SLP Toolkit Podcast, Episode 36, Transcript

Click here to download the PDF version of the transcript

Well hey Lisa.

What's up, Sarah?

You know, nothing just hanging out. This is a little different because we actually have video. So we're going to be able to see and speak with the person in the confessional.

Lisa (00:00:49):

Nobody knows that we have a visitor in the confessional yet it could have just been you and me.

Sarah (00:00:53):

Well I just wanted to let everyone know that I don't just have to look at your face for this one.

Lisa (00:00:57):

Wow. Ouch. That hurts a little bit.

Sarah (00:01:00):

No it didn't.

Lisa (00:01:00):

I mean, it didn't.

Sarah (00:01:00):

No. Introduce who's in the confession.

Lisa (00:01:04):

This is somebody we've wanted to get in the confessional forever. And we've met a few times IRL, which has been awesome. And can't wait until the next time. But one of our favorite presenters that we've ever had as part of SLP summit, this individual has the most contagious ray of sunshine kind of energy that you just want to be a part of. So we are very, very excited to have Dr. Eric Raj in our confessional.

Sarah (00:01:33):

Woo welcome!

Lisa (00:01:33):

If you are not super familiar with him. He is, I don't know how you can't be,

Sarah (00:01:40):

I was just going to say who doesn't know who he is?

Lisa (00:01:40):

but I'm just going to say Um, just a little bit about him. He is an assistant professor at Monmouth University, but also facilitates this really cool summer camp called Camp Shout Out in Michigan and that's for young people who stutter. So not only, you know, like you can imagine you have so much free time then to then also develop all of these cool apps that are all about getting kids engaged in their therapy. And, you know, as if you're not engaging enough, I mean, again, it's it, you've got all of these cool mobile apps and then also created that SLPvideogames.com. So very excited to have you here and to learn more about all of this.

Sarah (00:02:17):

Yes. Welcome.

Erik (00:02:19):

So great to be here. And let me tell you, I knew that this was going to be a video experience. So I brushed my teeth.

Lisa (00:02:26):

Wow I'm glad you did.

Erik (00:02:26):

I got, I got no chunks of bagels or chocolate chip cookies.

Sarah (00:02:32):

Nope nope.

Erik (00:02:32):

It's all good.

Lisa (00:02:32):

I can't promise the same.

Sarah (00:02:34):

Did you get a haircut since Summit?

Erik (00:02:37):

I sure did. Do you like it?

Sarah (00:02:39):

I do. I like it a lot. Can I tell you, I noticed a lot of comments in the chat and even in the Q and A, about your hair.

Lisa (00:02:45):

They liked the long hair though.

Sarah (00:02:47):

They did like the long hair.

Lisa (00:02:49):

It's so funny that people were literally even in the Q and A, I think it's funny when people put comments like that in a Q and A section, but it was like, Hey Eric, I liked the long hair. I think they just really wanted you to see it and not have it buried and all that feedback.

Erik (00:03:03):

And I think that's just such a great reminder of COVID, you know, when we weren't able to get the haircuts, you know, I went months without it. So when I look back at some of those video clips, I'm just remembering some of those times and hey, I might grow the hair back. You never know, you know,

Lisa (00:03:19):

At least now, you know, you've got options and that it has been well-received.

Sarah (00:03:23):

True.

Erik (00:03:23):

Exactly. Exactly.

Sarah (00:03:25):

Oh my God. It's so good to see and speak with you. Like Lisa said, you know, we've met a few times we've heard you speak in different locations, but had you as, have you presented for Summit twice or three times.

Erik (00:03:37):

This would have been my second time.

Sarah (00:03:40):

Second time. Yes. And so anyway, you are just an absolute pleasure and such a gift to not only humanity, but this field. And so anyway, it's going to be so fun to have this conversation with you.

Lisa (00:03:53):

Well, even, I mean, looking at some of the feedback, I know when you were even presenting live, Sarah and I were just like, it's just like, it's so like your energy is for people to be able to translate that over video is amazing. And it's so it's so apparent how much you love, what you do, that the students that you have, this genuine connection with any of your clients that you're working with. And so that's not like something you can't fake that like, so that's what I think is so contagious about it too. So even some of the feedback was just all about like, you know, using words like amazing and refreshing, and, you know, the idea of using some of these things that people think, Oh, a video game. I was thinking that would be something that we want to kind of get kids as attention off of, but you were showing how, no, this is something that we connect into their interests and it's everywhere. Kids are using video and video games everywhere.

Erik (00:04:48):

Absolutely. And I'm a big fan of recognizing the power of analogies. I think as human beings, we all kind of live in analogies. We see different things and we try to connect those things to other instances that can help us to better understand whatever the main thing is. Right? So for me with video games and a lot of this comes from past research that I've been kind of consuming outside of my world of speech language pathology. I've started to notice that with video games, there are so many beautiful parallels to the work that we do. And some of the big parallels that I'm seeing is the fact that most video games, not all video games, but most of them seem to have these three core components to them, right? And the core components are this. You have a character and that character is usually within some sort of environments . And that character is usually in the environment trying to do some sort of objective, right? So when we think about those three words, character, environments, and objective, it brings me right to the great work we do as clinicians, right? So we have a client, not a character, right? And we have an environment. The client is a part of whether it's the school setting, whether it's the home setting. And then instead of objective, in a broad sense, we have a client who's in an environment who's attempting to have some sort of communication goal in play. They're trying to meet, reach and surpass a goal so that they can grow as communicators. Right? So when we think about video games, I often talk to my students and I'm like, you know, you are a character in your own video game that is life. And you know, what is your environment right now that you're in? And what is that goal or that objective that you're trying to come at and grow past. So there's just so much beautiful parallel and getting the children started to think in that mindset, in my experience has been very eye-opening and it's helped them to really see new ways of attempting to grow as communicators.

Lisa (00:06:51):

I love that because it, I, I'm hearing also story grammar in that too. So you're just saying that basically you are the lead character in your own story and how is this going to turn out? So it's so cool.

