SLP Toolkit Podcast, Episode 23, Transcript


Lisa: (00:10)

This is Tooling Kit. It's a go, it's go time.


Sarah: (00:45)

That was really special. And a unique way to start this episode.


Lisa: (00:48)

I practiced that.


Sarah: (00:48)

After twenty three episodes of "hi Sarah. Hi Lisa." Now we're going to do something different.


Lisa: (00:54)

Well, some people might be on their morning commute. I just want to give them a little jolt of WTF in the morning. Anyways, this is one of those awesome days in the confessional that it's not just you and me.


Sarah: (01:08)

And those are the good days because I get sick of looking at your face.


Lisa: (01:11)

I was thinking I get sick of hearing your voice. So it's a good balance.


Sarah: (01:13)

Yeah. Perfect.


Lisa: (01:14)

So on that note, let's introduce our amazing guests today, who I've had the pleasure of knowing for several years now, the one, the only Amy Hill. It sounds like we have like a clap on that.


Sarah: (01:29)

I know. That was us actually clapping people, not a recording. So welcome to the confessional Amy!


Amy Hill: (01:36)

Hello! Welcome, I'm so excited!


Sarah: (01:36)

Do you know what you got yourself into?


Amy Hill: (01:38)

Not quite, I'm a little scared. A little nervous. Do I know where I'm at?


Sarah: (01:44)

Yeah, and you never know what you're gonna get.


Amy Hill: (01:47)

I know, it's you guys.


Sarah: (01:48)

I know. And that in and of itself is always scary, but then two, we barely prefaced anything other than what we'd like to talk about.


Amy Hill: (01:57)

Which is what?


Sarah: (01:57)

What are we talking about?


Lisa: (02:00)



Sarah: (02:01)

Supervision. Oh gosh, that was my head.


Lisa: (02:04)

How'd that feel?


Sarah: (02:04)

Let's cut that part out.


Lisa: (02:07)

Supervision of SLPAs, because I was even thinking of what our confession would be for today, and I know there are a lot of SLPs that are nervous of SLPAs even being in our field and don't know if they can even do the job that we would do. And so that's kind of what I wanted to talk about today is--


Sarah: (02:27)

Is that the biggest problem with an SLPA?


Lisa: (02:29)

It's one of the problems.


Sarah: (02:30)

It's that the SLP doesn't trust it?


Lisa: (02:31)

There are people that don't want to work with them.


Sarah: (02:32)

I just don't think they know what to do with them.


Lisa: (02:35)

Whether they don't know or they just don't want to know.


Sarah: (02:37)



Lisa: (02:37)



Amy Hill: (02:37)

I think there's some of both.


Sarah: (02:40)

I would not have expected the biggest problem with SLPA's to be that SLPs don't want to use them. I was thinking there isn't enough of them and we don't know how to use them well.


Lisa: (02:51)

So let's preface this conversation too, with a little bit about Amy and her background. So do you want me to do it or do you want to dive in?


Amy Hill: (02:59)

Let's see if you can do it.


Lisa: (03:00)

Oh gosh. Why did I even offer to do that?


Sarah: (03:02)

Let's hear her bio, go.


Lisa: (03:04)

Alright. She was born in Alabama. Just kidding, actually, Colorado, right?


Amy Hill: (03:10)

Colorado, yes.


Lisa: (03:13)

She was born in Colorado. She is a rockstar. I don't even know how-- do you drink a lot of red bull? Like how do you do all the things that you do?


Amy Hill: (03:21)

I've had some red bull in the past, but.


Lisa: (03:24)

So I met Amy when we worked in a school district and then you provided us contracted speech language pathologists for that. So that's how we originally got introduced. Then, come to find out that Amy was the former president of our state organization, ARSHA. She is currently-- what is even your role at Estrella community college? What is that called?


Amy Hill: (03:44)

So I am faculty and program director for the SLPA program there.


Lisa: (03:49)

So giving her some street cred there.


Sarah: (03:51)

And clearly the right person I have in the confessional for this topic. That's awesome.


Lisa: (03:56)

And your current role?


Amy Hill: (03:59)

I am also the executive manager of a therapy company. So I provide all the clinical support services for Light Streets Special Education Solutions and support all of our SLPs, SLPAs, OTs, PTs, special ed teachers.


Lisa: (04:20)

And that's why I thought you were the perfect person for this topic because not only have you supervised SLPA's yourself, and you're the head of the program at a local community college here in the Valley, but also you've worked with a lot of teams that are working within that framework of SLPAs are providing a lot of services.


Amy Hill: (04:39)

Yeah. I have quite a few teams that are SLPA teams and also OT cota teams. So, when you look at a team of professionals in a way they all operate the same way. And we have a lot to learn from the OT and PT fields and how they work with their assistants.


Sarah: (04:57)

Because that's been longer that they've been using them, so I think their roles just seem to be more clearly defined. Maybe the licensure and education of them is more established.


