Laurel Bruce : (11:32)

It's maybe it's a little less.

 

Sarah: (11:36)

A little less than half, it's still a high number of kids. Okay.

 

Laurel Bruce : (11:41)

And then we still had quite a few actually who were still in the pipeline or who had moved. So we have a chunk there that did that. And then--

 

Lisa: (11:48)

was there a typical model to provide those services? Like an amount of time for each session and an amount of time for the RTI window?

 

Laurel Bruce : (11:57)

Yeah. So what we did was we developed-- traditionally RTI is delivered in three tiers of service with tier one being a whole class approach-- and I've heard of SLPs doing different phonological awareness interventions as a tier one, which I think is great.

 

Sarah: (12:12)

So going into the classroom and teaching everybody?

 

Laurel Bruce : (12:14)

Yeah. And we didn't actually develop a tier one. We developed ours backwards. So we developed tier three first to support the kids who might need an IEP. And then we developed tier two. So the tier two students we would see individually. So that was also something very different as an SLP delivering individual services in the schools, which is not common, but we did individual treatment for usually 15 minute sessions. And it would be anywhere between-- tier two is two times a month and then tier three was four to six times a month. So that was kind of our model and it morphed a little bit as the years went on, but--

 

Sarah: (12:50)

why was I always under the understanding that tier three is special education? No? So there's actually three tiers and then special ed?

 

Laurel Bruce : (12:59)

Yes.

 

Sarah: (13:00)

Interesting. I don't know why I confused myself on this one.

 

Laurel Bruce : (13:03)

And then as you work up, and if you see that the students aren't responding in a certain tier, then you're moving up to the more intensive tier. So the tier one is the least intensive and then moving up to tier three with the most intensive. And then if that isn't supporting their needs, then we're looking at special education.

 

Sarah: (13:20)

So it was probably multifaceted. The results would be maybe the individualized treatment could have in itself have the impact, but then also you're getting them early. And then the amount of services that were offered. So the kids who were only like twice a month, did they make gains like that?

 

Laurel Bruce : (13:40)

They did.

 

Lisa: (13:41)

Over how many months? How long does it take?

 

Laurel Bruce : (13:43)

We did spread it out. So we would see these kids twice a month. So sometimes it would take a year. Sometimes it would even go into another year. So we did use-- one of the things that we wanted to be intentional to do is to use the chronological time to allow things to develop as well, for connections to be made. So they would get therapy, but it would be spread out over some time.

 

Sarah: (14:07)

Cause that's the other thing is I always thought of RTI as a much shorter window, usually maybe around nine weeks or so.

 

Laurel Bruce : (14:12)

Yes. And I have seen a lot of bottles that kind of reference a shorter timeframe.

 

Lisa: (14:16)

And maybe more intensive. So if they're spreading it out in that kind of model, then it's more frequent.

 

Laurel Bruce : (14:21)

Yeah. And so there are definitely different models that people use and I've seen the shorter ones as well. And I think those have been successful too.

 

Sarah: (14:30)

So, how did you decide when it shouldn't be RTI anymore? It should be an IEP?

 

Laurel Bruce : (14:36)

So one of the things that we actually used was our district's criteria for typical placement for our speech sound disorders. And so when they were getting upwards of eight years old, we were looking and saying, okay, this is definitely a delay, we've given them some support and they're still displaying articulation errors. It's impacting them in the classroom so we know that as a team, we're sitting down to make a decision about special education through an IEP is needed

 

Sarah: (15:03)

Because the interventions we're providing up to this point, aren't enough?

 

Laurel Bruce : (15:06)

Right.

 

Sarah: (15:06)

You're going to need something more intensive and specialized.

 

Laurel Bruce : (15:08)

Right.

 

Sarah: (15:08)

Okay. Okay. Interesting. Timewise, I think that's why in my head I was thinking it was a short time and maybe six to nine weeks. And if you can't make the progress in that amount of time, this is a student who would benefit from an IEP. But it doesn't necessarily mean that. You can go longer.