Sarah (00:07:04):

It's so freaking cool. And like Lisa had said too is, and I I've seen this throughout the chat in the comments and in different presentations with you too, is you in, and of your, you know, your energy alone, but also just your passion and your knowledge and, and everything that you bring to the table. I think we are all so envious of the students that get to work with you, because again, like even understanding that simple concept of this is their reality. You know, a lot of them, this is something they know really, really well. So how can I use that and make this connections? And, and I loved throughout your presentation clearly, you know, the video game world too, you know, you know, these games, so you're able to make connections and get them to kind of scaffold their thinking because, you know, you're, you're aware of the games and what they're watching on YouTube. And, and I think that's the key that a lot of people, unfortunately, miss is you've got to have that rapport and that background knowledge and all of that to really make connections with students. The rest of everything else we do is just like icing, you know, but that's the part that matters the most. And that is where you just like, just shine. It's just, it's fun. I love to watch you and your experiences with students.

Erik (00:08:11):

And I love to be curious. I think all of us as clinicians, we have this very real curiosity bone somewhere in our bodies, right? So with all of my clients that I'm just so blessed to be able to rock and roll with, I come at them in a very curious way. You know, they'll tell me about some obscure video game. And instead of me saying, well, I don't know that. So let me try to pivot to something. I do know I come at them and I'm like, hey, I don't know about that, but I want to know about that. And I think that's a great direction that all of us should consider going in whenever appropriate, because it puts children and clients in a position where they can teach us. Very often, there seems to be this power dynamic where I'm up here, like the almighty person as my CCC SLP, and that person's down here. Cause they don't have this thing called CCC SLP. But like, that's not how I jive in the world of therapy. I come at all of my clients eye to eye and I say, guess what? I got some cool stuff to put on the table and you too got some cool stuff to put on the table, so let's get it all on the table and let's get our fingers in the paint and let's finger paint, something really cool that we did collaboratively. So I tell them to give me the knowledge and I'm going to take that knowledge of this obscure video game and I'm going to figure it out and I'm going to interweave it into the work that we're going to do together.

Sarah (00:09:30):

It's so freaking cool.

Lisa (00:09:31):

It is. And it's interesting because even I did see it going back to your point of that. We have to pivot and understand what are their interests and preferences and build upon that. I did see one of the comments was like, Oh, you know, this has been a great presentation, but I just don't know how I feel about video games. And I just, I kind of chuckled when I read that because I'm like, this is what we do though. Like you have to think about, is it about you or is it about this student? And then how can you sort of change your thinking to look at this as a positive and not just, you know, this isn't about video games, it's about that student, their skills, their growth. And then you're just weaving it in to this idea of video games.

Erik (00:10:13):

Absolutely. Yeah. And I'm very aware of the most recent data that is coming out in 2020. And even now in 2021, I know we're just a couple of months into it, but there's published research out there that is pointing to a lot of children today are spending a lot of time in these digital environments because of lockdown initiatives, obviously all in the help of everyone to stay safe. So recognizing the environments that our children are in today, actively communicating verbally is so important for us to be aware of. And when we can, like you said, recognize that and then weave it into the work that makes sense as it relates to their IEP, that we are really being relevant clinicians who are recognizing where the children are at this particular point in their journey, in this thing called life.

Lisa (00:11:01):

Well, it's not just children. I mean, if we think of ourselves, if you connect something into me for something that makes sense within my life, then I'm going to be much more engaged in, in receiving whatever that information is. Then think of some of these staff meetings, sometimes that you sit in like at a school where I'm like that has zero to do with me and I'm going to tune out. And so I feel like if we just kind of shift that same kind of perspective on our students, that if it's out always things that they see zero connection to their interests or personal life, why are they going to enjoy, where where's that rapport building going to come?

Sarah (00:11:33):

Engagement.

Lisa (00:11:33):

How are they going to become engaged in what you're doing? It's just, and that makes so much sense when you like say it out loud, but it's something that I do see it can get overlooked sometimes.

Sarah (00:11:42):

Well I do think the video game thing, I'm glad you brought that up about the research too, is one video games do are kind of loaded, you know, for some people, because we, all we talk about right now, screen time, even pre COVID, that the amount of screen time that our youth, you know, I'm the first to admit my kids have grown up watching lots of screen time and having access to iPads and they had phones at the age of 12. And so that's a very different life than how I grew up as a child and so I know there's some controversy around the amount of screen time. And so I think that's maybe where that lady's hang up was. So how do you get people to kind of pivot around that idea of, yeah yeah, there are problems maybe with screen time, but we need to look at the benefits of video games in a different way.

Erik (00:12:28):

I think the first thing we can do is try to understand the differences in screen time. So this is very broadly stated, but I think it's safe to say from a research point of view, that there are arguably two types of screen time there's active screen time, and then there's passive screen time. So all of us here we're well aware of passive screen time. I don't know about you, but I'm a big Netflix fan. You know? So sometimes I like to just relax and passively, sit back and take in the information that Netflix is throwing to me, right. And there's a time and a place for that. Right? So the other side of that coin perhaps could be considered active screen time in that we, as humans are interacting in a very intentional way with digital content in front of us, we're making a character move throughout his or her environment. And we're making that character make some choices so that they are able to go from level one to level two. There's real thinking processes that are happening. And in the world of video games, there's very often a verbal aspect because you're usually speaking this out to maybe another partner that's a part of the video game experience. Or sometimes we're just saying these things out loud, because it just feels right in this very active role that we're taking in controlling our particular character. So it's recognizing that there's a difference between just sitting back and letting this stuff happen versus taking it very intentional seat and making this stuff happen. And I think that's what really video games helps us to do. We make things happen.

Sarah (00:13:57):

Yes. And the talking about it, I loved the examples you showed throughout Summit of the students talking about video games, because it reminded me of, I used to like be so confused by how much time my son could watch YouTube, where somebody was talking about the game they were playing. I'm like, so you're watching somebody play a game and talk about it.

Lisa (00:14:16):

Or the box opening ones. Or any of that.

Sarah (00:14:18):

They love that.

Lisa (00:14:18):

That's interesting.

Sarah (00:14:20):

Yeah.

Erik (00:14:21):

Us as human beings, we love to talk things out. I think yes, we live in our own heads because we have self speak all the time, but it's just this natural thing in our DNA to kind of want to verbalize and put it out there. And I think what we're starting to see is a real understanding that that's okay. And YouTube culture has opened up the doors for us to want to speak about things in an outside of our heads type of way. And that's beautiful for our students because think about it, some of the wonderful on our caseload, they might not necessarily want to use their voice too much for whatever reasons, whatever thoughts or feelings or past experiences that they've had. They might be a little bit reserved. So this can be used in an intentional way where maybe they can build their overall, want to communicate, build their overall confidence as communicators, where they can talk about some of these things. So at first, maybe they're just talking about it when no one is in the room as they're playing the video game. And then maybe you as a clinician, you can be invited in, in a therapeutic manner where they can be playing the game and they can be talking it out. So there's one more audience member. So we are building the overall trickiness, you know, with each new audience member adds a sense of anxiety, but it's carefully plantings anxiety that is absolutely relevant and needed to help them to go up the stairs towards their goals and objectives.