Amy Hill: (05:11)

Yeah. And it's more set with like the national associations, which is coming for speech, but cotas are recognized by their national associations. PTA's are recognized by their national association. So coming soon, ASHA is in the process of doing a national certification for SLPAs that is supposed to begin rolling out in 2020.


Lisa: (05:33)

Oh that's really soon.


Amy Hill: (05:33)

So next year.


Sarah: (05:35)

it's soon. But at the same time now I'm thinking, everybody else has been doing this and we haven't been.


Lisa: (05:39)

Well, they had a guidance document. So it's like one of those things where they talked about sort of the recommended do's and don'ts for working with SLPAs. And that's been around since what? about 2002 maybe? And they've revised it. But the situation with SLPAs is that even though ASHA has these recommendations, it's regulated by states, the licenses. So some states-- like I know our state--


Amy Hill: (06:04)

has a license. Some States have a registration, some do a certification, some have nothing, some require a bachelor's some require an associate's degree. Some require on the job training.


Lisa: (06:15)

So because it's not uniform, I think that's part of where there's been this sort of imbalance of people-- like, even in my role, when I was trying to get supports for SLPs in our district, it was, you might get an SLP that comes in and support your caseload, or you might get an SLPA. And some people were like, awesome-- and that was my experience when I started, I was like, I never have worked with an SLPA, but I'm just thankful for help. And there are other people that were just like, I absolutely don't want to work with an SLPA.


Amy Hill: (06:47)

And I think because all the states are different, that's been what's hindered us for so long and having that whole disagreement between part of our field that says, I don't know if I want to work with one at all, they're taking my job and my role. And then others that are like, I just need some help, and I embrace that help. So it's definitely shifting toward that "I need that help" from what used to be "no they're taking my job." And I think because more states are designating the exact roles of SLPAs, that has helped. But the biggest thing nationally is Medicare will never recognize any reimbursable provider unless you have a role, right? So that's been what's impacted our field as a whole. So cotas are recognized as a reimbursable provider because there's a national baseline establishment of what makes a cota. So and that's kind of what finally came to ASHA was if we don't do something, we're never going to get reimbursement of SLPAs at a third party reimbursement level, through Medicare and insurances. So ASHA was like, wow, we should probably finally embrace this. And the right people are on our board right now, the right people are in the accreditation part. And the group that I sit on with all of the SLPA programs across the nation, we've been meeting for years, but finally, there's enough of us that are saying "this isn't going away, we need to do something" to begin recognizing this so that we can move forward at a national level.


Sarah: (08:22)

Interesting. Because I was going to say, one, I was an SLPA and I honestly feel like I might've been one of the first in the district we worked in. Cause I had just graduated with my bachelor's and it would have been around 2004, 2005. It was the first time I ever heard it was a job. I made like nothing, by the way, they are making a lot more now than I made when I started. But it was amazing. I was like, oh my gosh, I can work with a bachelor's because what the heck else do you do with the bachelor's in our field? I was so excited. And so I loved it and then as an SLP having SLPAs, I wasn't worried about them taking my job. I was worried that my job was only going to consist of paperwork and diagnostics. I was worried that literally I was just going to be the one at the meetings writing all of the documents.


Lisa: (09:08)

Well, I think different districts handle that differently. So I mean, I've seen SLPAs used in some forms where they're the primary provider and it is that the SLP is the evaluator and attending meetings and doing all of that. That also because it's not super structured and it can be different from school to school district to district. That can be a problem because you can have districts that say, well, I'm going to give you your regular caseload and these three SLPA's to supervise, and that is not doable and in any good sense of the way that's going to be good for students, good for the SLP, good for the SLPA. But that's why I think when we get this kind of national certification, it should hopefully balance, things like that and alleviate some fears. And currently SLPAs can only work in schools or clinics as well?


Amy Hill: (10:00)

So they're not restricted to any setting, but the only settings that can really employ them are schools, and then in Arizona, clinics and home-based because we have Medicaid billing that SLPAs are considered a reimbursable provider for. So they can work anywhere that gets money, that isn't from a third party insurance per se, and DDD is more of an access provider. So that's why SLPAs in Arizona can get reimbursement because DDD that provides our funding for most home and clinic based, students recognizes SLPs as a reimbursable provider and then the schools have Medicaid in the public schools. So they're recognized there, but there's nothing in any of the statutes or laws that prohibits; they can't work in a hospital or they can't work in the skilled nursing facility. It's all a matter of why would I hire somebody I can't get reimbursed for?


Lisa: (10:54)

Right. And that makes sense. So thinking in terms of what SLPA's typically can and can't do-- and again, this is different from state to state if there even is regulation. ASHA will even say if you call and ask any questions, they defer to whatever the states say SLPA's can and can't do. But what can we talk about as far as basics for somebody maybe who has not worked with an SLPA?


