Thank you to everyone who wrote into the “Surviving the Financial Crunch” post and for sharing your personal experiences regarding the financial hardships we are facing not only as an industry, but also as a nation. Therapists wrote in from across the country: Pennsylvania, New Jersey, South Carolina, and Illinois, voicing individual stories, concerns and frustrations.

For some of you, your unfaltering dedication to EI was heard and is respected. Some of you even shared different ideas regarding HOW to fix the problem(s) in your area and what needs to happen to make things better. Others recommended that therapists leave EI altogether and pursue areas where there is also a need, which of course are many and just as noble. In addition, some readers have already left EI and as one therapist stated simply and honestly, “I hope someday to go back to it (EI) but I have bills to pay”.

Others have shared that these financial woes ARE affecting not only EI but other populations, such as Head Start programs, day cares and nursing homes as well. Not to add salt to the wound, but I also need to share a story.

A close friend of mine works as an OT in our neighborhood school district, which is a large and well respected area for education. At their recent back-to-school meetings they were informed that the district believes they can pay the employees until December, but is not certain that they will be able to past then. The reason why I wanted to share this is that although moving into another venue of speech therapy may be a temporary solution, who knows what the more long term reality may be.

If you are like many of the other millions of Americans out there who have been closely watching the health care debate that has been raging through the country this summer, you may or may not have your own vision of what the solution(s) may be. I, of course, have my own opinion of what needs to happen to improve health care in this country, which could also directly affect EI services for many families who need it; however I would like to open the floor to the readers out there.

Now that we have shared our concerns and know the bitter reality of what is happening to our education, health care and overall economic situations in this country, what should we as a people be advocating for? What does the country need to rebuild our economy and the field of EI which is being threatened as a result? Now that we have identified the needs and problems, let’s talk about the solutions!

"I was reading some more of your blogs and just had a question for you. I need to use PECS with so many of my kids and do not have the resources.  My company will not pay for Boardmaker or the printing costs of all the pictures.  My boss recommends having the parents do the "work" with producing the pictures, but several of my clients do not even have computers or printers.  Basically, time and cost involved are difficult obstacles for me.  (We are not paid for extraneous time we spend doing things for our clients and families.)

So, in response, here are some helpful and inexpensive ways for therapists to gain access to pictures that can be used for therapy:

If you would like to incorporate pictures into your therapy plan and expand the child's communication repertoire, but do not have access to Boardmaker, here are some additional ways to access pictures:

• Cut out pictures from old magazines and catalogs—Cooking Magazines and ones like Parents and Cookie are helpful and full of pictures related to children and child-centered activities.
• Use the internet—You can Google what you are looking for and Google Images will supply pictures. You will still need to print them but will save the cost of buying a picture program.
• Explain to families what you want/need to do to help their child. You never know if they would be willing to participate and/or have a friend or family member who could help out.
• Purchase Boardmaker on your own (you could then use it in your own home) OR see if fellow coworkers would be willing to split the cost with you and purchase it for your office computer. The Boardmaker program costs about $300 and most likely you could use it as a work-related tax write-off.
• If laminating is also a cost issue, try reusable clear plastic pockets and/or photo albums from a dollar store to house your pictures. You can also glue your pictures onto cardboard, which will help to give them some strength and durability!

Do you have other ideas on how to cut therapy costs? Please write in and tell us!

Well, not exactly; at least, not right now. Even if these statements are true, and the need and demand for therapy exists, if the money isn't there to pay for the services then how secure is the job after all?

This past week my boss sent out an email to our staff announcing that the state was having a "budget crisis" and that funding for Early Intervention was one of the possible programs on the chopping block. Her email was attached to a previous message, urging citizens to "get involved" and "take action" on behalf of our community and the many services that are being threatened. In addition to this email, our company recently needed to restructure parts of our department in order to stay financially afloat. Several professionals were laid off with very little to no warning, while others were relocated to various positions within the company.