Sarah (00:15:50):

So for those who did not watch Summit, you did give just an example just then, but tell me kind of, how do you use the video game to meet the student's objectives?

Erik (00:16:00):

Sure. So firstly, I'd love to look at video games or from a visual perspective, and I will often pause a video game and I'd say, you know what, tell me about what you see. Let's pretend actually that I can't see the screen. And I just want you to just describe it to me. So from a speech language pathology perspective, wow. That hits so many different aspects, right? So then we can niche down from there depending on what the goals and objectives are. Right? So the child is speaking about the environment and then I might try to have some analogies in play. So in a lot of video games, there often is a thing that is blocking a character from kind of moving forward, right in the work that I do, working with children and young people who stutter, that's often a very common theme. The fact that for some reason, something is blocking them from moving forward with their words. So we try to find these video game aspects, and then we try to bring it into their own personal experiences. So if there's this moving object and the character keeps hitting that moving object, they need to take a step back and they need to kind of understand the environments and they need to plan, and then they need to try it again. And then we can turn that beautifully into the world of stuttering, where they can think about their own environment. They could think about their own ways in which they, at times might self modify how they're communicating to see if that's helping them to move forward as verbal communicators in that particular point in time. So I'd love to really take it in an open-ended way at first, but then we get to a very specific way with just exploring video games like that.

Sarah (00:17:47):

Well, and I think that came up a couple times in questions too, is the examples that you shared the kids know that the kind of terminology they, they clearly have been taught some of the strategies and things. And so are, were you teaching those strategies to like the examples that the one little guy that was on there, did, did you do that through video game or did you teach strategies in a different kind of context first and you're working on those things and then you're applying it to video games?

Erik (00:18:15):

That's a wonderful question. I think it's a little bit of both. So certainly my students need a bit of foundational information for them to kind of calibrate with me. Right. But it's not to say that, okay, we're going to spend five sessions straight where we're just going to be doing drill, drill, drill. What is the definition of a cancellation? What is the definition of an easy onset? And then the magical six session is like, hey, now we're going to have fun. I like to have it in a way,

Lisa (00:18:47):

That's like session two

Erik (00:18:49):

There's this beautiful back and forth where we are intentional with learning some foundational knowledge, but then we very easily transitioned that into the more interactive screen time that we were just speaking about. And then we take pauses, we take breaks and then maybe we'll go back to a little bit of making sure that we're all on the same page with our shared vocabulary. And then we unpause that world and then jump back into the video game world. So it's a beautiful back and forth that can exist.

Lisa (00:19:17):

Well again, and you already talked about how awesome it is to use analogy so that you're teaching these skills, but then also doing it in this way that relates to the video game. And then that is meaningful for them. So the learning process has got to be much more meaningful for them. You know, those terms are not just, like you said, definitions on a page. These are my reality as a character in my video game. And you know, I'm going to figure out in this fun environment, how to kind of like work through that. Yeah, there was, I mean, I saw in some of the questions too, that you do a lot of one-on-one work. How does this translate if you have a small group?

Erik (00:19:55):

Sure. I think it really works wonderfully in small group because what it allows us to do as clinicians is sometimes take the opportunity for us to be the fly on the wall and allow the group members to kind of converse with each other. So from a numbers perspective, it's easy for me to think in, in the world of twos. Okay. So let's say there's three people, total myself being the clinician and then two clients. So I could very easily set up the conversation where I would say, let's all look at this video game screen right here and client one I want you to tell client to what's actually on the screen and client two I want to see, can you understand everything that client is saying? From an organizational standpoint is the way that this client is it to you. Connecting with you because we talk a lot about organization and how we can be the most effective expressive communicators. So I, in that situation and more of the facilitator, so I'm kind of putting on the table and then I'm taking a seat back and I'm allowing them to kind of be a part of the therapy experience in a very peer to peer manner. And research shows that to be quite important when the time is right for those children and where they are in their journey. So I feel like the video game experience allows me to do that very often, so I can set the stage for the video game experience and then together they can be manipulating the screen and I'm just there as the overseer and I kind of swoop in when necessary. So I think it does make sense in the group setting as well.

Sarah (00:21:35):

And I love that you said that because that's the one thing I think I noticed in your examples that you shared also is that you're not leading, you're following their lead. And I think that's really hard for us sometimes. I remember getting in trouble in grad school, one of my supervisors. Yep. Said you talk too much you've got to stop talking and I said, but it makes me uncomfortable when there's these really long. And so I'm trying to help and she goes, what's not helping stop doing that. Like allow for pauses allow for, you know, follow their lead, you know, add to maybe something.

Lisa (00:22:07):

I got the same feedback. I think that's probably pretty like if you're an earlier clinician and even, I mean, it is still even hard now it's something I've got to consciously think about, but I think that's pretty universal as budding therapists.

Sarah (00:22:20):

And don't you think it's easier to do the teaching.

Lisa (00:22:22):

Oh yeah. But then what's interesting is that you even think about, so the school district that we worked in, the teachers were on this evaluation framework called the Danielson framework. And that was part of it is that it should be more of this facilitating role. Of course your planning and organizing, making sure that you have the behavior supports in and there is instruction going on, but it is more about letting the students take the lead and then you're there to provide those cues and supports and scaffolds and guide maybe, you know, some of it, but it's not just the, you know, you doing a dog and pony show because that's when everyone tunes out. I mean, whether it's a large group classroom or one-on-one.

Sarah (00:23:01):

Yeah.