Amy Hill: (11:18)

I always say there's three kind of basic things that all SLPAs do kind of across the nation that are probably pretty similar from state to state. Number one is treatment, right? So providing treatment to those clients, to those students that are on the caseload and then planning or doing lesson planning or prepping for those sessions and then doing the notes about those sessions. So when you look at that continuum, those are kind of their three primary roles is; how do I look at this treatment plan developed by an SLP, pick the materials, pick the activities to then target, do that target, and then keep that data and documentation to then report back to my SLP to then decide where do we continue to keep going?


Lisa: (12:03)

So never evaluation from terms of eligibility, or what's going to happen next, but they can use their data to determine if their treatment is effective?


Amy Hill: (12:12)

Right. With their SLP. So they can't do the interpretation of it, but they can say "here's the data I've gathered." And then the SLP can look at it and say, okay, are we ready for a new goal? or, wow, are we off base? And do we need to try this other way to target therapy? Or maybe, that strategy you're working for with R isn't working at all, let's try this one. And then that SLP and SLPA should have that open communication, collaborative relationship of what am I doing in therapy as an SLPA, isn't making a difference. And if not, then what do we need to do to change that? and have that ongoing discussion about all the clients, all of the students that are on their workload.


Lisa: (12:54)

So that's the idea of supervision is supposed to provide that balance of, if you do have that fear of is the SLPA working with my caseload or students effectively? That's where supervision should alleviate that. Because if you are providing that supervision, you would know if something's working, not working and be able to support the SLPA in that way.


Sarah: (13:16)

What's the requirement for supervision?


Amy Hill: (13:18)

Of course, it varies state to state and with ASHA. So each state determines that. So in Arizona your first 90 days of employment, there's 20% at minimum for direct 10% indirect. But they're always 100% of the time being supervised and overseen by an SLP. So that's something some people get into the minutia of, "well, I only need to see them 10% and 20%." But no, you're responsible for them a hundred percent of the time. It's just, you are required to provide direct supervision for a minimum of that and indirect for a minimum, but really whatever their hours are that they're employed for a week, you're providing their oversight.


Lisa: (14:03)

ASHA has that verbiage, something like "under the direction of"-- so anybody that's working under the direction of the licensed certified SLP, whether that be an SLPA or a graduate student, or whatever the case may be, you need to be ensuring that you're giving enough supervision to meet the--


Sarah: (14:20)

I think that's where it gets a little tricky and messy. I got really lucky because I was always in the room with my SLPA on the same campus. So lucky. So I wasn't always fully watching her cause I was catching up on paperwork or doing whatever, but I could hear her, I could see, I could jump in if I needed to, she could come ask me questions if she needed to. But that's not always the case, right? They can be on a campus alone with an entire caseload?


Amy Hill: (14:46)

Well, yes. So the SLP is still the person with the caseload, but could they be there providing therapy pretty much independently for the majority of their week? Yes. After they've been employed for 90 days, then their minimums drop to 10% and 10%. So when you think about 10% of your services or even your hours that you're working for a week, that's not a lot. And that's where a lot of SLPA's kind of get discouraged 'cause they're like, well, my SLP has their own job per se, and they only come see me every Monday for eight hours or whatever. Okay. Well, they don't see me the other days. And I think that's the hardest part is that as a supervisor, you have to think about how do I still see my SLPA with all of my clients at some point and some frequency? How do I make sure that they're following the treatment plan? How do I review these notes? And I think that's the biggest challenge for SLPs is to figure out how do I do this supervision? And it doesn't always have to be me sitting in the room. I mean, I've used things like zoom, Skype, FaceTime, and I've called in and looked at, okay, let me see you work with Johnny and then I can help troubleshoot this thing that is happening right now. But a lot of people don't think about how do we use technology to provide better supervision?


Lisa: (16:07)

Well, and so just maybe to back up a little bit too, to define direct and indirect supervision. Direct is in the moment supervision where I can provide feedback based on what I'm seeing in this moment versus indirect is basically everything else. So it could be reviewing--


Amy Hill: (16:21)

reviewing notes, talking about them, lessons, reviewing text, emails, all of those forms of communication that we do with our SLPA.


Lisa: (16:31)

Reviewing a recorded session. So I can't give you feedback in the moment, but if maybe your SLPA says I'm really having a really difficult time with the student, they could record it and show it to you, and then you provide that feedback.


Amy Hill: (16:44)

Yeah. And then with the direct-- from state to state, one of the things that varies even between a state and ASHA is whether telepractice is considered direct, so that you always have to look at whatever your state says. Because some people interpret direct being okay, if it's a synchronous session where I'm there with the student as an SLPA and my SLP is also on the same session that should count as direct. And when you look at ASHA, it absolutely does. But for example, here in Arizona, we have a statement in our statute that says direct means onsite, in view. And our attorney general in Arizona has decided that that means physical presence in the same room.


Lisa: (17:30)

That's really hard.


Amy Hill: (17:31)

So if there's somebody doing telepractice, they then have to figure out how do I get in that same room with that student at some point? Which makes it even more challenging, especially with all of the rural-- and urban areas around our nation--


Lisa: (17:47)

with the student or the SLPA?


Amy Hill: (17:48)

That's always the question too, because it's a gray area of who do I need to be there with?