In addition, our entire staff, myself included, are presently struggling with reduced caseloads. We all have numerous openings in our schedule. My caseload is currently about two-thirds full, so needless to say, I have been unable to make my expected productivity for the past two weeks. Because of our caseload crisis, one of my coworkers is now working only two days a week instead of the four she has worked for the last several years. A friend emailed me earlier today sharing that the school where she works cannot pay her right now because their budget has been cut.

Based upon conversations with my boss and coworkers, it seems as though the reasons for our caseload shortage are varied. There have been recent budget cuts on various levels. In addition, I've heard that the amount of children being referred for services and being found eligible for services have both decreased. I wonder how much of that; however, is also financially driven.

Please share how your businesses, school districts and early intervention programs are doing in this troubled economy and if and how you are surviving the financial crunch!

In the weeks that followed, I learned both through my own experience and my research that where this little girl was currently functioning may be her best. I learned that many of these children progress somewhat normally until the age of approximately 18 months and then they begin to plateau and possibly regress. Some will acquire a few words, others none. In this particular case, she did not progress normally until 18 months. It was reported that normal development stopped within the first few months of life and my colleagues report that the skills she had developed closer to 12 to 18 months are now disappearing. At the time, she has no words, very little eye contact and few purposeful gestures.  In addition, we are beginning to see the onset of various stimulation behaviors, such as spitting and hair pulling, as well as tremors that doctors report are part of her diagnosis.

So, the question for me now becomes, what is my role as therapist in the remaining months before her third birthday? How much influence do I really have in the skill development of this little girl?

I see my role at this time as someone who can help keep this little girl safe when she eats as well as be a support for the family who is clearly struggling through the ever-changing behaviors and syndrome symptoms that are continually emerging. We have practiced direct speech stimulation methods, various oral motor techniques, sign language and picture communication for over 8 months now with very little to no change. She will intermittently scan two music pictures and make an attempt to touch one; however this has only been observed during music time in a very structured setting and not with concept pictures such as yes/no and more/all done. 

My reason for writing this post today is two-fold: A) I would love to hear some suggestions and feedback from readers about ways I could best serve the needs of this child and her family and B) invite other therapists to share their stories regarding any work they have done with children under the age of three who present with a severe and profound disability.

Thank you for reading.

My hope is that through this post we can begin a discussion regarding the all children we treat in 0-3 who have been diagnosed with severe and profound disabilities.

There is a family I have worked with for the past two years. The little girl I see will be turning 3 next month and has a diagnosis of Down syndrome. She has a little sister and two wonderful parents. I have had the amazing opportunity, as we often do in this job, to watch a family grow not only in size but also in hope as they welcome a team of strangers into their home to work with their most sacred possession: their child.

So in a very successful attempt to thank the therapists (all 5!) that have worked with their little girl the better part of three years, this particular family invited each of us to attend a Philadelphia Phillies game with their family. In addition, we were each given three extra tickets to invite our own family and friends. What a treat!!

This past weekend, the day finally arrived and four of the five of us were able to attend and did in fact bring three members of our family. It was such a wonderful day! I had the privilege of spending time with not only my own family at the ball park, but also with this very special little girl and her family in a non-work environment. My family loved it and seemed to really enjoy meeting a child and family from my "job". In addition, all the therapists loved spending some social time together. EI home care can be quite isolating, so having an opportunity to see each other outside of work is certainly rare and extraordinary.

One of my most favorite moments of the day occurred at the beginning when I first walked into the ball park and heard my little friend yell, "Hi Stephy!" She often calls all of us "Peggy", who is one of my coworkers, but today she knew my name even though I was "out of context" and not at her home. She talked throughout the game to each of us, answering questions and making requests for "chips" and "fries please". I saw her parents prompt her speech and use sign language and all remarked on how bright and vocal she is. The joy of seeing teamwork and over two years of commitment come alive is truly my speech spirit moment of the month!