Erik (00:23:01):

And you know what I've started to really understand over the last few months. And when I say last few months, really like being in that teletherapy world, I've started to understand the power of being quiet. That's hard for a lot of us because we sometimes feel the need to put in auditory noise when there is silence. But you know, when I've been starting to really explore video games with some of my students, I've started to recognize just how important it is to give them space in order for them to kind of understand where they're at from a communication standpoint, help them to understand their thoughts right now. And it gives them time to kind of calibrate so that they are able to communicate in a way that is comfortable for them. And in a way that is perhaps matching up with some of the things that we're working on. So I think that the digital experience of playing video games has allowed me to kind of take a step back and allow there to be some quiet time because quiet time is not wasted time, quiet time allows children to really get ready to do what it is that we want them to do

Lisa (00:24:14):

Well, even in our personal lives, quite time can be hard. If you think about like, if I'm cooking there's music on, in the background, or I have friends that have to go to sleep with the TV on and things. So it's, I don't think it's just about this therapy piece, but for the SLPs in particular, I think it is more about that. Like, well, crap, if I'm not saying anything, then nothing's going on. If anybody's watching me, they think I'm a crappy therapist. And I actually might think I'm a crappy therapist because I'm not fixing anything right now, but it is it's, there's so much more stuff that goes into that.

Erik (00:24:45):

How about this. This is something that I'm just thinking about right now, the power of hand gestures and this idea of, if I'm not.

Lisa (00:24:51):

As I'm talking like this

Erik (00:24:52):

This is beautiful. What, what we sometimes are trained to think is that if we're not saying something, then nothing's happening, but I'm helping some of my students in this digital world recognize the power of hand gestures. So if they do need some additional think time, I've helped some of my students recognize that, you know what, this actually is a great indicator that you're using think time. So just simply by going, this shows me that you need think time, and this is helping them to be more effective, expressive communicators, because they're expressing a very real intentional aspect.

Lisa (00:25:28):

Right now

Sarah (00:25:31):

I'm listening.

Erik (00:25:34):

Yeah.

Lisa (00:25:34):

I know and I'm nodding and we're like, yes, yes.

Erik (00:25:35):

So these are paraverbals that are absolutely helping students. So it's connecting beautifully with what we're talking about as colleagues and friends right now.

Sarah (00:25:43):

Yeah. It's so good. Can I ask real quick? This is like a, I saw this come up several times. The tech setup. I do think again, Lisa and I talk about this all the time too, is where we are in time. Just how much we've evolved since well, exactly a year ago, last March when everything kind of fell apart with technology, this idea that, you know, like we've been comfortable with zoom because we used it all the time for our platform for Summit, but you know, a lot of people weren't. And so they're evolving in this technology to the point where I think they're more comfortable, but I know there were a lot of questions about how does this look tech wise, like.

Lisa (00:26:17):

Well, zoom versus Google meet, if I'm on Chromebook versus on something else that there are different kinds of even share-ability things with those platforms that can trip things up.

Sarah (00:26:28):

Yes, I think so. Anything new and novel? I think panics people, like, I love this. I'm with you, Erik. I want to try these video games, but I'm not even sure what this looks like. So can you kind of walk us through, how do we do this?

Erik (00:26:39):

Totally. I think there's power in the screen. A lot of different platforms have a lot of different features, but one of the more universal features is the ability to screen share a browser. So with a lot of these video game initiatives that I'm exploring, it simply revolves around you sharing your screen so that the child is able to see a video game. And you as a clinician at times, could choose to play the video game and the child could be verbalizing different things that help you along as the controller of the video game. Or what you can do is you could send the child or children, the actual URL, they can pull it up on their end, and then they could share the screen with you. And then through prompts and cues some hand over hand, they're able to manipulate the video game while they're communicating with you or their peers. So it's at times, yeah, it can be a little bit tricky, but as clinicians who I think are able to evolve, because I think that's what COVID really showed us, that we are so adaptive as professionals we can get into the groove and have this be a piece of the puzzle that might work with some students will work for all. No, but is there anything that works for all students, but for the ones that it does work for? That's what I'm talking about.

Sarah (00:27:56):

Yes. Yes.

Lisa (00:27:57):

Mic drop.

Sarah (00:27:58):

Exactly.

Lisa (00:27:59):

So there was a question too, just that popped up as far as if you have students that don't have as high of language skills, are there adaptations or modifications.

Sarah (00:28:09):

more complex needs.

Lisa (00:28:10):

Right whether it be that they have an intellectual disability or maybe just a developmental delay in addition to having or being a stutter, how does that shift your use of video games or therapy techniques in that way?

Erik (00:28:26):

Totally. So I can say that I've supervised a wonderful student, a graduate student who was working together with the child that did have a one-to-one aid. And that was a great opportunity for us to allow that extra person to be a part of the therapy experience. Now, we recognize that with one-to-one aides, you know, they're there for certain instances that help the particular clients, but we don't want to necessarily be communicating to that one-to-one aid that much, because we want to make sure that the communication, you know, rays of sunshine are kind of coming from the clients to the clinician, so on and so forth. So I think that it's very possible for you to integrate different types of digital experiences when you're working together with a client, for example, that has a one-to-one aid because that one-to-one aid can very well help the child. If it's a gross motor aspect, then you know, that one-to-one aid in my experience has helped to manipulate the digital things on the screen or the digital character that's in the video game. So I think that we are by nature, very creative and again, bringing it back to adaptability. We can adapt our ideas to really help children across the spectrum in a way that is meaningful for that moment in time.

Lisa (00:29:42):

Well and I think too, speaking of even like having a one-on-one aid, often times what happens is that one-on-one aid out of a place of wanting to truly help does more than they probably should for that student. So it's a great way as a clinician, if you're in that environment to kind of help them learn how to support versus do for, and then I think too, if you're working in a classroom, there are probably a lot of skills you could hit using video games. So if you went in there and did some sort of group activity, and you're focusing part of it on maybe fluency stuff, or even, you know, hitting other language components and building vocabulary and sequence, I mean, there's so much you could work on within this framework. It's just kind of going back to what you said, adapting based on where that student is at their level and moving them forward.

Sarah (00:30:29):

Yeah.

Erik (00:30:29):

Totally.

Sarah (00:30:30):

Okay. Now of course we can not, not talk about data because it's our favorite thing in the world to talk about. And it did come up as a question, how are you taking data when you're doing

Lisa (00:30:39):

When you're so damn engaging.

Sarah (00:30:41):

Exactly. Like, I feel like you're doing like everything that's so happening in that moment is you don't want to like like take time away from a moment to take data. So there's a balance there. So, so how do you typically do it?

