Early Intervention Speech Therapy : personal reflections

The Speech Spirit: Giving Thanks

Stephanie Bruno — Tue, 24 Nov 2009 17:28:00 GMT

Happy Thanksgiving and Welcome Back to the Blog! Today's speech spirit post quite simply is a reminder to be THANKFUL! I would like to start off by saying "thank you" to ADVANCE magazine and all the parents and therapists who have supported this blog...(read more)

A True Story of Acceptance

Stephanie Bruno — Fri, 18 Sep 2009 12:30:00 GMT

Last December I was assigned a new child to my caseload. She was already being seen by several of my co-workers who each informed me of their grave concerns regarding her development. At the time, she had not yet been diagnosed with anything other than...(read more)

Part 2: Parents and the Five Stages of Acceptance

Stephanie Bruno — Mon, 14 Sep 2009 18:24:00 GMT

Last week I wrote a post entitled Parents and the Five Stages of Acceptance . Today's post is a continuation and will provide more information about what Elizabeth Kübler-Ross taught us and how we can utilize it in early intervention. Based on my research...(read more)

Surviving the Financial Crunch

Stephanie Bruno — Tue, 01 Sep 2009 15:50:00 GMT

There was once a time when I naively thought my job was immune from the financial struggles and strain that plague many other industries. Speech therapists are always in high demand, right? I can pursue any speech job I want because there is a shortage...(read more)

Speech Spirit: Emerging Relationships in EI

Stephanie Bruno — Thu, 13 Aug 2009 14:51:00 GMT

For today's post I would like to reflect on some of the beautiful relationships that can emerge when you devote yourself to early intervention therapy and working with families with young children. There is a family I have worked with for the past two...(read more)

O-M Debate: A Reflection and Follow-up

Stephanie Bruno — Mon, 10 Aug 2009 15:05:00 GMT

Thank you all so much for sharing your comments and research in our oral motor debate! As Lisa, CCC-SLP from VT stated, I "certainly stirred the pot" with last week's post. I did want to get us talking, but I didn't mean to create such a firestorm! This...(read more)

Going Beyond the Call of Duty

Stephanie Bruno — Tue, 14 Jul 2009 21:32:00 GMT

For today's post I wanted to reflect a bit on some of the different aspects of EI home care that are often a part of the job; however may not be within our scope of practice as a speech language pathologist. For example, this past week alone, I listened...(read more)

Speech Spirit: Future Challenges in Early Intervention

Stephanie Bruno — Mon, 08 Jun 2009 18:06:00 GMT

Normally I write the Speech Spirit post as the first entry for each month. However, last week I chose to finish my two-part interview with Christy Marzzacco, CCC-SLP and CED (Certified Teacher of the Deaf). Therefore, today's post will serve as the Speech...(read more)

A Day in the Life

Stephanie Bruno — Fri, 22 May 2009 14:03:00 GMT

Today has the potential to be a really long day. The morning started when the alarm sounded at 6:30 am. I got out of bed, crafted my lunch and made sure I had enough water to get through the day. The weather man is calling for 80 degrees temps so I need...(read more)

The Speech Spirit: Early Intervention Therapy Works!

Stephanie Bruno — Fri, 01 May 2009 14:03:00 GMT

To start off the month of May and this month's Speech Spirit post, I want to discuss a concept that I think we as therapists sometimes forget when in the midst of treatment and meetings; and that is the undeniable truth that early intervention services...(read more)

Stepping Out of the Therapist Comfort Zone

Stephanie Bruno — Mon, 20 Apr 2009 21:33:00 GMT

This past weekend I had the joy and privilege of presenting at the PSHA (Pennsylvania Speech-Language-Hearing Association) Convention. I offered information on two topics that I am passionate about and have addressed previously on this blog, namely how...(read more)

The Speech Spirit: April 2009

Stephanie Bruno — Fri, 03 Apr 2009 13:06:00 GMT

Today's post is the first of a new month and highlights my next entry of "The Speech Spirit". Today's post addresses a concept I have played with over and over again both personally and professionally. I have debated how to eloquently present this belief....so...(read more)

Addressing the Issues: Data Collection in Early Intervention

Stephanie Bruno — Fri, 27 Mar 2009 13:27:00 GMT

In a recent post, I mentioned that data collection in our county has changed. As a result, readers have also started writing in to share their own experiences. One reader's comment from New York read, " We have to keep a calendar at the home where each...(read more)

More Changes and Challenges in EI

Stephanie Bruno — Thu, 19 Mar 2009 21:06:00 GMT

Earlier in the week I raised a few issues that have started to become more and more pressing in my work in early intervention.