Reviewing all the comments offered and taking the time to critique my own contributions as well, here are my concluding thoughts:

Lisa went on to say that, "It (O-M therapy) is really an all-encompassing term that we should use carefully and specifically, making sure we use techniques that make sense in terms of our goals and our patients' needs". I agree with her and in addition, I believe that when we engage in a debate such as this, we need to clearly define the nature of the individual child's delay/disorder we are trying to treat, which helps to determine HOW we will treat it.

One of the readers, Sherril, CCC-SLP from NJ, offered a comment describing well the type of very young babies and toddlers I see in my current work position. She used the term "orally defensive". In my experience, many of these children also seem to present with global sensory-based issues that appear to be hindering a variety of milestones including their speech development and most likely their eating habits as well. Many times these children appear to be on the autism spectrum; however that may also not be the case and because they are so young that diagnosis has not come yet. With these children, their whole body is involved in the delay. These children often require a team of therapists to remediate their issues — OT, PT, Education and Speech in order to help them move along developmentally. Children who present in this way are very different from a kiddo with a speech delay, cleft palate, apraxia, etc., who may benefit from direct phonemic cuing, speech stimulation, etc. and who may only require the intervention of a speech therapist. All of these children present with a speech delay/disorder; however the cause of the problem is most likely very different.

In retrospect, I feel that I should have better defined the population I was addressing in my Oral-Motor Debate post.

In all the work that I do with children ages 0-3, when I use oral-motor methods to help stimulate oral movement, awareness, imitation, etc., it is simply one method and it does not stop there. The OM techniques I use are always accompanied by phonemic cuing and direct speech stimulation as well as pictures and sign language depending on the child's needs. The reason why I choose to incorporate the oral-motor piece is because the child is NOT responding to traditional speech therapy. Whenever oral-motor techniques are incorporated with a child who is "orally defensive" and also not using their mouth to communicate, I have seen positive results.  

One final thought — I have learned firsthand as a student and recently as an adjunct professor and supervisor that what is found in our university classrooms, textbooks and research papers is absolutely vital and lays the foundation for our life's work. Just as important, however is hands-on experience in the field. To study and read about something is one thing, to live it everyday, problem-solve it by incorporating various techniques and put your skills to use in creative ways that work for individual children and families is quite different. When debating issues, such as oral-motor therapy, it is important that both be respected and heard.

Thank you again for reading and for your contributions to this blog!!

When I read these accounts, I had two immediate thoughts. The first was that I strongly disagree with many of these claims based upon my own success with oral-motor treatment and my second thought was to do some research of my own!!

• speech sound production: articulation, apraxia of speech, dysarthria, ataxia, dyskinesia
• feeding and swallowing: oral, pharyngeal, laryngeal, esophageal; orofacial myology (including tongue thrust); oral-motor functions"

In addition, ASHA states that "oral anomalies" are within our scope of practice and potential etiologies of communication and swallowing disorders include examples such as:  "cleft lip/palate, dental malocclusion, macroglossia, oral-motor dysfunction".

So, my next thought is, if ASHA recognizes that "oral anomalies" are within our scope of practice, why wouldn't we use oral motor therapy techniques to treat them when appropriate?? In addition, I was taught that oral-motor therapy is one of the best and most effective ways to treat apraxia, which is also listed above as within our scope of practice.

Back in April, 2009 I wrote a post entitled: What's In Your Oral-Motor Toolkit?, which included a complete list of the various tools and methods I use everyday to treat children with a variety of delays/disorders that require oral-motor support. The majority of what I do each day focuses on the mouth, whether it's related to speaking or feeding. To ignore a child's ability to recognize their mouth and the movements it makes doesn't make sense to me. I have found that the better a child can motor plan oral and verbal movements, as well as increase the overall awareness of their mouth, the more success I see with their speech.