Lisa: (17:55)

That's tough, yeah. You would think if the supervision is of the SLPA I would be in the same room as the SLPA.


Sarah: (18:03)

So this might be some of the stuff that we'll get hopefully more guidelines for with this new ASHA certification. Right?


Amy Hill: (18:11)

Yeah. And I think once national certification comes, every state's then going to have to look at how do I fit with this? And then some changes will probably then unfold state to state based on how that rolls out.


Lisa: (18:25)

Yeah. What do we know so far about the national certification as far as are they going to be paying an annual fee like SLPs?


Amy Hill: (18:31)

My understanding is they would take something similar to a Praxis exam. So there will be some national tests that rolls out first. So that's what's supposed to come hopefully by the end of 2020. So that would be step one. So then they would take this national assessment. If they meet whatever the passing score is, then they would be a member of ASHA and have some type of a certification that's a national credential like we have. And then from there then they'll look at, do we need to put in any educational requirements? Is my understanding, which it sounds like it would be similar to an associate's level type of entry. If you have above that, great, but if you're a state that has just on the job training, that probably won't fly anymore once everything comes out. And then with that I'm sure that they would then make recommended language for states for all of the pieces of everything that have always been in their guidance documents all along, but haven't been required. But they would probably be provided more as "here's state X, look at this and see if you need to make any changes."


Lisa: (19:39)

So to work as an SLPA, then you will have to be accredited? There's not going to be anybody grandfathered in? There's not--


Amy Hill: (19:44)

I'm sure there will be a grandfather in. As with anything, my guess is if you can pass the test, educational requirements would be grandfathered in for a period of time. And then at some point, anyone after that would have to meet-- similar to what they did when they started licensure here in Arizona. There was a period of time where you could grandfather in certain things. So I'm sure that they would have to do that.


Sarah: (20:10)

I loved the comment you made very early in this conversation about how we need to look at other professionals and figure out how they're doing this and making it so successful. Because I did want to talk about any recommendations you have for what is the best way we can work with SLPAs? Because I will tell you, I loved being one, but I also loved having them. I do know where I was weak, which would have been in the training of said SLPAs. I was fortunate enough that they were super competent and so I just let them run with it, and I would stop things if I needed to once in a while. But for the most part, I don't think I gave them the support they needed.


Lisa: (20:47)

Well, and it's hard too, because I hope that's something they consider in this process, is what if an SLPA is new to me? What are some supports and training documents and courses and those sorts of things that will help me be a good supervisor?


Sarah: (21:00)

So, yeah, that's probably a two-fold question then. So what does make a good supervisor? And then two, how do we best utilize SLPAs?


Lisa: (21:06)

I'd like you to actually name some names of some really crappy supervisors.


Sarah: (21:11)

Throw some of them under the bus. They're probably listening. Just kidding, we only have 10 listeners, we're fine.


Lisa: (21:15)

But I think, again, going back to you have supervised yourself, several SLPAs, and then you also manage these teams of SLPs and SLPAs. There's gotta be some common mistakes that you see that could be avoided with why.


Amy Hill: (21:29)

most of them, yeah.


Sarah: (21:31)

How does it work so well for occupational therapists and physical therapists? There's gotta be some secrets here.


Amy Hill: (21:36)

Yeah. And I think the thing that I see in thinking about all the SLPAs, personally, that I've supervised, there are ones where I've thought, oh my gosh, is this year ever going to end? And then there have been others where I've been like, wow, I couldn't do this without this person. So I think we all have to think about our strengths at the time we're supervising because as SLPs, we also have many demands upon us. Not only from our professional life, our caseload, the district we're in, the clinic we're in, wherever we're working has its own set of things that's pulling from us. And then we also have our personal life that's pulling from us, regardless of-- you know, you try to keep the two apart. So I think those two things always impact mostly communication with the SLPA. So I think some people as an SLP, we talk fast, right? We walk fast. We're pretty--


Lisa: (22:30)

We think fast, we want things to just happen.


Amy Hill: (22:33)

I think we often overlook the simple of establishing a communication basis at the beginning of "we need to have a conversation every week, every other week" and set it up right at the beginning and go over the expectations, go over "here's the scope of work here's in this setting, in this relationship, these are the things you're going to be doing. These are the things you're not going to be doing. This is what I'm going to be doing. This is what you're going to be doing." And just going through the entire scope of work on paper, I feel like really helps the SLP and the SLPA cause it reminds you of the things they can't do by law. And it reminds you of their role and how you are the supervisor. That is your caseload. You're not turning it over to them. They're there to help you. And they're there to support you. And how do I take this individual's personality and their strengths and mesh them with my own? So I have some SLPAs who have been the most creative people in the entire world, but they were not good at organization or they were not good at X. So thinking about how do I take what's your strength, bring it into this relationship? And how do I use my strengths to then help you grow? And that training piece that you mentioned is the biggest one, because I think again, SLPs we're so used to everything that we're always being pulled to do. And we're always the "yes people" who do too much and overextend ourselves and we don't think about how do I step back and make sure they know what it is that I'm expecting them to do? And how do I make sure that they can always feel comfortable coming to me even if I forgot to do something and I need to be the one that's big enough to say, you know what? I didn't communicate well with you and how can we go back and fix this? Because it's never personal. It's kind of like when you have an advocate involved with the kid on your caseload, it's not about me, but all the team gets all in an uproar about it.