Erik (00:30:54):

One of the things I've really been trying hard to understand over the last two years is this idea. Can I teach my own clients to keep their own data while I'm keeping my own data? So something that I've used like in the prior work that I do is this idea of I say this phrase to my students is there, So these are like high school students. I work with, I say, is there a tweetable moment that you come across in the therapy that we're doing? And tweetable moment is just a general idea for like, is there like a catch phrase or something that sticks out to you in the moment when you're doing therapy? So when I work with these students, I'm really teaching them to take qualitative data. So there's quantitative, that's more numbers based and there's qualitative. That is based in the words, right? So just as an example in January, I was working with a student. This is a student who stutters and we were having a great conversation that revolved around this transition that he was going through. He was now going to start to be able to drive. And now he was talking about some of the things that he would do when he has his driver's license. So he was talking about how he felt uncomfortable going through the drive thru and using his voice to communicate to that computer screen. Right. So as we were talking about this, he came up with this really cool, what we call a tweetable moment, where he said something like the computer screen doesn't care, what you sound like, as long as you got the money, it was something loosely like that.

Lisa (00:32:24):

So amazing

Erik (00:32:26):

So that students like, that sounds like a tweetable moment. I'm like, it sure does. So he wrote that down himself, he's keeping data, then I'm keeping data. And the way that I do things is we have a shared Google doc up at all times. So he's typing in the same doc that I'm typing in. And after a session, I have a lot of great stuff. Some of it based in words, some of it based in numbers. And also he has some stuff that he added based on words and sometimes in numbers. And like, I feel like if we can kind of train some of our clients to do that, it really helps with the overall experience. And there's such ownership to that, right? When the child is able to see, huh, this is a highlighted moment. I'm putting this in our document. It's just like you go you're right. That sure was important. And I'm so happy you brought that to the table, man.

Lisa (00:33:13):

Well, and I think it's so cool too, that even what you highlighted in your presentation, too, that there is such a lack of kind of presentations that focus on adolescents. So somebody had noted that like, wow, thank you so much. Because even, I think in school, there were birth to three clients. Sometimes the occasional clients that came into the clinic, you might have a school internship. Usually it was younger kids or adults. And so there is such, you know, thinking of that engagement and connection into what your client looks like. An adolescent needs, different terminology and different buy-in. So that is super, super cool.

Erik (00:33:50):

I think this connects this idea of teaching our clients to click their own data. This absolutely can work with our younger friends too. So sometimes I'll use this term, like a that's a wow moment. You just gave me a real, wow moment. Can you write down what you just did? That was so wow. And the student will say, I took a chance and I did XYZ, and this is like a fifth grade or sixth grade student. Right. So there are so many ways that we can help our clients to do that regardless of age, but we need to adapt it in a vocabulary and in an overall form. That makes sense to them.

Sarah (00:34:22):

Yeah. And I love it to talk about the qualitative data. I, I think, I don't know if it was ingrained in our, in us that quantitative data is everything. So like all my data experiences, I remember through school and in those early years was I just needed a lot of pluses and minuses and some tallies. And that was my data. And if I didn't have that, I didn't take data. And so this idea of that qualitative piece and how much more meaningful it is really in the grand scheme of things. And so I love that you're, you're teaching them to do it, your, your doing that and having that guide therapy. And then there is the quantitative piece to measure the criterian and of whatever that goal is. But I mean, there's a balance there of how much quantitative data you need to take.

Lisa (00:35:03):

Well and that the qualitative is meaningful, that it's not like writing Chipper Chat is not qualitative data. It's gotta be data that, you know, if we take any data quantitative or qualitative, it has to be for purposes of driving treatment forward. And so writing chipper, chat is not gonna do that.

Erik (00:35:21):

Yeah. And when I think about numbers, one of the ways, so here's a little bit of information I could throw to your listeners, throw their ears right now you can consider doing number scales in a way that is very powerful. So for example, 1 to 10 how do think you did right there with whatever it was, right? And then you help the child to say, Oh, I think that was a five. And then you say, great. What would it look like if it was a six? So now you're having the child give you some qualitative data. So now they're thinking about quantitative numbers, but now they're adding some qualitative to the mix and then you do the thing again, and then you ask them to really rank, where do you think honestly, you were at, then they might say, you know what, not quite a six, I think I'm still at a five. So you're jumping back and forth from qualitative to quantitative qualitative, to quantitative. And in the world of research, we would call that mixed methods. Right. But helping students to recognize they can understand a 1 to 10 scale and how really anything we do in the great work we do as SLPs can be transitioned into a 1 to 10 scale and boom, that's some numbers for you that can give you percentages or really help your building principal to maybe recognize, Oh yes, there's numbers here. Because sometimes, you know, the overseers of the work that we do might not truly understand that powerful qualitative piece. And we can help them with different things like that.

Sarah (00:36:41):

Yeah.

Lisa (00:36:42):

And the meta component. I mean, let's talk about that, that they are so aware of their goals and their progress. I mean, that in itself is so powerful and something that, I mean, I think one of those dreaded things when you're working, especially in a school setting is like, if somebody asked a kid, what are you doing in speech therapy? And they're like, Oh, we play video games. Can you imagine how well-received that would be versus if they understand why they're playing video games and they have that wrap-up moment at the end to really reflect on, Oh, I'm practicing, you know, my strategies in the context of, you know, blah, blah, blah, blah, blah. It just is so much more meaningful if they know what they're working on. They've got to know, it's not like, again, going back to where this like wizard of Oz, where we are all knowing and all powerful, and the kid has no clue why they're even there. That's not going to get you very far.

Erik (00:37:31):

And one of the goals and objectives that I throw to all of my clients is something along the lines of the student will be able to successfully verbalize at least two goals that the student is working on, you know, after at least three sessions or something. So if we, as clinicians are intentional with helping them to really own their goals, then they're going to own those goals and recognize the rationale and the why behind every single thing that we do.

Sarah (00:37:58):

Yeah. I have the goal question came up and I, and I have to say, it's always interesting to me because I see this a lot with AAC. We'll get questions like this. Okay, cool. Yes. I want to use AC with my client, but how do I write a goal for that? Well, somebody even asked during your presentation. Okay, cool. I want to play video games with my clients, but how do I write goals for that? I think we forget that the difference between what the goal is, and then the means we're using to help the student achieve that goal. And so you're not writing goals that say things,

Lisa (00:38:29):

Video games

Sarah (00:38:29):

The student will be able to pass level seven.