One reader recently commented that she has "found [oral-motor therapy] very helpful for children with low muscle tone and tongue protrusion (Down Syndrome, certain neuromuscular disorders).  I have noted increased intelligibility, by reducing tongue protrusion, strengthening jaw, (and) improving ability to make dissociated movements of tongue lips and jaw. Also helpful with numerous cases where child displays oral posture: retracted lips and a fixed jaw position."

Amen! I could not agree more! I know I do not have solid numbers and a published research study to support my belief or claims; however I see the benefits come to life everyday in many of the homes in which I work.

My final thought for today's post:  If there is no current research to support oral-motor therapy as a valid method to treat speech production, maybe we, as a professionals, need to conduct research studies and begin documenting our successes so that we have numbers to back up our hard work!! Just because the research isn't there, doesn't mean the techniques do not work.

PLEASE write in and share your thoughts!!

Recently, more and more readers have been commenting on the blog and have also been sending me personal emails asking for advice and guidance regarding various populations and disabilities. I absolutely love the feedback and I think the networking that has occurred is invaluable. What I am attempting to do in order to answer as many emails/comments as possible, as well as continue to generate discussion, is to use various inquiries to create posts around the issues that are in question.

My goal is to serve the readers and our profession in the best way I can, which is to connect parents and therapists involved in the EI process. As I stated back in October 2008 when the blog first began, my "hope is that as this blog develops it will become a touchstone for both therapists and parents in search of the delicate balance between educating the mind, strengthening the body and liberating the spirit of a child with special needs".

Thank you for helping to make this hope a reality.

Below are several questions from readers that have been sent to me in recent weeks that I wanted to impart to the public.

Please share your thoughts, comments and expertise with your fellow therapists. Future blogs for August 2009 and beyond will also address many of the topics highlighted below:

• I have been working with a 2 year old girl w/ Cytomeglovirus for about a year. She presents as a child with severe CP. She has limited limb movement, a feeding tube, and has difficulty holding her head up. She vocalizes randomly and occasionally produces a consonant. I think that I am doing everything I possibly can with her (Beckman Oral motor, bubbles, eye gaze choice from field of 2, cause & effect toys, vowel production w/ accompanied gestures, etc), but would love to hear ideas from any of your readers.
  
• Can anyone help me make a decision about the use of "oral motor therapy (OMT)" when ASHA's stance is that there is no valid research that supports using it? I want to do the best possible therapy for all the children I serve but I'm confused that I'm still hearing about OMT when our national office doesn't support it. Same holds true for sensory integration. There is an OT in the area who has had amazing results working with children on my caseload who have severe autism. Although she has offered to train me at no charge (brushing, swinging, pressure, etc.), I am reluctant to go there as again, ASHA does not approve it and I don't want to end up getting sued for "doing it wrong." Thanks.
  
• I'd like to see you address the role of the ST as a support/resource person, as counseling is one the primary things our therapists do (in EI).
  
• I would like to see you talk about (especially for new EI therapists) the devastation and grieving process that families go through when their child is given a diagnosis.

One of the first thoughts I had regarding my experience in working with children with Down syndrome is that although they share the same primary diagnosis, their personalities, characteristics, strengths and weaknesses are all different and vary between individuals and families.

For example, I currently have three little ones on my caseload with Down syndrome and each of them of course requires their own individualized therapeutic plan. Two of the children are turning 3 within the next two months. One of them has incredible verbal skills, yet just started walking within the past 6 months, while the other walked by around 18 months and yet continues to struggle significantly to communicate. This little one also has several older siblings and has wonderful role models to help her along. The third child is similar to the latter. She will be three in December and only has about 10 words/signs that she uses independently; however their home is much quieter and there is less reinforcement for speech and language.

