Welcome to Health Care POV | sign in | join
Speech in the Schools

'Is the Teacher a Racist?'
November 20, 2015 8:29 AM by Teresa Roberts

“Do you think that the teacher is a racist?”

Does this question offend you? Does it depend on the context? Does the context matter?

Here is the actual situation: the special education team is reviewing referrals from general education staff. One teacher (not present) has referred a fourth grade student for concerns about his reading and math skills. The student is identified as African-American in a school where the majority of students and staff are identified as Caucasian. This student would be considered a minority at his school and within the greater society. The administrator asks the team, “Do you think that the teacher is a racist?”

What would have prompted this question?

•    District sanctions for disproportion: Perhaps the district had faced fines for having too many students from culturally and linguistically diverse backgrounds receiving special education services, as compared to the general population.
•    Referral rates: Perhaps the school had a history of referring many children from culturally and linguistically diverse backgrounds for special education services.
•    Over-identification: Perhaps the school had a history of inappropriately identifying students from culturally and linguistically diverse backgrounds as having a delay or disorder.
•    Cultural sensitivity training: Perhaps the administrator had recently completed a cultural sensitivity training and considered this to be a reasonable question.
•    School culture: Perhaps there were concerns about school climate and inclusive practice within the school community.

All of these issues are serious concerns. An entire discussion about institutional biases within educational systems is valid, as schools have a symbiotic relationship with society. It is appropriate to ask about the role of cultural and linguistic factors in the classroom. It is not appropriate to ask one staff member if another staff member is a racist.

SEE ALSO: American Disabilities Act at 25

‘Racist’ is a dichotomous term reflecting identity. It is often used to imply an inherent trait within a person and presupposes a permanent mindset of ‘racism’ consistent across all settings and contexts. ‘Racist’ may be used as an accusation.

Yes, people may demonstrate behaviors that are (or appear) racially biased. It’s likely that all of us have inadvertently, or even purposefully, demonstrated negative racially biased behaviors. We live within a complex society, which grants hierarchical levels of privileges to different groups based on racial/ethnic identity, among many other variables. We are all affected by pervasive, systemic issues across media, business, policy, law, infrastructure, etc. It is essential to question these issues, however, we can explore the role of cultural and linguistic factors without using accusatory language:

•    “I would like to hear more about cultural factors in the classroom.”
•    “I’m wondering about the role of racial and ethnic communication characteristics for the student and the teacher.”
•    “Let’s talk about diversity in the classroom and how it may be affecting student performance.”

There are no simple solutions to entrenched societal challenges. We can advocate for thoughtful consideration of the issues. We can find safe and respectful ways to start these discussions.

You Might Also Like...

Disclosing Disability

What healthcare workers need to reveal in a job interview.

Hearing Loss in the Workforce

A clear solution for an invisible challenge.

More Than a Label

Does classifying people with developmental disabilities as severely intellectually disabled deny them opportunities?

Bilingual Care

Bilingual SLP certificate programs are imperative when providing services to a growing population of multicultural clients.

Graduate School Applications
November 16, 2015 3:24 PM by Teresa Roberts
Do you know anyone applying to graduate school? Here are some tips to share:

Writer’s block: Fight the freeze by starting in the middle of the essay. Sometimes we discover introductions through conclusions. Return to the opening lines only after you’ve reached the end.

Answer simple questions: Unsure what to say? Start with everyday, plain language. Writing is about sharing your ideas. Editing is about refining them.
•    Why do you want to be a Speech Language Pathologist?
•    How did you hear about this field?
•    How have you worked with clients?
•    What classes have you taken?
•    What are your favorite classes?
•    What are your areas of interest?
•    What inspires you?
•    What do you like about Speech Language Pathology?
•    Why do you think that you will be good at it?

Overwrite: Write long answers to simple questions. Words are like clay and we need a lot of clay to create a sculpture – the more words, the better. Overwriting is free expression without judgment. Don’t delete during this stage – just keep writing.

Ask “why?” again and again: Every time you answer a simple question, ask yourself “why?” If you think, “I want to be a Speech Language Pathologist to help people communicate,” then answer the questions “why do I want to help people communicate?” and “why is communication important?” Find the underlying reasons for every statement you make. If you think, “I like neurology,” then ask yourself “why?” again and again to discover your values.

Value statements: Explain the origin of your values and beliefs. People come to this profession for different reasons. Find your reasons by asking yourself what matters and why it matters.

Learning examples: Reflect on times that you’ve had an emotional response to learning. Describe these pivotal moments in your understanding. Include course material, meaningful observations, positive interactions with clients, etc.