 

Laurel Bruce : (15:27)

You can. And that's where I feel like the freedom of RTI-- you can try some things for a shorter time and see what the data's showing. You can look at trajectories, you can try things for a longer time and see. It can be very individualized, which is one of the things that is great about RTI, but it also doesn't necessarily mean there's one prescribed way to do it.

 

Sarah: (15:47)

Right. And is it pull out? Can you pull them out?

 

Laurel Bruce : (15:51)

We did pull out, yes. I think a lot of tier one interventions are push in.

 

Lisa: (15:55)

So you were able to do this with a team that this became a regular role where you were just providing RTI services? For our listeners that don't have the opportunity to develop such a team, how would you suggest they start?

 

Laurel Bruce : (16:10)

Yeah. And I think with RTI, even with the team model that we did, we started small and obviously districts are strapped for resources and personnel. And so starting small and seeing where it takes you I think is a great place to start. So starting with one student, maybe there's one student that has caught your attention that is really in need of this. Maybe has R errors and R's in their name, something that is really, you can tell this child needs some intervention sooner. Maybe they have older siblings that you've already worked with on an IEP. And you're seeing the same patterns in them. And you're like, you know, if I could start the sooner, I could probably see a very different outcome than for some of the other people in their families.

 

Sarah: (16:54)

Well, are there some kids I'm going to guess are better candidates than others? You can kind of tell the kid who's going to require some intensive interventions. And I don't know, even necessarily by sound, like a lisp or a TH. We can probably knock that out pretty quick, versus an R. But you were even doing this with students who have an R.

 

Laurel Bruce : (17:14)

We were, and that was one of the things. So the research, as it turns out, the kids that finished through RTI did so typically an average of around six hours of therapy. So not a lot of time, but it was spread out chronologically and there were kids that needed the support of an IEP. And those kids, we wanted to really look at and compare with kids who had speech sound disorders and had just gotten services traditionally through an IEP. So the research actually did show that the kids that needed an IEP still took significantly less time than the kids on an IEP. It wasn't anywhere near seven hours. It took a lot more time because they have more errors probably and things like that. But--

 

Lisa: (18:01)

they still benefited from that boost?

 

Laurel Bruce : (18:03)

Yes. And I think like you were saying, Sarah, there could be a number of reasons why. It could be the individual treatment. It could be the fact that we were getting to work as a team and they're getting to see-- all of the kids saw more than one therapist. So they got different input and different tools from different SLPs, which was a wonderful and unique opportunity. And then starting earlier. So there's a number of reasons why it could have been effective and we're not exactly sure which of those was the key element, maybe all of them.

 

Lisa: (18:35)

So if I want to do this on my campus and I have a caseload do I tell my administrators? Or is it better to ask for forgiveness than permission?

 

Sarah: (18:45)

What you're plotting over there is I want to do RTI, I actually think this is a genius way to service these kids.

 

Lisa: (18:51)

I don't want to be told no. So I'm just going to do it.

 

Sarah: (18:54)

So I'm just going to set this up myself?

 

Lisa: (18:55)

Yes. And then just be a rock star, even if no one knows except for me and the kid.

 

Sarah: (19:01)

Okay. I'm not going to lie. When I moved to the district that said I couldn't do it, I may have used the same procedure from the district before. So I still did it on the up and up with families. Obviously you need permission. They need to know you're working with their child. One, they need you to talk to them. But two, you do want them to sign off that they understand what this is going to look like and they're okay with it. So once I got permission from the parents, I did set up RTI with students. So I guess I kind of did do that.

 

Lisa: (19:35)

I guess you're fired.

 

Sarah: (19:38)

Well too late 'cause I quit.