Sarah: (24:39)

Feelings are involved.


Amy Hill: (24:41)

People start to get hurt when--


Sarah: (24:42)

you get real subjective


Amy Hill: (24:43)

when it has nothing to do with any individual person, it's about a parent trying to do the best thing for their child. And this is the same thing. It shouldn't be personal. And that's what I try to tell my students is you need to go into these relationships and you need to come to where they are at and meet them. And you need to be a little personable with them and share. And granted, you're not going to tell your supervisor your entire personal life, but you have to have some give and take of establishing a relationship with that person. And that's where I sometimes see the failures in an SLP that doesn't want to have any personal conversation with you. I just want to keep this business. But at the end of the day, I need to know what do you like to do on the weekend? Because then we can have a conversation.


Sarah: (25:31)

You've gotta have rapport. We wouldn't ever start with a student and not build rapport first. And I was also gonna say the whole time you were describing that, I kept thinking I am so loving and tolerant of my students. The things that I am willing to do and show and share and train and teach. But a grown ass woman adult? My expectations are off the charts. And I think we're all really guilty of assuming knowledge. I think we all assume that those people are competent and should know these things, which I didn't know shit when I was in SLPA. It's actually embarrassing, but I'm a very good actress and faked it very well. But you know what I mean? Like, I didn't know anything. So you think I would really know what that SLPA does and doesn't know and be willing and supportive, but I think--


Lisa: (26:11)

but the part of it is it's not-- it's the communication upfront. So set the expectations, not just for the roles and responsibility, but I think moving forward, your expectations for communication. How often are we going to meet? Obviously we can meet in between then if needed. But then also even thinking about the personality differences in communication styles, maybe I don't want you to call me. I just want you to send me a text if you're gonna be five minutes late. Like those sorts of things are things that if you don't work that out in the beginning, then what happens is you work it out as it pops up and then you get people that get really pissed because they just assume well, you should've known you were supposed to do this and the other person's not even in that frame of mind. So that can cause tension, the relationship can start to break down and you know, the communication is key at the beginning, and then throughout.


Sarah: (26:59)

those expectations have got to be spelled out. We can't assume somebody knows how it is that you like to do things. Especially SLPAs who've been around for a while and have worked with different personality types because we are similar in a lot of ways, but then a lot of us do do things very differently. And so those SLPAs that have to work with more than one SLP. I mean, God bless them because I think it would be really, really tricky because everybody does things just a little bit different. I always wonder too-- I think that I was really probably lovely to work with. I think I'm a lot of fun. I don't think any of my SLPs would have been like, she's an asshole. I don't know, maybe they would have. But I'm sure there are-- SLPs are real type A and a little territorial. So don't you think, I mean, do you have those issues where you've got SLPAs calling you and telling you that the SLP is real difficult?


Lisa: (27:45)

Or vice versa? The SLP that says I can't work with this person but doesn't recognize that it's probably them.


Amy Hill: (27:50)

Yes. I've seen both. Because some SLPs are like, oh, they're doing this, they're doing that. And when you have a simple conversation and say, well, have you talked with them about that? Many of them are like well, no, they should know that. The same as an SLPA, a lot of times they're intimidated to bring something up that maybe they aren't comfortable asking about because they see us in there as a professional. And that's where I think going back to the OT field and the PT field, and even thinking about doctors and everyone has some kind of an assistant that helps them right? But in our field, we all take everything so personally, whereas the other fields, I feel like always look at it from a professional aspect. We're in a professional relationship, you are my assistant.


Lisa: (28:38)

It's what's best for kids.


Amy Hill: (28:40)

Right, and we're both doing what's best, so come to me. And I feel like because they have a different thought in mind at the beginning, it's a more professional health care mindset. Not school touchy feely, I don't want to hurt somebody's feelings.


Sarah: (28:56)

Isn't it fascinating? For people who are professionals in communication, we're terrible communicators sometimes. And in this situation, it's very interesting. I don't know what it is about that but Lisa and I had the privilege of going to an SLPA class at ASU, a group of SLPAs, it was one of the classes they were taking. And one of them was telling an experience they had had with a really difficult SLP and how she won't listen and she--what was she saying? Do you remember? It was very territorial-sounding to me.


Lisa: (29:25)

She took it very personally and I think so that it's not just that the SLPs can take things personally. She took it super personally, everybody that was listening to her story could hear that. And they were actually giving her feedback, the students were.