Credit others: Who has helped you? Describe support and mentoring in your life. When you credit others, you share the knowledge that you gained while honoring the expertise of others.

Recognize uniqueness: What can you say that no one else can say? Find the truths about your experiences, skills, commitment, and interests that are not the same as other peoples.

Cultural and Linguistic Diversity: Reflect on your personal and professional experiences understanding the role of language and culture in communication and social interaction.

Check the basics: A personal statement is a persuasive essay. Build evidence showing that you are prepared for graduate school. Make sure that you have information about your experiences, employment, volunteer work, skills, academic coursework, etc.

Graduate programs need to know: (1) why you are interested in the field, (2) the experiences and skills you bring, and (3) your readiness for high-level academic coursework. Tell everyone why you want to be a clinician. Our profession needs the new ideas and enthusiasm that you will bring!

You Might Also Like...

Focus on Education

This comprehensive guide is a resource to help improve your career.

Student Loan Forgivenes

Find out about programs that offer to eliminate qualifying student loan debt.

5 Reasons to Work While in College

What hiring managers are looking for is that something extra.

Conference Calendar

Check our nationwide list of educational opportunities.

Dear Future Leader
November 6, 2015 11:14 AM by Teresa Roberts

Last week you told me about a recent leadership meeting: participants, proposed initiatives, attempted negotiations, and post-meeting allegiances. I didn’t hear what you needed, but I should have. I tried to dissuade you from higher-level politics. I don’t know if I felt jaded, or if I was trying to protect you. I care about you a lot. I don’t want you hurt by the system, or transformed into something that you are not.

I’ll tell you what I did, but you are your own person, so your course will be different:

Solidify values and vision: Reflect on characteristics and traits linked to your professional vision. Chose adjectives, e.g., “informed”, “resourceful”, etc. Use belief statements and inclusive language to form goals, e.g., “All practitioners have the right to access current research in the field,” “All clients have the right to culturally sensitive services,” etc.

Determine needs and strengths: Interview clinicians across levels of experience. Make calls and visit people. Ask new clinicians what would help them the most. Ask experienced clinicians what system changes they recommend. Use open-ended questions. Act as an unbiased reporter taking notes. Thank people for their time and ideas. Remember each person’s unique insights and strengths.

Learn organizational history: Interview long-time employees. Find out about prior influential leadership, times of major policy changes, previous programs and teams, etc. Trace funding streams of financial allocations.

Review policy: Learn basic fundamentals of federal law, state law, and district policies. Refer to ASHA policy statements. Evaluate how Special Education legislation was interpreted locally. Remember that working within an organization does not negate your clinical judgment.

Organizational initiatives: Track local and regional philosophical shifts and projected program adoptions.

Prepare for negativity: Some people have limited understanding of daily issues and say dismissive and inaccurate things. When this happens, listen impartially to gather more information: “I hadn’t heard about that. Where is this happening?” Provide an alternate interpretation or counter example. Remind everyone that there are multiple ways to view any given situation and one solitary exemplar is not a trend.

Manage feelings: Suppress instinctive emotional reactions. Conversations provide data for planning and progressive steps toward goals. View people as uninformed, not malicious.

Craft recommendations: Combine and synthesize information to form possible steps, e.g., policy changes, committees, trainings, guidelines, etc.

Plant seeds: Start to share small pieces of your ideas with everyone. Pique others’ interest in moving toward positive shared goals. Shape aspects of goals to align with others’ strengths. Let people create meaningful roles for themselves.

Discover solutions collaboratively: Solutions may appear after sufficient foundational information has been shared by all parties. Balance patience with activism. Understanding fosters receptiveness to recommendations. Prepare three possible mutually beneficial solutions with varied levels of implementation to present to administration.

I know that you are incredibly intelligent, creative, and caring. I have watched you consider leadership roles and I’ve encouraged you in the past. You have the potential to initiate changes that will support students and staff now, and in the future. I believe in you and I am prepared to help.

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.

Blending Clusters
October 30, 2015 8:36 AM by Teresa Roberts

Clients working on cluster blends, /pl/, /bl/, /fl/, /kl/, /gl/, and /sl/, may initially demonstrate vowel epenthesis, inserting a schwa between two consonants, e.g., “puh-lay” for “play”, and altering the syllable shape from CCV to CVCV. We can directly teach how to blend consonants to produce near simultaneous release of sound – and lose the schwa (“uh”).