 

Laurel Bruce : (19:40)

Yeah. We're not condoning doing anything against your administrators, but it's great to have a conversation I think. And one of the things too is to use a guide. Look at how your district in general-- if they're providing RTI for other learning disabilities like reading and math, what kind of a process have they used? And I think one of the things that we saw in our district was the district did provide additional resources and personnel to deliver those RTI services. And so we said, why can't we get some extra to provide those services as well? I think SLP's, we're just used to taking on more and more on our plates.

 

Lisa: (20:17)

We're used to hearing no too. I think there's that weird where they don't really understand everything that we do. And I've always hated when the emphasis is on the reactive and not the proactive. So that's sometimes how you feel when you're trying to ask for something it's like, no, not until it is a bad thing will we get those resources in. So sometimes it's like how you present it I think and information you use.

 

Sarah: (20:39)

And who you present it to.

 

Lisa: (20:41)

and more than once. I mean, I know there were times where I had brought things to administrators and heard a "no," but I was really persistent.

 

Sarah: (20:49)

Right. And prepared. Have that argument. We talked to Jenna Rayburn a few months ago about something she changed in her district. I can't remember what it was. I don't think it was caseloads. She was working on something, was it workload, caseload analysis? something. And so she printed everything from ASHA and she had all of her ducks in a row. And so she went there and presented it with data and evidence to support whatever it was that she was asking for. And she got it. So be prepared. This is one of those things I don't think you can just say, hey, I heard this is a good idea, I want to do it.

 

Lisa: (21:21)

That's a quick way to a no.

 

Sarah: (21:23)

And then again, I always think it's all about who you ask. So find a person who you think is progressive enough that they are going to be willing to look into this. I found a lot of success using RTI. Again, it was going to be those students. I always went with the ones that either had one of those errors that's just typically resolved quicker anyway. So again, the /th/ the lisp, or the kids who were stimuluable. When I was having a conversation with them, give them a couple of strategies and get them to do something. Those are great candidates for RTI because clearly they just are gonna need that little extra instruction and not anything intensive.

 

Lisa: (22:04)

Did you have an RTI block in your schedule that you just rotated kids in? Or how did you do it?

 

Sarah: (22:08)

So I had both. I had a couple of times in my schedule designated to do RTI. About two 30 minute sessions a week, kind of just built in. I took away testing time and did that. And then the other thing I would do is typically I'd have articulation groups anyway, and I would just add those students into that group. And again, with the parents' knowledge, because now that I just said that out loud, I am thinking, can you do that? Can you bring in RTI students with students on IEP's?

 

Laurel Bruce : (22:37)

So, that's been an issue that I've heard discussed, and some people think yes, and some people think no.

 

Sarah: (22:42)

When I just said that out loud I did question myself for a second on it. That was on the up and up, but the parents were aware of it, they knew. And why do I feel like we looked into that and it was okay? This is one of those when this is okay, who knows? Again, it's all interpretation. And I wouldn't have done it without parents knowing, and they're the ones who are going to cause conflict, right? If they're not happy with something, I don't know. I don't know. Here's the deal with all of this, about what everything we're saying. You probably do need to get clarification on your district's policies with how to handle all of it.

 

Laurel Bruce : (23:18)

but it is something you can try on a very small scale. It does not need to be something that revolutionizes your building or your district, it can be done on a really small scale to supplement and help some of those students just a little bit younger. And it helps them from the standpoint of obviously getting help earlier, but also helps us because typically working younger is a little bit easier. And so if we do a little bit of RTI, it can actually help in the long run, reduce caseloads a little bit.

 

Lisa: (23:48)

So even if you maybe just start with some kindergarteners that you don't want to show up on your caseload later.

 

Sarah: (23:51)

Right. And that's the thing is, is I have seen the argument that says I don't want to add anything. That's more kids I have to see. So now I'm adding to my caseload and like you said, in our district, when we were doing our caseload numbers, we couldn't count students on RTI as part of our caseload. And so people saw that as a problem. To me, it was worth it because I had those students for such a short amount of time that to me, I would rather see them for nine weeks, then three years on my caseload. And number two, anything I can do to eliminate the paperwork I'm all over. And so the fact that I never had to go into all of the eval process and all of that and do all of that paperwork, that's worth it to me.