Below is the email I received from our graduate student reader, which I would like to share with the public with the intent of prompting a variety of helpful responses:

"I currently am a grad student in Buffalo, NY for Speech Path and am working with a 2 1/2 year old with Down syndrome. So far, I've done a lot of play therapy with her, but those skills are pretty well developed. I am having trouble thinking of more structured activities that will meet her goals that are also age appropriate. I want to include books in every session also. We are working on artic sounds (b,m,h,s,d, and wh), as well as following directions involving actions, labeling pictures/objects/actions, and using two combined signs to request, label, or comment. If you have any great ideas, or books that you've found kids her age just LOVE, I'll take any advice!"

My response: Some initial suggestions I have are to use a complete oral motor plan (if that is not happening already), as well as a picture communication system to help her become more independent in her daily routine. Also, I use a speech book with the one very verbal child I work with and it has proven to be very successful. We use the book to work on both speech (artic sounds) and language ("I want _____"). This also gives the family something concrete to practice throughout the week. Next, make sure to include the family in your plan. Ask them where she is struggling right now and figure out how you can address these areas to help make your work more functional.

Please write in and share your suggestions as well as any other helpful information regarding working with young children diagnosed with Down syndrome.

None of the above mentioned tasks are a part of my training as a speech therapist. However, in this job, we enter people's homes on a weekly basis and many times, we also enter their lives. We see and hear all sorts of information that may concern us, make us uncomfortable and call us to take action in ways that may not be in our job description.

I know that I am not alone in saying that sometimes in this job you just have to do what needs to be done. In addition, it's hard to work on speech and language if basic wants and needs are not addressed. For example, how do you address speech and language needs if the child is hungry, their diaper needs to be changed or they desperately need a bath? How can parents focus on and carry out the suggestions you offer when they are not sure if they can pay their bills and put food on the table? Issues such as these are a very realistic part of early intervention home care.

If you look at Abraham Maslow's hierarchy of needs, which he wrote in 1943 in a paper called "A Theory of Human Motivation", he discusses how certain needs must be met in order for a person to be motivated enough to focus on the next level of needs. The following link http://en.wikipedia.org/wiki/Maslow's_hierarchy_of_needs  discusses all of these needs in more depth. At this time in my career, I see the truth of what Maslow has outlined in his hierarchy and the reality exists that sometimes we step out of our role to address the issues that cannot and should not be ignored.

Please share ways you have stepped out of your role to help a family in need.

Happy July and I hope everyone had a wonderful July 4th Weekend!!

Today's entry will serve as the spirit post for the month of July and will continue to focus on the importance of the initial visit, which is where trust is built and the relationship between therapists and the families we work with begins.

In the last post, Getting Started in EI: Your Initial Visit(s), I wrote that the initial visit is an opportunity to "establish a strong and healthy rapport with the family—first impressions are important!" To achieve this, I always let families know ahead of time that I am going to "interview" them during my first appointment. Also, I explain to them that many times the information I have received regarding their child may be outdated, inaccurate or lacking detail; therefore I want to hear first-hand from them what is happening at home and what their priorities are. 

Regarding the child, I am always very friendly, of course and I let them take the lead. I smile and greet them with a big hello, but I construct my focus around the parent—I make my rapport with the parent my priority. Also, if I go out first with a co-worker who has been working with the family previously, which I often do, they are interacting with the child, so I observe and ask questions along the way. I find it is the best way to truly see the child present level of functioning ability.

At the end, I summarize the session for the parent and discuss the ways to address the speech/feeding issues that exist. This part of my visit may actually be the most important. I reflect back to the parent the information they have shared with me, letting them know I listened and I HEARD them. In addition I share with them my professional interpretation of what may be happening with their child, answering any questions they have and present to them my "plan of action" as I like to call it.

My goal is to leave the parent with a complete picture of what speech therapy for their child will look like in the upcoming weeks. By doing this, I think parents realize the importance of our first visit, the value of my observation and interview questions and what the next step(s) will be to address their child speech, language and feeding needs. By doing this, the foundation of trust is created and has solid framework on which to grow and develop as therapy progresses.