After a client has mastered placement for alveolar /l/, blends may be challenging. Make sure the client is familiar with the parts of the mouth and how sounds are produced, e.g., identification of articulators (tongue, lips, jaw), tongue tip placement, lip sounds (/p/ and /b/) versus tongue sounds (/k/ and /g/), etc. A basic understanding of speech sound production lets us describe how /l/ blends involve anticipation and preparation. Speakers are generally already in position for the next sound in a sequence, before they have even started to speak.

“When you say two sounds together at the start of word, you say them at almost the exact same time. Our mouth is actually ready to say two sounds together.”

/pl/ and /bl/: “Open your mouth wide and lift your tongue tip to the bumps right behind your front teeth (alveolar ridge) for /l/. Now freeze your tongue there. Don’t move it. Ready? Close your lips and keep you tongue tip high. Is your tongue tip still behind your teeth? Great! Ready? When you open your lips for the /p/ sound, then say the /l/ sound, too. Your lips will say /p/ while your tongue says /l/. They will both be saying sounds at the same time.”

/fl/: Follow the same directions for /l/ placement at the alveolar ridge. “Keep your tongue tip up high for /l/. Now lightly bite your lower lip to get ready for /f/. Is your tongue tip still touching the top of your mouth? Great! Ready? Just as soon as you start making the ‘ffff’ sound for /f/, start make your /l/ sound. They can come out together.”

SEE ALSO: It's All About That Alveolar Ridge

/kl/ and /gl/: The back of the tongue and the tip of tongue are both active. Production of /l/ is slightly retracted from the alveolar ridge because of the velar production of /k/ or /g/. “Let’s make a /k/ sound.” (Have client look in a mirror with a flashlight to see tongue retraction.) “The back of your tongue is doing the work. See how far it pulled back in your mouth? Now we’re going to see if we can make the tip of your tongue work too. Freeze the back of your tongue for /k/ and see if you can point your tongue tip up toward the roof of your mouth. Let’s see if the back of your tongue can make a /k/, while the front of your tongue makes an /l/.”

/sl/: “Your tongue stays up high for /s/ and never drops. Start your /s/ sound with your tongue tip up, and as soon as you start it, tap your tongue to the top of your mouth for /l/. The /s/ is really fast because your tongue is starting the /l/ as soon as it can.”

Some clients benefit from specific explanations of placement and movement to sequence sound combinations. Our knowledge of speech science lets us describe the co-articulatory process.

You Might Also Like...

Software Uses in Speech-Language Therapy

SLPs and educators must select the most appropriate modes of instruction for learners.

New Options in Speech Therapy Software

The ultimate goal is not to replace the need for therapy, but rather to enhance its effectiveness.

iPad Use for Children With Apraxia

Parent and SLP observations exploring the impact.

All About Apps Resource Center

Speech-language pathologists take their practice to a whole new level thanks to SLP apps.

It’s All About That Alveolar Ridge
October 23, 2015 8:19 AM by Teresa Roberts
In General American English, 30% of consonants are produced at the alveolar ridge (8/26 consonants). The tongue tip directly touches or closely approximates the alveolar ridge. We differentiate tongue movement from jaw movement, independently elevating the tongue, and isolating specific areas. We stabilize the sides of the tongue along the top molars and lightly flick the tongue tip. Alveolar sounds require lateral (side) lift and tip pointing.

/t/: Tongue tip makes direct contact with alveolar ridge to build up intraoral pressure, explosively released for sound. Remember: spelling doesn’t reflect speech production. Sometimes we think we say /t/, but we actually use a glottal stop (complete blockage of airflow), like in “mitten”.

/d/: /d/ adds voicing (vibrating vocal folds) to /t/.

/s/: Tongue tip is close enough to the alveolar ridge to form a narrow slit for rapid airflow through a narrow passageway creating high frequency sound. Tongue hovers slightly below the alveolar ridge while air flows over it. Lateral stability allows the tip to lower just enough for air to escape.

/z/: /z/ adds voicing to /s/.

/n/: /n/ adds nasal release to /d/. Velum lowers and air is released through the oral cavity (mouth) and nasal cavity (nose).

/l/: /l/ with alveolar placement, as in “light”, “look”, “lake” has tongue tip at the alveolar ridge. For /l/ with velar placement (after a vowel), as in “all”, “feel”, “pull”, the tongue tip does not lift – the back of the tongue raises toward the velum.

/r/: Bunched /r/ has retraction and tongue is humped up toward the pharyngeal cavity (back of the mouth). Bunched /r/ may have side elevation at the molars forming a central groove. Retroflex /r/ has the tongue curved (arched) backwards with the tip coming close to the alveolar ridge.

tap: A tap is rapidly stopping airflow at the alveolar ridge when /t/ or /d/ is between two vowels and the second vowel is stressed, like “data”, “sweater”, “better”, “madder” and “matter”. A tap is a fast sound that seems like something in between /t/ and /d/.