 

Lisa: (24:36)

I mean, that's six to 10 hours right there that you're spending on testing, writing an IEP, attending meetings. So if you can take that-- you said you were getting success in six hours. If you can redirect those six hours into something that helps you help that student even more quickly and not have to write a report, it's a win win.

 

Sarah: (24:56)

To me it's a win win. I thought it was worth it too.

 

Laurel Bruce : (24:58)

And that was part of what administration really was interested by. We don't necessarily need more time, we need to redirect the time we already have. And that was something they could really get on board with.

 

Lisa: (25:10)

So what are some great strategies that you were able to implement? I always think of sounds like /th/ or something. Those are pretty concrete and straight forward. But do you have any cool strategies since we're looking at maybe implementing even RTI with younger students? For an R sound? Any great tools out there that you've seen?

 

Laurel Bruce : (25:32)

Sure, yeah. I love talking about therapy tools. I love the social media component of the SLP land out there that we've been able to interact and dialogue more about this. And right now, Amy Graham is doing a lot on her Instagram and showing different therapy techniques, which I love to see, and I'm showing them to my graduate clinicians.

 

Sarah: (25:52)

We love her.

 

Laurel Bruce : (25:53)

Yeah. And so definitely one that is my go to is kind of using the L to R strategies. So having a student articulate the L sound while moving their tongue posterially along the roof of their mouth is kind of my go to strategy for R.

 

Lisa: (26:08)

Because they're really related sounds.

 

Laurel Bruce : (26:10)

They are, they're both liquids phonetically, and they both are voiced. They're the same manner. And so really all you're doing is changing the placement. And that's one thing that I tell my student clinicians as well is the IPA is really your best therapy tool. Because basically you're trying to change the place of a sound, typically. Sometimes the manner. And figuring out what the target sound has in common with what your student can produce and looking at that relationship and how you can alter it is really the core of arctic therapy.

 

Sarah: (26:46)

We just saw you present a couple of weeks ago. And when you went over that, I was all mind blown emoji. Like why had I never actually looked at that? And so you had up a chart that had all of the sounds and then the manner and placement and voice. And then it was comparing the sounds. And then you were trying to make that point that if you look and see in the example of L and R, they only differ by placement. So that is going to be a great one to start with, because now you're only having to change one thing versus like, where you have to affect matter and place and voicing. So interesting, I had never thought about it before.

 

Laurel Bruce : (27:28)

Yeah. Thinking about that the tools that a child actually already can say are the things that we can shape and use is really kind of my go to and where I like to think through what aspects do I need to change and what aspects is he stimulable to change?

 

Sarah: (27:45)

The other point you made and I had never thought of before was not telling them what they're working on.

 

Laurel Bruce : (27:50)

Yes.

 

Sarah: (27:50)

Will you talk about that?

 

Laurel Bruce : (27:52)

Yeah, absolutely. So I think this comes from Pam Marshalla or at least that's who I heard it from. But basically the idea that in their mind R is associated with this errored pattern that they've been practicing for years and years. And so when I first work with a student, I don't tell them we're going to work on R, because if I do that, it's going to activate that old motor pattern, that old errored pattern that we're trying to overcome. So what I do instead is I tell them, we're going to work on some sounds today. We're going to play with sounds, we're going to work on a back sound, something like that. So I still want to tell them why they're there, but I don't want to give it the same label as what they're associating with their error. So I usually don't tell them, and usually I let them figure it out on their own. They're smart. And by the third or fourth session of us going (makes sound) they're going, "that sounds a little like an R sound."

 

Sarah: (28:46)

It was one of those moments where I was like, duh, never thought about it. I always told them, "okay, you can't say your R and I'm going to help you fix it.

 

Laurel Bruce : (28:54)

I did too. I mean, it's drilled into us to let our students know why they're there and what they're practicing, which we can still do, but we can label it just a little bit differently.