Sarah: (29:36)

But it was funny cause she goes, "yeah, I think what I'm going to do next time is I'm going to tell her." And the minute she did it, I literally was like "um, I'm going to go with you don't ever tell your SLP anything."' 'Cause we just-- we don't do well with that. So it does, you've got to have good communication.


Lisa: (29:54)

And talk too, don't tell anybody anything. You're talking about expectations from both sides. And so the SLPA should be prepared as well. And maybe this is something that you have to guide them into feeling comfortable sharing, but you need to know what their strengths and weaknesses are. You need to know what they need more support in. Even basic things, like I had one SLPA that I was working with that-- I had ED classrooms on my campus and there was a kid that had a meltdown and I was working on my computer. And then all of a sudden it's like you tune in and I was like, oh crap, she's escalating this. And so I helped her deescalate it, the kid left and she had been an SLPA for 15 years in the district. And so I said, have you ever worked with kids with ED before? And she goes, no. And I was like, oh my gosh, that should have been something we talked about at the very beginning. I assumed because she had so many years of experience this was an area that she had experience in.


Sarah: (30:51)

And she never said "I didn't." She never said "I'm not comfortable doing that, I've never done it."


Lisa: (30:55)

Or maybe you don't even understand what you don't know. So that should be something as SLP's-- I should have already said this is what my caseload consists of. Have you worked with students like this before? Tell me what you're comfortable with. Let's set some goals of how you can grow your knowledge beyond just working with students and learning that way. But it's one of those simple things where I'm like, somebody could have gotten hurt that day, and thankfully that didn't happen. But it was just something a simple question-- and I had assumed that she had worked with kids with emotional disabilities before and she hadn't.


Amy Hill: (31:30)

Well, the other thing in our field that when you think about it, no one taught us in grad school, hey, you're going to have to supervise somebody one day and this is what you need to know. But in some of the other allied health fields, they do that. And that's where, in some of my discussions with some of the graduate programs, that's definitely an area that they're trying to improve on because at the end of the day, everybody graduating now will supervise somebody at some point and they will probably supervise interns, SLP CFs, and SLPA's.


Sarah: (32:01)

which I have done all three by this point. And there's all three very different experiences.


Amy Hill: (32:07)

But some people think, oh, it's all the same, but it's not. They're all three very different experiences. And I think as a profession, we haven't done a good job of creating continuing education for our supervisors or our supervisees, like an SLPA, as in how do you advocate for help if you need it with your SLP? Especially if you have 15 years of experience. And think about it, every one of us as SLPs, every time we come into something and it's like, ooh, I've been doing this for 20 years. Who am I going to ask this question? Because we should know it all right? And we have trouble with this. So how can we not expect our SLPA to be in that same frame of mind when they're like, I don't know how to do this. How do I ask somebody?


Sarah: (32:54)

I couldn't treat an R very well, five years in and I think this SLPA who just finished her schooling a month ago is going to know how to do it? I mean, seriously.


Lisa: (33:03)

So we know communication is key. Are there any other tools or tips or things that you've seen over the years that you feel have fostered a good dynamic with SLP/SLPA teams?


Amy Hill: (33:16)

Definitely when it comes to paperwork-- 'cause I think the other big challenge is because as a supervisor, you might not always be on your campus, but you should always know what's happening on that campus with that SLPA. So I think sometimes the paperwork is a challenge and where are their notes? Where are their lessons? Where all these things housed? Is somebody doing it in a book that's on their table? Are they using Google docs? So definitely what I've-- over the last few years, there are two things that, I mean, as any supervisor supervisee; my cotas that I work with, the PTAs we use and the SLPAs, we all use Google docs where we can all have access to seeing their notes in real time. Same thing with their schedules, with all of their progress, updating of their daily notes, their summaries. Everything that we do, we try to do in that type of a framework so that the supervisor and the supervisee can always see it. Same thing with logging supervision, which is another thing that a lot of people don't think about is I should be logging all these things and all these interactions, but how do you do it efficiently?


Lisa: (34:28)

Well, in Arizona, it's under the responsibility of the SLP license to log that and maintain it for two years after supervision has ended.


Sarah: (34:37)

what if you ask your SLPA to do it for you?


Lisa: (34:39)

if it's a task that they do--


Sarah: (34:43)

'cause I did and she was great at it.


Lisa: (34:45)

But technically, I mean, when I was done supervising we would just sign off on it and then upload it into a Google folder and I would maintain it that way. So I don't think-- they can help collect the data. It's not that. Even for other things they're collecting data for you to review.


Amy Hill: (35:02)

Right. And then the other thing is, I mean, you guys already know this, but SLP Toolkit, is definitely--


Lisa: (35:09)

I've heard of that, I've heard of that.


Amy Hill: (35:11)

I've been using it for two years with every one of my teams and none of them would ever go without it now because they can see everything that they need to by just logging in. So as a supervisor, they can log in, they can see the notes, they can see the sessions, they can see the progress monitoring updates. They can put in summaries in the notes. So they try to use that for every possible piece, because then they're only looking in one system instead of I need to look in IEP pro and see what their goal is. Oh no, I can see it in here. Oh, I need to now look in Synergy to figure out did they log all of the notes they were supposed to log-- or not Synergy, I meant Desktop or Go Solutions. So when you think about all of the systems that we have to use, using SLP toolkit and having everything in there then makes it easier for us to just copy out of that system, into the others.