So, you've got your bag of therapy goodies all packed, you have your Mapquest directions and your appointment is scheduled. Now what??! Well, here are some suggestions coming straight from my own routine as well as some helpful tips that one reader recently shared:

• OBSERVE! Back in October of 2008, I wrote a post entitled The Feeding Solution: Part 1—Evaluate. In that post I wrote, "I spend at least one entire session interviewing the family and observing the child in the home and daycare..." I continue to do this now at every initial visit without fail and it has proven to be foolproof every time. This visit gives me the opportunity to see what the child is capable of doing without my demands being placed on them, as well as see the dynamics that exist within the family—information that is priceless when working in EI homecare. In addition, it allows me to have a full hour to establish a strong and healthy rapport with the family—first impressions are important!
  
• INTERVIEW! Also back in October 2008, as well as into the first week of November, I wrote a series of posts entitled Interviewing Parents—Speech-Related Questions to Ask. Again, priceless. As well as observing the child and family at my first session, I also spend that time interviewing mom, dad and whoever else is available. Many times the paperwork we receive is slightly outdated or doesn't paint a full picture of the child. I use my initial visit as an opportunity to investigate and gather as much info as I can. Once I have the info, I can then begin planning an effective and appropriate therapy plan individually designed for that child.
  
• TEAM UP! If the child you are seeing has a team of therapists who have been working with them prior to your arrival, arrange to go to your first visit with one of these therapists. OBSERVE the child in therapy. SEE what they are doing with your colleagues. Why reinvent the wheel?? If the other therapist(s) already have a behavior system in place or a sensory diet that is working, you need to know about it so that you can incorporate into your session. Once again, this information is crucial to your therapy.
  
• PATIENCE AND A SENSE OF HUMOR! (compliments of Geri, SLP from NY) I wanted to include this pearl of wisdom because it is so incredibly true and so important to remember especially when you are first starting out. Have patience with YOURSELF and with the child and family. This is new for everyone. Also, relax, smile and learn to laugh at your own shortcomings. Some sessions are wonderful and some are terrible and it is important to learn from both!

Please write in and share how YOU conduct your initial visit with a new family!!

• Bubbles! Kids love bubbles! There is only one child I have ever worked with who didn't love bubbles; otherwise it's a foolproof way to inspire focus and eye contact, as well as an independent request for "MORE!"
  
• Whistles/pinwheels/feathers/etc. All great ways to help children motor plan their ability to "blow", especially when bubbles are still too difficult for them.
  
• Picture Communication. This comes in all sorts of forms for me! I use pictures for songs, which I found on the internet. Pictures for communication requests, pictures for vocabulary development which can be found in programs such as Boardmaker, and the list goes on and on....!
  
• Sign language handouts/book. When I introduce a family to signing with their child, especially if we predict it may be more then just some of the basics, I supply the family with resources to help them practice signing throughout the week when I am not there.
  
• Lotion/Vibration Tools/Mirror/Nuks/Toothettes. These are all great for oral motor stimulation! Back in April I wrote a post entitled "What's in your Oral Motor Tool Kit". The post is a complete list of oral motor toys and tools that I use on a daily (sometimes hourly!) basis.
  
• Puzzles. I love using puzzles of all shapes, sizes and complexity levels to help develop a child's focus, play skills and vocabulary!
  
• Play Doh. This is great for those sensory-seekers who again, need help with focus and play skills. I also use this to build vocabulary through sound/word imitation, such as "zoom!", "rolling, rolling", etc.
  
• Speech book. For my speech-only kiddos and/or little ones with really good attention, I use a plain notebook as their "speech book". It allows a central place to put pictures and to do simple articulation activities to help zero in on sounds. I encourage the family to add pictures of family members, magazine pictures, etc so that the book truly becomes part of the family and something the child can feel proud of.
  
• Parent resources. On Dec. 2, 2008 I published a post entitled "Web Resources for Parents". In addition to the Internet resources, I also equip myself with a variety of reading material for parents, to help generate thought, discussion and action in the home.
  