 

Sarah: (29:03)

So you're just talking about how you're playing with sounds and trying some different things. And then you start with the L, "I want you to put your tongue up behind your teeth and drag it across the roof of your mouth. And let's just practice that and let's do some sound with it while we're doing it." So that's all you're just telling them to do?

 

Laurel Bruce : (29:18)

That's all they're doing.

 

Sarah: (29:19)

Amazing.

 

Laurel Bruce : (29:20)

And then adding some syllables. And I told the students that sounds a little bit like Legos, and you can build, put them together to make words and sentences. And so we slowly add syllables and then consonants and build up to more complex word shapes.

 

Lisa: (29:34)

You shared a cool app that during your presentation too, that you said is a new one.

 

Laurel Bruce : (29:38)

Yes. So there's a new app. It was developed by Tara McAllister at New York University and it's called staRt. So it's Speech Therapist's App for R Treatment. And it's a really cool--

 

Lisa: (29:51)

So it's staRFt? She said, staRt. She said for R treatment, they forgot the F, so it's staRFt.

 

Sarah: (30:04)

It's a silent F. Continue.

 

Laurel Bruce : (30:07)

So anyway, it's a great app because it provides students with feedback on their productions. And it's got a really child-friendly interface where it looks like a beach and there's a little starfish--

 

Lisa: (30:17)

that's a therapy friendly perspective too. Is there a margarita on said beach?

 

Laurel Bruce : (30:24)

Right. So, and what it does is it actually shows the feedback of the acoustics of what the child is producing. And there's a little wave that is supposed to peak where there's an R and there's a tutorial built in that will show you that. But it's a wave-- if you use an external microphone for kids to see it in real time

 

Lisa: (30:43)

So as that line moves closer, they know, hey, I'm in the right direction, and then they can kind of keep on with that motor movement to get there?

 

Laurel Bruce : (30:51)

Yeah so the line is the target, and they're trying to get the wave right on that line. And it's really--

 

Sarah: (30:55)

so that's for that visual feedback?

 

Laurel Bruce : (30:57)

Right. And it's a great way to do it, especially for kids who are younger, who are trying to conceptualize what they're doing. They can just get the peak up. So it's a great tool.

 

Sarah: (31:07)

And you said it's free?

 

Laurel Bruce : (31:08)

It's free right now, yeah. They're offering it for free. So go to Tara McAllister's website, I guess.

 

Sarah: (31:14)

And we'll link to it. Anything that we talk about in this episode we'll put a link to. One of the things I was just thinking about is I think I've got paperwork somewhere that I used as my example from a district where we were successfully implementing RTI to get the permission and kind of let the parents know. I'll see if I'll link to that. Did you have something?

 

Laurel Bruce : (31:35)

We did use forms. We started off with paper permission forms, and then we talked to the legal personnel in our district and asked if we could do email, if that was enough documentation, and they said yes. And that really streamlined the permission to be communicating through email. So that was really nice. And one of the things though I think with the paperwork for RTI, that's really critical is unlike an IEP, it doesn't follow students from place to place. So if you have students that you know are going to be switching schools or districts, you want to be cognizant of communicating with parents, "let us know that ahead of time so we can prepare some paperwork for you"

 

Lisa: (32:12)

that you can bring to the new school.

 

Laurel Bruce : (32:13)

Yes.

 

Sarah: (32:14)

Yup. That makes a lot of sense. In fact, I do remember that coming up a few times. And that's when I would really sit there and think, is this going to be a student who needs an IEP? Because if they are, I want to get that ball rolling now so that they don't move to the next school and have to start from the very beginning again and waste all that time.

 

Laurel Bruce : (32:30)

Right. Or one of our greatest fears was they would get to that stage where they can kind of do it with support, but it hadn't generalized yet. And they were in that process and we didn't want to drop them right at that point.