Success with alveolar sounds depends on structural and functional elements:
•    What is the relative height and shape of the hard palate?
•    Does the lingual frenulum allow for complete lifting of the tongue to the alveolar ridge with the mouth open (is there tongue tie)?
•    Are velarized /l/ sounds used in place of alveolar /l/ sounds?
•    Is the tongue able to move independently from the jaw?
•    Is the tongue tip able to tense and form a point?
•    Are the sides of the tongue able to curve inward?
•    Does the tongue rest along the alveolar ridge (mouth closed) or does it rest on the bottom of the mouth (open mouth resting posture)?
•    Are all alveolar sounds made with the tip, or are there blade productions (tongue tip placed down on bottom teeth and mid-flat portion of tongue touching the alveolar ridge)? Which alveolar sound(s) is/are the client producing with the tongue blade versus the tip?

Difficulty with alveolar sounds may result in challenges with a third of speech sounds. Let’s spend some time appreciating the significance of the alveolar ridge!

You Might Also Like...

Autism Resource Center

Autism information for SLPs, including features, multimedia, blogs and more.

E-Book: All About Autism

Download an e-book focusing on challenging behaviors for individuals with autism.

Patient Handout: Early Signs of Autism in Infants

This patient handout can help parents discern the earliest signs and jumpstart therapy.

Speaking of Autism: Across Contexts And Ages

This blog focuses on approaches and strategies helpful within therapeutic settings such as early intervention and in schools.


In Defense of Blinders
October 16, 2015 8:06 AM by Teresa Roberts

“If you’re not outraged, you’re not paying attention” is a familiar political quote, expressing a form of social commentary. Those of us who work within organizations have reasons to be outraged. We are beholden to processes and procedures designed by others. We live within complex structures with layers of bureaucracy and pre-established rules and regulations. An organization is like a mini-society.

Choosing to see a problem has risks, as does ignoring a problem. There are extremely multifaceted and systemic problems in society and within a given organization. Although there are valid reasons to feel outraged, we simply cannot function in a perpetual state of outrage.

Selective use of blinders provides control over our own cognitive resources and energies. Blinders can block out distractions that prevent you from advancing toward a goal – a metaphorical narrowing of the field of vision to focus on an immediate activity.

In an organization, there are dangers of habituating to illogical and unsupportive practices. A person could become jaded and blasé about injustices, or develop negative emotional responses (cynicism), or passive and unemotional responses (apathy).

Blinders may let us remain honest with ourselves because they may provide a sense of control over our reactions. Choosing to use blinders does not negate your understanding of a situation, as it is a technique to defer analysis to a later time. Skilled use of blinders requires recognizing them as a temporary tool:

Remember that as individuals we made a deliberate decision to operate within an imperfect system for a greater purpose.

Recognize when it is ‘time to pay attention’ to a larger problem, and when it is ‘not time to pay attention’.

Use self-talk to regulate the use of blinders: “This new (policy, software system, meeting time, etc.) doesn’t make any sense, but I need to follow it for right now in order to continue to provide services to clients. I will chose to process my feelings and thoughts later.”

Have a trusted friend help you monitor the use of blinders: “Tell me if you think that I’m ignoring big issues, or if it looks like I’ve stopped caring.” Apprentice to your former self and reflect on your early experiences working within an organization to help you maintain perspective about the stages of professional understanding of bureaucracy.

Practice taking the blinders off in a safe environment: express righteous indignation and process your feelings at periodic intervals with an understanding individual. Generate ideas and possible solutions.

Our work is challenging. Sometimes it may feel like the infrastructure that surrounds us does not fully support client and practitioner needs. We excel because we improve client welfare inside imperfect surroundings.

You Might Also Like...

Software Uses in Speech-Language Therapy

SLPs and educators must select the most appropriate modes of instruction for learners.

New Options in Speech Therapy Software

The ultimate goal is not to replace the need for therapy, but rather to enhance its effectiveness.

iPad Use for Children With Apraxia

Parent and SLP observations exploring the impact.

All About Apps Resource Center

Speech-language pathologists take their practice to a whole new level thanks to SLP apps.