Lisa: (36:04)

Even for SLPs not working with SLPAs, that was kind of what we were thinking is wanting it to be in one collective space. Instead of it being all-- we still have to put it in other places. But going back to what SLPs can and can't do, if how do your SLPAs use SLP toolkit then?


Amy Hill: (36:22)

So they keep all of their notes for every session and the amount of minutes they've provided, the treatment notes. They do a group note saying if they did a certain activity and there were three kids in there, they talk about what they did in that group note without student-specific specific names. And then they chart on the student's specific goals in there. They also use some of the progress monitoring tools. We use that before we do a quarterly progress report. So they'll go in and do--


Sarah: (36:49)

they collect the data?


Amy Hill: (36:50)

They collect the data,


Sarah: (36:52)

They just don't interpret it, they can collect it.


Amy Hill: (36:54)

Correct. And same with the present level assessments, they're collecting the data. They're not interpreting any of it. It is a yes or a no. Did they do it? Did they not? Make a note. And then as an SLP--


Sarah: (37:04)

and they are allowed to do that.


Amy Hill: (37:04)

We're going in and then interpreting that.


Sarah: (37:08)

I think people think oh it's an assessment, they can't do it. But they can. It's not a standardized evaluation and they're not interpreting it.


Lisa: (37:14)

The only part that could be considered interpretive is the language sample. Those kind of open ended--


Amy Hill: (37:21)

And those we skip. So my personal-- the ones that we do, our teams, they do all of the present level assessment except the language sample and the narrative. So those first couple--


Sarah: (37:31)

Do they record it for you?


Amy Hill: (37:33)

Yes. So then they record a sample, drop it into again, Google drive, and then we can always go listen to it. And even when they do something with an articulation kid, so if they do the present level for articulation, we have them record it and put in a sample and then we go listen and do the actual recording. But they're using the list that's there.


Sarah: (37:54)

If they're uploading all those files to Google drive, by the way, they can attach them with that paperclip in any of the student's data. I know I always forget to tell people that. You could actually put the language sample in there, but yes, yes. Oh my gosh I'm so glad because it is, it's one of those things where I think one of the trickiest things is if the SLPA is seeing that student a lot more than you are, and then you're the one who has to go in and write an IEP for that kid and pick new goals you have to-- like before you would just have to trust that they took decent enough data, or that they have the skill set to be able to give you that information. But the present level assessments, if they collect that data for you, you're going to have a pretty good understanding where that kid's at. That's awesome. Happy to hear that.


Amy Hill: (38:36)

And we've also been doing a lot of training with goals because as a state goals are always the thing being audited, especially in our schools. And being found out of compliance because people are putting too many things in goals and they're not doing a baseline that matches the goal. And that's where I think, again, in having it in Toolkit, you can put that in there, then you can put the baseline and then they can see, okay, here was the baseline. And as an SLP, I can be looking in that without having to go back and look at four quarters of notes. Everything is right here on one screen. And then if I'm like, I'd like you to do this progress monitoring assessment and gather this piece, then I can go add that in real quickly and then shoot them a message. And then they'll email me back when they have it done. So I think it gives a good overall picture of everything you're doing as an SLPA for me as a supervisor to see in one place.


Sarah: (39:32)

That's awesome. We did not pay her to say that. We didn't ask her to say it, that just came from her. That's so cool. We love to hear stuff like that.


Amy Hill: (39:40)

It is. And all of my SLPA's, they all say the same thing. Because once you do it-- and the one thing that we're looking at for next year is we're trying to get everybody to use it exactly the same way, because you can do kind of your own take on what you put where. But having that we have multiple people that have been supervisors, we're now taking their input to say, okay, what is the best way? And the most efficient way to see this data when you're looking at it from a supervisor? And we're planning on having all of our SLPAs doing training and having them do it exactly the same. So that then I, as the manager, can go in at any time and make sure, okay, yes, they're doing it. And then the SLP supervisor can see it. And then it has that consistency of we're all transparent. We all see if a supervisor switches because we all know things happen. People have babies in our field. Lots of 'em.


Lisa: (40:35)

Damn women.


Amy Hill: (40:35)

So when they go on leave and someone else comes in, they can easily come in and see, okay, it's all the same thing. Yes, different kids, but the format's the same, the way we're using it is the same.


Sarah: (40:47)

Oh my gosh, so much better. So much better for the SLPA's.


Amy Hill: (40:51)

That is my goal is to keep-- and that's kind of the refinement that we learned through this year being the second year that we used it in (unintelligible)


Lisa: (40:58)

Then you can write recommendations for us, that we'll just share with everyone.


Sarah: (41:01)

That's great. That would be lovely actually.


Amy Hill: (41:02)

How do we use it consistently between each one?