 

Sarah: (32:41)

Yes. I know going back to the tiers-- tier one. I was remembering some of the things too, is I liked the idea, we talked about going into the classroom and teaching the whole class. And I have done that with kindergartners gone in and done some activities and stories as a whole class on how to work on the sounds that we're going to see. Any of those common error sounds. The other thing too, is we were highly encouraged to have teachers work with the students on the speech sounds as part of tier one. And so our role was to go and give them some tips and strategies--

 

Laurel Bruce : (33:16)

How'd that go?

 

Sarah: (33:16)

--of things that they could do. Guess. Take a guess, take a guess how well received that was. For a couple of reasons, and again, I get it, teachers have a lot going on already. And so when you're trying to ask them to do one more thing-- and I think, again, coming from a place of "no, that's your job. I don't want to do your job for you" kind of thing, it was not well received. But there's always going to be that teacher who you do have a relationship with that you can kind of-- what's the word? Not troubleshoot.

 

Lisa: (33:45)

Just work with.

 

Sarah: (33:46)

Like a test. I would say, hey, will you-- are you willing to try something?

 

Laurel Bruce : (33:52)

A pilot

 

Sarah: (33:52)

Pilot-- that's the word I was looking for. I'm just really curious if this would work. And here is the /th/ sound, it's so easy. Here are the tools that I use, my bag of tricks that I use. With this kiddo who's coming up, the next time he does it, will you just try it and just see? And then I'm going to give you a piece of paper where I just want you to write in this one box and write this one thing for me and so that would work. And then once they saw success and had some buy in in there, then they were a little bit more ready to do it.

 

Lisa: (34:20)

well, and I think it depends too on who you're asking. If you're asking a fifth grade teacher, they're like, get out of my classroom. If you're asking-- I had a kindergarten teacher that I worked with that I taught her a whole visual framework for S blends because I was getting a lot of referrals from kindergarten on cluster reduction. So I was like you're teaching sounds, anyways, letter sounds all of that kind of phonemic awareness kind of thing. So why don't you add this visual cue? Here are some ways to teach the different blends. I hardly ever got a referral from her after that.

 

Sarah: (34:52)

That's what I was getting ready to say. Don't go say "hey, for part of tier one, you have to do this. Let me show you what you're going to do." Bad approach, go in there with you just want to be helpful and show them some cool things and do it as that whole class approach and get them excited about it and they'll have buy in. And again, look at all of those students that you saved from ever coming across your caseload. So when I would do a presentation in a kindergarten classroom, was that 30 minutes outside of my groups and paperwork and everything else I had to do? Yes. But I think that's really worthwhile to take some of that time to do that. I am a huge fan of being proactive, not reactive. Right? and so anything I can do to not have these kids show up later down the pipeline, I'm all over it.

 

Lisa: (35:40)

Plus just for your general reputation on campus, that you're not just holed up in your speech room doing these mysterious things in there. That you're actually showing them and modeling for them what you're doing. So it's just overall good practice.

 

Sarah: (35:55)

They liked it. Again, find the ones that like it. There's going to be other ones who are just not interested. At all. But find the ones that are willing to do it. And I thought I had really good experience, is it's all about the approach and how to handle it.

 

Laurel Bruce : (36:07)

Yeah. And letting them know what we can offer them. Because they're busy too. So what are the things that we have in our tool kit that we can offer to them?

 

Sarah: (36:17)

That's it. You're offering support. You're trying to support them, not give them one more thing to do. And so that's why it didn't really work out that well. So once I kind of changed my approach, then I had some more support. But for the ones who were like, "no, I'm not going to do it." Well, then those were the kids that I would have to go in and do the interventions with. I would talk to parents though also and tell them here's some things that we're trying, here's what you can do at home to help support them. And for those parents who are the ones who initiate the request, they're on that. They're willing to do whatever they need to do.