Lisa (00:38:33):

I mean, I guess you could but that would weird.

Sarah (00:38:35):

Right?

Lisa (00:38:35):

You might get fired

Sarah (00:38:36):

Right.

Erik (00:38:37):

Exactly yeah. It's recognizing what belongs in your goals list and what belongs in your treatment plan. So certainly if I'm writing a treatment plan where I'm going to be talking about materials for a moment, yes. I can list the material, whether it's a video game or whether it's chipper chat so on and so forth. But yeah, when I'm talking about goals, these are broad goals that relate to communicating and your materials more than likely aren't going to find their ways into the goals.

Sarah (00:39:00):

Right? Yep. Yeah. I saw that come up and again, it was that moment where I I'm sure I've questioned things like that. And goal writing is so hard. I get it. And goal writing for stuttering is challenging. We we've had Nina reads present for us a couple of times, too and, and talking about goals and how we need to really be thinking differently about, because again, quantitatively, it's much easier to take a goal on something like the student will be fluent 98% of the time.

Lisa (00:39:27):

Right.

Sarah (00:39:28):

And clearly that's not a great goal for our students for lots of reasons. But you know, talking about some of the goals, can you, I mean, I always hate when we're doing this kind of like putting you on the spot, but what would some goals be for your students that you give them, you know, regularly when, when they're working on fluency?

Erik (00:39:47):

Yeah. Well right off the bat, I have to give big props to Nina Reeves because I've seen her speak on this topic many times before. So she is hands down the person that should be answering this question, but I'll give it a go too.

Sarah (00:40:01):

We have her coming on next month. I think.

Lisa (00:40:03):

Well it'll probably air next month, but yeah, within the next couple of months.

Sarah (00:40:07):

So we'll follow up with that too. But yes, I want to know your perspective on this.

Erik (00:40:10):

So how about this? It's all about the doing in the work that I do. So I want my students to be able to do whether the do is inserting themselves into a conversation or whether the do is using their words to state what their wants and needs are in that particular point in time. So from a goal perspective, let's say I'm working on a child who I really want him to be able to in the very beginnings, initiate the conversation in the zoom room. That means he's going to have to probably put his hand up to let it be known to the rest of the zoom classroom, that he has something to share. So that right there that's expressive communication. So maybe a goal like that might be something like the student will be able, the student will successfully raise their hand at least two times during a community, during a classroom experience so that they are able to insert themselves into a conversation. So that was really that wasn't worded to too nicely. But what I'm trying to get at is we can quantify the doing, he took a chance and this is quantifiable. I mean, did you do it? How many times did you do it? I, it once, well, how many times did we want you to do it during that particular set in time? Well, I want you to do it twice. Okay. So you're at 50% right now. So what do we need to do as a team to collaborate? To help you feel like you might be able to raise your hand two times next time, because you're showing us that, you know, the answer, but you're still hesitating. So that is something that you can absolutely do from a goals perspective.

Sarah (00:41:54):

Well, the fact that you even just get your first example of a goal was initiation. Again, I think so many of us who do not lack your expertise on this topic it is something I want to know more about, but it's just not, you know, it's an area that I've always kind of struggled with. And I think a lot of ways, but even that my typical goals are always going to be and maybe like they will be able to identify three strategies. They will be able to, it's all very fluency based, right? So the fact that your first example was that they will initiate, which tells me they've gotten some of those underlying things going on, that I'm not seeing above the surface confidence and the fear and all of those things that happen, why they're not initiating any of the strategies and any of that therapy you're doing for that student, you're going to see the progress because they start to initiate.

Lisa (00:42:44):

Well and I think what people forget too, is that goals are not, you know, even the IEP in general or treatment plan. It's not like this. I fill in these boxes and it's all disconnected. You're telling that kids present levels, their strengths, their needs, and you're outlining why these goals are important. The goals are kind of like the means to the end. So it's, it's not that the goal has to be so lengthy or wordy that it explains your rationale for everything that you're working on. It's just that these are the strengths. These are what we need to work on. And then that goal is how we're going to get there. And then how, what is it that I'm quantifiably looking for in my sessions in order to determine progress on that? And then we regroup and, you know, I always think too, like goals can change IEPs can change at the latest a year, but you know, if, if a kid met the goals or if you're like, huh, I probably should have worded that in a different way. You can, you just edit it, like it's, but we feel so locked in to getting it just so perfect. And if we look at it as that child's story and really being comprehensive and telling it, then it will, those goals will make sense because you will have given it context in another part of that treatment.

Erik (00:43:54):

And how about this as clinicians? I think it's appropriate for us to allow our children to come into their own narrative. So whenever possible, this is something that is beautiful, that I've seen time and time again, my fourth, my fifth, my sixth graders, I might say to them, hey, what do you think your goal should be? And sometimes that to the, to the listener that might not, they might think, Oh my gosh, how might a student be able to answer that question? Students can answer that question. Sometimes we have this assumption that, Oh, students don't know, but in my experience, I work with some really smart fourth, fifth graders. And sometimes when I, them that question very broad, what do you think your goals need to be? They start to give me something and little bits of that can actually beautifully solidified the goals that I eventually do come up with and I'll take a step back. I don't, I don't necessarily come up with my goals. We come up with my, with our goals. So it's a, it's a very collaborative process. And if we can keep that, where collaboration at the forefront of our mind during goal experiences, then cool things can come to the table.

Lisa (00:45:01):

Absolutely.

Sarah (00:45:03):

And again, something we talk about all the time with making sure that we're involving family and teacher input in that decision making, but as an elementary school speech therapist, I don't know if I really ever had conversations. I mean, about the goals.

Lisa (00:45:18):

Yeah. You're on the grind of meeting deadlines and, and, you know, just hammering out these treatment plans. And it doesn't mean that you're not doing great work with students or care about them. It's just, it becomes this like, you know.

Sarah (00:45:29):

Chore.

Lisa (00:45:30):

Yeah. Just like a paperwork.

Sarah (00:45:31):

And it shouldn't be, like you said that then what are the amazing experience to have the kids' input on that guide your thinking and then getting really meaningful goals.

Lisa (00:45:40):

We did have one question that I'm curious, your response on this one that about speaking of parents, what if a child's parents specifically request that you don't use the word stuttering? Do you have any suggestions for kind of overcoming that barrier?