I hope that you have found this helpful, especially for those recent grads and professionals that have just started working in EI. Of course there are tons of wonderful resources out there, so for those of you who are long-time veterans of the field, please weigh in and share your expertise!

I'd like to start with some of the personal items I keep handy that make constant car travel actually ENJOYABLE:

• A hands-free cell phone device. Since we spend so much of our time driving, it is definitely worth it to have a hands-free device (which is also mandated by law in many places now). My car is my office and sometimes I need to make phone calls throughout the day, plus families will call to cancel or talk and either way, it's important to be prepared, available and safe.
  
• Cell phone car charger. Although I charge my phone every night when I get home, on the rare occasion that I forget, I always have backup if I need it!
  
• Insulated lunch bag. One of the best gifts I ever received was an insulted lunch bag! When everything else in your car is exposed to the elements while you are working inside someone's home, your food stays warm in the winter and cool in the summer. This keeps a smile on my face even when the weather outside has reached an extreme temperature!
  
• Umbrella. You never know when a passing shower or thunderstorm may roll in, especially this time of the year. I have been caught in downpours before and it is not fun to sit in soggy clothes in someone's air-conditioned home. I keep an umbrella in my car at all times.
  
• Insulated thermos. Keeps your beverages toasty on wintry days!
  
• Frozen water jug/bottle. This suggestion was recently shared with me by a wise co-worker. Every night during the summer months she puts a jug of water in the freezer so that it is ready to go in the morning. Because it is solid ice when you leave for work, it slowly thaws throughout the day and provides a cold drink even hours later during the dog days of summer! It works and is wonderful! You can add lemon and/or lime to lighten the flavor!
  
• Tissues and napkins. Like I said before, my car is my office. I've spilled coffee on myself a dozen times and have eaten numerous paninis and fruit salads while driving. Needless to say, napkins and tissues are a must for food purposes, as well as the unexpected sneezing attack!
  
• Good music and/or radio commentary. Two staples I cannot do without!

Please share some items you can't you live without in EI!!!

Next week I will highlight therapy items that are an absolutely MUST for an EI SLP!!

Over the last two weeks I have had the unique experience of teaching a graduate level class at West Chester University, a wonderful institution both locally and nationally recognized for their Department of Communicative Disorders. Although, I myself graduated just a short time ago, I have been struck by the incredible changes in technology that have occurred in the last 10-15 years. I am teaching not 1, but 3 classrooms at one time. I have 15 students in my actual classroom, as well as two "distance learner" classrooms, one in New Jersey and one in Harrisburg, PA, with a grand total of 24 students.

The university uses a program called "Blackboard" which allows me to post announcements, send emails and outline course assignments in a central place for all the students enrolled in the class to view through the internet. I carry my laptop with me and can display documents on a screen that all 3 campuses are able to view at the same time. The students are so accustomed to using all these different technologies that half the time, they are helping me problem solve how to send information to each of the campuses and then receive it back again so that I can grade it.

Needless to say, this has been a very humbling two weeks. Being in this position has been challenging and has given me a new perspective and appreciation for our life's work. These young women (and men—there is one male in the class), are so bright and eager to learn about what awaits them. The challenges they will face in EI, the public school system, or whatever path they chose to follow are looming in their near future and they know it. I can sense the mix of excitement and anxiety in the questions they ask and the info they want to know—they are sponges soaking up what I say and any expertise I can offer.

I remember that time so well and I am amazed at what I have learned in this past decade. The confidence that has developed simply by getting up and going to work each day and tackling the tasks that I have chosen to accept is significant. I am very grateful to be in a situation now where I am able to serve the youth of this country who like myself, have chosen to dedicate their education and life to teaching children with disabilities. It's a very spiritual notion to see life repeating itself and watch this next generation of young adults tackle the issues we face each day in the early intervention work force.