 

Laurel Bruce : (36:50)

Yes. And that was one thing that we found with RTI was that talking about being proactive, we had parents that we would ask them if we could work with their students. And they said, thank you so much for asking this question because we were wondering, we weren't sure. And we didn't even have to ask anybody, you came to us and said, can we address this? And we were-- it started the relationship off in a different way. Instead of them coming in, banging down the door saying help us, we're going to them and offering something.

 

Sarah: (37:19)

Yeah. Very cool. I know you said it's one of the reasons you went in to to do your PhD, was that you wanted more information on this. Now I know you're getting ready to do your dissertation, all of that. Is this something you want to continue to pursue? Is RTI in particular?

 

Laurel Bruce : (37:34)

I think RTI is a wonderful model. I think the model in itself is one of the things that gave us the freedom to work earlier. And I think one of the things-- I actually worked a little bit in a private school as well, and I had the chance to work with five-year-olds on R at that school. And I saw the power of earlier intervention. So one of the things I'm really interested in research-wise is both when is the optimal time to intervene? And what does it look like to intervene as early as we possibly can? Even in our lab we have a project going right now where we are working with infants, as soon as they're born we're giving parents support because they have galactosemia and we know there's a really high incidence of speech and language issues with these kids. And so they're getting therapy right from the get go, and we're tracking their speech and language development as they age.

 

Sarah: (38:25)

That is fascinating.

 

Lisa: (38:27)

So you're going to have this written out by next week?

 

Laurel Bruce : (38:29)

Oh yeah, definitely. I'll send it to you.

 

Sarah: (38:33)

I'll link to that in our resources.

 

Laurel Bruce : (38:38)

We'll see how long it takes.

 

Sarah: (38:41)

So interesting. I'm so excited for everything that you've got going on. That direct connection to your levels of research and how it impacts clinicians. And so even the whole RTI, I loved what you were able to do with that, that shows how we can actually use it. And if it's effective for us. I'm not a big fan of reading research for the sake of research. I need to know how it impacts my life.

 

Laurel Bruce : (39:09)

Research is only effective--

 

Lisa: (39:11)

I let Meredith read the research for me.

 

Laurel Bruce : (39:14)

I do too.

 

Lisa: (39:15)

The Informed SLP.

 

Laurel Bruce : (39:16)

I'm reading research in my area, but I have no idea what's going on in autism. So I'm always on The Informed SLP going what's going on in this area that I'm not staying up on? But yeah, I think research is only as good as we're able to implement it clinically. So we can sit in the ivory tower and do all this research and have fun. But if we can't bring it to the therapy table, then it's not doing anyone any good.

 

Sarah: (39:40)

Preach.

 

Lisa: (39:42)

Preach.

 

Sarah: (39:43)

Could not end on a better note. Thank you so much. I hope we addressed-- we had a lot of questions on RTI after that last podcast. So I hope we answered everything.

 

Laurel Bruce : (39:52)

There are always questions. I think because RTI can be adapted in so many ways. So I think continue to have dialogues, continue to brainstorm about ways to do RTI. I think another way that I've seen people do it is in kind of those quick five minute artic sessions. I know some SLPs will take-- especially that first part of the day where there's announcements and the pledge and things, and they'll just pull kids out really quickly. So there are a lot of different ways to be creative. And I think sometimes when we're in the mundane daily tasks, that we do--

 

Lisa: (40:22)

it's hard to see that.

 

Laurel Bruce : (40:24)

it's hard to be creative. It's hard to have the space to really reflect and come up with creative solutions. So use the times that you have a bunch of SLPs together to really be creative and think outside the box about how we could improve service delivery.

 

Sarah: (40:39)

Yeah. And I'd love to hear from you guys too. If anybody listening wants to let us know what's working for them and successes they've had in this area let us know. We're happy to share it.

 

Lisa: (40:48)

You can reach us by email at podcast@slptoolkit.com. And then also, if you have a chance to rate and review this podcast, if you like what you're hearing, it helps other people find us. So definitely do that in iTunes.

 

Sarah: (41:00)

All right. Peace out.

 

Lisa: (41:01)

Bye.