Sarah: (41:05)

Because I do, I think, oh, that's gotta be so hard. I remember the SLPA I had worked with I think, two or three other SLPs? And all of us required different things in our notes. We had different data forms, we had different organization systems for how to store things. And I thought, oh gosh, how could you ever keep this all straight? Oh, I like that. I like the uniform of that. And that's one thing, I do think that's the district's job or in your case, the company's job, who's providing the SLPAs out to districts to provide continuing education and support. I mean, we really need to be doing a better job of that and then even--


Lisa: (41:43)

Because we want this to be successful, this is a win win for everyone.


Sarah: (41:46)

I think it's a win win too. I fully support this. That'd be my confession is I am in. I want this to be successful for everybody.


Lisa: (41:53)

Well, it's the same kind of grievances across the country when it comes to what our issues are at working as SLPs. And it's usually my caseload's too high, I don't have enough support there's this, that, and the other. If we are able to get more support in our field that helps us, we have more people in the field, it helps the kids.


Sarah: (42:12)

All about the kids.


Lisa: (42:13)

it's for the children Sarah.


Sarah: (42:14)

It's all for the children. And you can't see, but usually when we say it's for the children, it's with a hand motion.


Lisa: (42:19)

it's like that emoji.


Sarah: (42:19)

like a sweeping hand. For the children. So I'm glad ASHA's going to get on board, hopefully. Hey, maybe we'll do a follow up after that all goes through and we can talk about what that starts to look like. Again, I think it's unfortunate that we're a little behind the times there.


Lisa: (42:34)

But you know, as long as we catch up eventually.


Sarah: (42:37)

Anything else, was there any other--?


Lisa: (42:39)

no, I think we covered kind of what we wanted to cover coming into this. And this is actually our last podcast of the season. Isn't it? We ended with a bang.


Sarah: (42:49)

Yeah. So we're going to do season two, obviously 'cause we're not going to disappear, but it'll be a while before you hear this lovely voice again.


Lisa: (42:56)

Which one?


Sarah: (42:57)



Lisa: (42:57)

Oh, okay. But we have loved having you in here. I think this is super helpful and we also--


Sarah: (43:06)

I think it's a great conversation that needs to be had and because it is so new and so--


Lisa: (43:10)

just unstructured right now, we'll get there though.


Sarah: (43:13)

Unfamiliar and yeah.


Lisa: (43:15)

But the biggest thing is don't be afraid. It can be a really awesome experience. I can honestly say I've not worked with any SLPAs personally that it was just a complete disaster. It was more about, there might be breakdowns in communication, and maybe some training that needed to happen, but you put that investment in and you get just like a hundred fold back. And think about how many people too-- I used to love having somebody that was in my field working with me because I felt so isolated most of the time being the only SLP on a campus. So it was like a little speech team.


Sarah: (43:49)

I do think I always got real lucky though, because there is personality conflicts. There's not like-- even amongst SLPs, right. We're all kind of different. And we always say there's like two camps of us.


Lisa: (44:00)

But the SLPAs tend to be more flexible. Yeah, I do think so. I think it's the SLPs tend to be more rigid in certain ways, but it goes back into-- I think even what we were saying before, everything's done fast, including assessment of students, working with students, what we want to have done. We're always like 14 steps ahead. So we just need to pause, slow down for just a minute and make sure that this person is feeling like they can keep up pace with you. And it really does. It becomes such a rhythm working with somebody else. And they're wanting to do a good job for you and wanting to do a good job with these students.


Sarah: (44:33)

Amy, did you ever have any that are like oil and water cannot work together?


Amy Hill: (44:36)



Sarah: (44:38)

Why do I feel like you're just like a referee a lot? Are you? Is that your second job title? third job title?


Lisa: (44:45)

Do you drink a lot of wine?


Amy Hill: (44:45)

some days. Some days. Yeah.


Sarah: (44:47)

And is it just cause we're all women?


Amy Hill: (44:49)

I think that's a lot of it. But there are some men and I mean, they-- I haven't had as many things happen with the men that have supervisory supervisee relationships. So I think a lot of it is it's just that female "I'm a strong personality" and I really think it's we walk too fast, we talk too fast and we forget that we're 50 steps ahead of where they're at. And we have to just take a moment and go back and help them.


Lisa: (45:20)

And it goes back to what you said of, I think we have infinite tolerance for kids or whoever it is that we're working with, but not the adults always.


Sarah: (45:27)

Right. Yep. Fantastic. Couldn't leave on a better note.


Lisa: (45:31)

We have loved having you in here. Thank you so much. And for all of you listening, if you can take a minute to rate and review us, only if you like what you hear, just kidding.


Sarah: (45:40)

Only if you have something nice to say.


Lisa: (45:42)

But that really helps I think anybody that's looking for SLP podcasts out there, they can look at the reviews and it's very helpful.


Sarah: (45:49)

Yes. And then we'll see you for season two. I don't know when, someday. Alright, bye guys.


Lisa: (45:53)