The one that was first and foremost is the demand to use the term "daily routines". As a therapist working in a wide variety of home environments, sometimes identifying definable routines can be quite a struggle. I've been in homes where they never eat a meal as a family. They are constantly on the run, busy and scattered. This makes tracking routines and data very challenging.

Another scenario I also find surrounds the issue of toys. Toys are supposed to be the way children learn and explore endless concepts and skills. They should be part of their "daily routine". I've been in homes where there are no toys and I've also been in homes where toys are everywhere — broken and in piles and pieces all over the floor. The focus of therapy then becomes, helping the family CREATE daily routines that can be measured and recorded for the purpose of data, which sometimes diverts attention away from other aspects of speech and language.

This brings me to our next change, which is an increased concentration and demand on data collection. Our county now encourages both the therapists and the parents to keep organized and definable measurable data. Once again, for some parents this is extremely difficult and overwhelming. What I have done is create "parent charts" that I give to families to help them easily record what their child did/said throughout the day.

I would love to hear feedback from other therapists/parents on how this may be handled in your area!

Regarding therapist data, I was recently informed that it is now supposed to be submitted to our coordinators two weeks prior to every meeting. Now, one of the difficulties in our county is that we are only compensated for the time we are physically with a child. All the work we do outside of actual therapy time, such as making pictures, laminating, photocopies, phone calls, meeting/paperwork preparation is technically "non-billable time". They encourage us to do as much as we can within the home with the family during billable time; however it seems as though the list of "things to do" keeps growing and some of it will certainly take place outside our billable time.

My final issue to address has not happened yet; however I hear everyday that it is fast approaching (by May, 2009): our paperwork will be computerized. Our IFSP (Individualized Family Service Plan) will no longer be handwritten, it will be typed and both coordinators and therapists will be responsible for entering the data. I am curious how other counties in early intervention are handling computerized IFSPs? There are many unanswered questions...will the county provide laptops? How will we print out data for the families? Does this once again cut into "non-billable time"? I have seen computerized IEPs work beautifully in several school systems; however I am curious as to how it will work in home care.

Thank you for reading today's questions and concerns. Any insights readers can offer would be greatly appreciated!

"Daily Routines" and Other Changes in EI

Stephanie Bruno — Tue, 17 Mar 2009 16:37:00 GMT

In today's post I'd like to discuss an issue that has become quite pressing within the county where I work as a speech therapist in early intervention. Part of why I raise this issue is to see if other therapists out there across the country and world-wide have been focusing on this element of therapy as well.

Generally speaking, one of the main goals of early intervention therapy is to help the child be able to function independently within their "daily routines". Although this has been the main focus for as long as I have been working in EI, the emphasis on the "daily routines" element has recently increased. This term has become the focal point of our goal writing, data collection and therapeutic plan and although it makes sense in theory, it is often difficult to assess, treat and analyze.

Recently in an IFSP (Individualized Family Service Plan) review meeting, I needed to write a new speech goal for a child who is receiving speech-only services. Her main need for therapy is articulation-based. Her language skills are solid but she is still very difficult to understand.

The goal I proposed was the following, "Child's name will improve her ability to use words to express her wants and needs across all environments". The immediate response from the county coordinator at the meeting was that this goal is too "clinical" and we are no longer able to say "across all environments". Instead we need to say "in daily routines". I would like to say that this was simply the opinion of this particular coordinator; however I have heard stories like this from my coworkers, so I can safely assume this is now a regulation of our county.

Now, I am not one to create a fuss; however the reason why I chose the wording I did was because this particular little girl is doing pretty well in her daily routines. She needs help mainly with articulation both at home and at her little school program, hence the term "across all environments". As a side note, I never realized that this was a "clinical" term?!

In general, numerous other changes and guidelines have been recently instituted into our paperwork; however no training has been provided nor has there been any official notification of changes being made. Instead, we as therapists are told what we are "supposed" to be doing and saying while in review meetings with parents.

As therapists, I believe we can play the game much better when we know the rules, but if the rules keep changing, how is anyone supposed to be successful? How are we supposed to be prepared as well as an effective resource for parents if proper training and education regarding new guidelines are not being provided?

So, my question for readers is this....is this struggle one that you are seeing in your own county or district as well and if so, how are you addressing it?