Erik (00:45:55):

Sure. I often will speak to my parents in a manner that lets them recognize that stuttering is something that does need to be feared. It is a word that helps us to better describe these potential temporary disfluencies in their forward flow speech. And I think from the get-go, if we, as clinicians can paint the picture that this is a word that we use to describe, and there's nothing wrong with this word, I think that it might help a parent to perhaps start to reconsider some of their internal struggle with learning with perhaps not wanting to use that word. So to really answer your question, let's say I had a parent that said to me, you know, I don't want to use that word . I feel like we, as a family, we don't use that word and I kind of want to keep it that way as a caring clinician. It's my responsibility to first say to them, you know, thank you for sharing that because I'm happy they gave me that information. And then I need to ask the question, tell me more about that. Could you tell me more about that? Because if we can open up the dialogue to really understand, well, what are the lived experiences of that family unit that maybe caused them to adopt this idea of not wanting to use the word, then I can get a better idea as to how I can best guide them. And maybe through caring collaboration, they might come to a point where they do kind of say to themselves, Oh, you know what, the ways in which we were before, maybe they're not as clear as, as we want them to be. And, and that's what it's all about. We come work together as a team to get more clarity so that we could keep moving forward. And I think if we ask those questions, honestly, Oh I'm curious, you know, why do you choose to not use that word? It might help us to really help everyone grow in the process.

Lisa (00:47:52):

Well, think of the impact on the student too. Like if the parents are fearing that word stuttering, then that's going to have a ripple effect onto the, the child as well. So if we can help support that.

Sarah (00:48:03):

There has been a theme throughout this entire conversation.

Lisa (00:48:06):

We love Eric?

Sarah (00:48:06):

Besides the fact that we're obsessed with you is this word facilitator, I'm actually thinking we should rename our professional title because I do. I feel like so much of what you're you have been sharing is that even that last bit you facilitated a conversation, you didn't tell them what they should think or how they should feel, or, you know you started a conversation and allowed somebody to hopefully have an opportunity to rethink.

Lisa (00:48:31):

And break down some of those barriers.

Sarah (00:48:33):

Yeah. Yeah. It's super, super powerful. And to do that with our students. And I did want to, I have to ask about Camp Shout Out. I know you are a facilitator for them, but I don't know a lot about it. Can you tell us a little bit about what that is?

Erik (00:48:47):

Oh sure. So Camp Shout Out is a terrific sleep-away summer camp experience for young people who stutter between the ages of 8 and 18. And it is based out of the West side of the state of Michigan. And it has been started by two fantastic clinicians. Kristin Comella is the first clinician. And the second clinician is Julie Rainer and together they have combined their forces to create such a dare I say, magical learning experience. So Julie is very much in the world of camping and summer camp experiences. So she goes to like the ASHA of summer camp conferences. Like there's a, there's a summer camp like conference, and she's just always loved the outdoors and all of those things related to the outdoors. And she's also a speech language pathologist. And Kristen Comella obviously is very well-versed in instances relating to stuttering and is just such a fantastic clinician. So they've collaborated and they've made this wonderful camp that has been going on for 11 years. And I've had the pleasure of being a part of it for six of the last 11 years. And we come together in a outdoor environment and yes, there are therapeutic experiences in the camp setting, but it's not that traditional experience where like you're sitting in a chair and you're doing like this drill, drill, drill, it's being aware of the environment. How can we utilize the environment to kind of keep growing as communicators? How can we put ourselves out there to take some chances? So put it this way when you work together with a child in a camp setting, and there's perhaps the, the horseback experience, some of those children might say, Oh gosh, I'm nervous. I'm nervous to go on the horse. Why are you nervous? Ah, horses can be so unpredictable. I get it. Well let's plan. What are some of the things we could plan for when we do the horses? Right? So we do that and that can, and does look exactly like stuttering therapy. So the child says, ah, you know, I'm nervous to make that phone call. Well, why are you nervous? Well, the phone, the person on the other end of the phone call, there's so unpredictable. I don't know how they're gonna react. So then I'll say, okay. Hmm. Well, let's plan. So notice how the whole idea of planning is baked into the, the camp experience. Cause they plan for the horseback riding. And now they're planning for the phone call thing and it's this constant back and forth of going from one subject to the next. And overall it's helping us grow as people because you're better off that you, you jumped on that horse. Cause now you experience something new and you're better off that you made that phone call because now you're able to get the thing that you're trying to get. Right?

Lisa (00:51:36):

Well, and the idea of, again, we're not just teaching definitions that are completely isolated and it has no connection to a student's real world. I mean, anything that we can do, whether it be stuttering therapy or any type of therapy, the more we can make it, contextualize just, it makes that much more sense for students.

Erik (00:51:53):

That's key. And the outdoors brings such a beautiful element to who we are as human beings. So I have consumed a lot of research outside of SLP more in the world of clinical psychology, licensed professional counseling. And there's a lot of research that points to the therapeutic work we do outdoors is almost like introducing a third member into therapeutic experience. Meaning you have clients as member, one clinician as member two and wilderness as member three, and the wilderness can really impact positively or negatively in the ways in which we are doing things. And the ways in which we are speaking about things. And I'm just really excited to keep exposing myself to more research on that because it definitely connects to the work that we can do as clinicians,

Lisa (00:52:42):

Well and the idea of community too, to be in a community that is, you know, you're going to be totally accepted and people that may sound like you. And, and that there's an extra layer of feeling safe in that situation too.

Erik (00:52:56):

There's something so powerful when you bring children who stutter together. So it's not uncommon for our newer campers who are eight, nine, ten years old to start at this camp and look around. And they're like, I've never met another child who stutters ever. Not only do they meet one child who stutters today, but now they're surrounded. We have anywhere between 45 and like 55 campers. So they now see all these wonderful campers and they can connect in such meaningful and lasting ways. And there's plenty of opportunities for us as the adults to take a step back and let that peer to peer interaction, play it, play itself out.

Sarah (00:53:33):

Yeah. It's so freaking cool. I love this so much. See, so it's not just all video games. There was outdoor involvement there.

Lisa (00:53:39):

Horseback riding.

Sarah (00:53:39):

Horseback riding.

Lisa (00:53:39):

Come on.

Erik (00:53:43):

Rock climbing, zip lining, all the good stuff.

Sarah (00:53:48):

Exactly. Okay. We can not end this without talking about your website that you just created I mean, first of all, I know Lisa mentioned at the beginning of this episode that you have developed 25 apps.

Lisa (00:53:57):

Do you code them? You develop them?

Erik (00:54:01):

Yeah. When I was younger, so we're talking 2011, 2012, 2013. I did all the stuff at the very beginning. Now, as I'm getting a little bit older, life is a little bit more tricky. I'm a father. So I'm kind of bouncing a lot of things. Now I collaborate with my really close friends. I do all the wireframing. Now I do most of the graphic design. But yeah, yeah. For the most part I'm kind of conceptualizing and giving birth to these things. Yes.

Sarah (00:54:26):

So freaking cool. We love technology. You know, but am I coding SLP toolkit? No. Now I did take.

Lisa (00:54:33):

One course.

Sarah (00:54:33):

One course.

Lisa (00:54:35):

I thought you were doing it now.

Sarah (00:54:35):

And I did learn some basics about HTML.

Lisa (00:54:39):

We always say enough to be dangerous. She knows enough to throw out these terms that I'm like, wow, let me just take it. Why do we even need Isaac?

Sarah (00:54:45):

Exactly. Yep. Isaac's job security is just defined, but I want to talk about your website, the SLPVideoGames.com, because I will tell you I went on there and there's a free trial. So there's a game that you can play for free when you go on there called Get Rid of Red?

Erik (00:55:01):

Yes.

Sarah (00:55:02):

Oh my gosh. I'm not. I have to say I'm not actually a big video game person. Like I might . play with my kids a little bit, but I don't usually like kind of get sucked into it. That game is so addicting. I was only on level five and then I was getting so frustrated because I could not make yellow eat red or kill red. I should say they don't eat anything. They die.

Lisa (00:55:19):

Wow.

Sarah (00:55:20):

No, maybe not die is that aggressive.

Lisa (00:55:23):

Maybe a little bit. Now I understand where the SLPs don't want to play video games.

Sarah (00:55:26):

Ok explain this so it's not aggressive. They disappear.

Erik (00:55:30):

Sure.

Sarah (00:55:31):

Sure. They kept hitting the little triangle spike. But anyway, and so you created, that was just one of how many games on that site ?

Erik (00:55:37):

So right now. There's 13 different video games on that website. And it's my hope to keep growing that as a nice collection of things that clinicians can choose to explore. And the real gist of the, that website is this idea that you have these really wonderful video games that you can incorporate into the work that you do. And the pause button on the video games is intentional in that when you pause it, you don't necessarily just see a blank screen. The screen then turns into a set of flashcards that you as the user chose. So if you're working on speech sound disorders, there's all of the different sounds that you could choose to kind of pop up there. Or if you're working on different language aspects, there's tons and tons of you know, the most common language things that we as clinicians would work with our clients. And, you know, you could play converse while you're playing. And then if you want to take an intentional learning break, you can pause and see more of the more traditional visuals. And then you can unpause and then you can maybe play and then talk about some of those visuals or see if you can see some of those visuals in some of the background of the actual game that you're playing. So when you mentioned that game, get rid of red, there's lots of different spikes. So that's an S- blend right there SP sound, right? So they could verbalize maybe some sentences that has to do with spikes or you know, different things like that. So It's fun.

Lisa (00:57:02):

If your working on the /k/ sound it can be like kill or die.

Sarah (00:57:07):

It's sounds so aggressive. It's not that aggressive of a game people. But it was crazy addicting and like you said, even so one I've got this. I had picked, I think I picked a speech sound to work on while I was playing it. But the problem solving in and of itself is such an important skill that I feel like can be underdeveloped sometimes. And so there was, there was some real strategy there and I could see how that would come up in a conversation of, I need to talk through this with somebody so I could get past level five.

Erik (00:57:36):

Absolutely. And when we can help our children to walk through some of those decision-making processes in a verbal way, they're really the more you do it, the more it becomes more automatic. And we can take data on that. We can celebrate when we understand we can give the digital high-fives of course, but then we can also see that the character advanced to the next level. So there's another sense of accomplishment. Right. They verbalize it, they talked about it and then they actually did it in some visual manner that is really lasting for children, in my opinion.

Sarah (00:58:08):

Yeah. Yeah. And did you launch this pre you know, the world going to teletherapy or was it kind of, cause, I mean, again, this is such a, like a, an amazing resource to have when you are on a computer screen already.

Erik (00:58:24):

Yeah. So as a creator, I can say that I have anywhere between like five and seven things I'm working on, like at the same time. So I officially started playing with this video game idea in like 2019. So it definitely was like pre pandemic, but then once the pandemic happened, I was like, yeah, maybe I should pause on some of these other projects and kind of just focus on this, cause like, I need this as a clinician right now. I need to scratch my own itch. And if, if any other clinicians feel that it might be out for that for them. That's great too. But like, I need this right now. So that's when I really tried to put the pedal to the metal.

Sarah (00:58:57):

Yeah. It's a great resource. And just the endless again, like the fact that you have all those built-in tools and stuff anyway, that we need when we're targeting really specific goals. Um, but then it's such I mean, in and of itself, it's fun, it's engaging. It's a great incentive. And so anyway, it's super cool. And you guys definitely need to check that out. I will link to any resources that were mentioned throughout this episode on, you know, the, what do you call that episode summary thing.

Lisa (00:59:23):

Yep.

Sarah (00:59:25):

Yep. Sure that. But Eric, we could literally tie now for like 17 hours. I felt like very much the whole time I was doing, like you talked about earlier with the gesturing, with the thinking that thinking.

Erik (00:59:35):

Yep. Putting the hand on the chin. It's very powerful.

Sarah (00:59:38):

Your whole time. I was just really feeling it.

Erik (00:59:40):

Oh thank you.

Sarah (00:59:40):

Thank you so much for joining us in the confessional to have this conversation.

Erik (00:59:44):

Thank you for the invitation. I love all the great work that you and your team are doing. And we as a field are so appreciative of all the great stuff you do with SLP summit. Thank you so much on behalf of the field. I don't wanna speak for the field, but hey, thank you for all of us. You're awesome.

Lisa (00:59:58):

On behave of me and New Jersey and the field.

Sarah (01:00:03):

Thank you, Eric. I hope we'll get to have another conversation soon.

Erik (01:00:07):

Can't wait.

SLP Toolkit Podcast, Episode 36, Transcript

Take the headache out of present levels, progress monitoring, and daily data.