Letter to a Friend
October 9, 2015 7:45 AM by Teresa Roberts
Dear Friend,

Thank you for trusting me and telling me about everything. I didn’t realize how difficult this fall has been for you. The problems you described are painfully familiar:

•    Fundamental imbalances in the amount of tasks required within the time period allotted
•    Insurmountable paperwork and documentation, and the sinking knowledge that you could easily fill all of your time with paperwork alone
•    Lack of building level support due to insufficient understanding of Special Education processes and legal requirements
•    Daily meetings before and after school extending the work day into the evening
•    Suggestions for interventions that you should implement that appear as veiled accusations of an inability to provide a sufficient level of support for students
•    Lack of respect and understanding for your training and expertise
•    Subjection to the continual rotation of administrative policies and the whims of certain administrative personnel
•    And more, because there is always more…

You told me what this is doing to you. You told me, with a quiver in your voice how you are affected:

•    Lying awake at night making lists in your head about the tasks that you are expected to accomplish the next day
•    Crying at work
•    Recognizing that your continual stress level is affecting your ability to be emotionally present when you are at home with your family
•    Fearing that you may be missing out on your own life because you are consumed by work
•    Feeling inadequate because you work hard daily and are not able to accomplish all that is expected
•    Questioning your ability to continue in this field, tinged with a thread of desperation about changing jobs, moving, changing careers, or changing anything…

You said quietly, “I think I’m burned out,” and in your distress, you lamented how much you had loved this field, this avocation, and this gift of communication that we share.

You still love this work – our fundamental clinical work. I could hear it when you told me about the students and we problem-solved tricky cases together. I sensed it when your expression changed and you smiled while sharing funny stories about student interactions. I know that you care deeply about the needs of your clients.

We work under federally mandated guidelines, which are interpreted at the statewide level, and implemented at the local level. We work within complicated, convoluted, and restrictive bureaucratic organizational systems. You are not alone in your experiences. Some of us might not talk about these challenges for fear of drowning in disillusionment.

Every year is a re-commitment to an organizational infrastructure in which we agree to abide by given mandates in order to provide therapeutic services to clients. We have all tried to make positive changes. Sometimes things change. Sometimes they don’t. We all wish that we could make it better. As you make a commitment to this school year, know that this is a choice.

We hugged when we said goodbye and we joked about compartmentalizing and disassociating. I hope that you know how much I value your friendship and how much I respect the work that you do.

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.

Advice on Giving Advice
October 2, 2015 8:57 AM by Teresa Roberts
When the right advice is given at the appropriate time, it improves lives. When off-hand, unsolicited advice is given, it may be a source of frustration. The concept of advice is to guide another person in making a decision or completing an action. As Speech Language Pathologists, we are often expected to provide advice and demonstrate expertise. We may inadvertently begin offering unsolicited advice to our colleagues, as well as our friends and family.

Sometimes advice isn’t about offering solutions, but about honoring thought processes. Early in my career, I worked in a wonderful, supportive program for children with high levels of needs. Sadly, this unique program was discontinued. I was confused and distressed. I talked to the school principal, seeking guidance and advice. As a new clinician, I had little knowledge of policy and funding issues. The principal said to me, “The fact that you care that this program is ending and that you see its value, shows me that you are a knowledgeable clinician.”

The principal didn’t lecture me about systems, revenue streams, or educational trends. She didn’t show me how much she knew about institutional practices. She let me know that there are times for advocacy and times for acceptance within one’s career, and within an organization. Most importantly, for me, she let me know that she believed in me. The underlying message that I heard, was that I was good at my job – that I was competent and capable

When we are given valuable advice, we remember it, because it changes our outlook and our self-perception. In our roles as experts, it is incredibly easy to slip into a state of offering advice continually – it just feels like it’s supposed to be our job, however a stream of recommendations isn’t always warranted.

Perhaps there are ways to give less advice in general and to start to offer the type of guidance that both teaches and inspires.

•    Give specific advice only when it is directly solicited, e.g., “Can you give me some advice?”
•    When you think that you have knowledge to offer, ask before you offer it: “I have some ideas about that, let me know if you want to hear them sometime.”
•    Recognize the value of the question and the situation: “The fact that you are thinking about this issue shows that you are aware of a lot of the important factors.”
•    Build the other person’s confidence: “Your concerns show me your dedication and commitment to providing quality services.”
•    Inspire the other person to reflect and to act: “I think that you have might have some great ideas about how to start.”

Carefully timed and well-crafted advice allows others to shine and that is what is remembered. What advice has helped you in your career and what has made it memorable.

You Might Also Like...

Software Uses in Speech-Language Therapy

SLPs and educators must select the most appropriate modes of instruction for learners.

New Options in Speech Therapy Software

The ultimate goal is not to replace the need for therapy, but rather to enhance its effectiveness.

iPad Use for Children With Apraxia

Parent and SLP observations exploring the impact.

All About Apps Resource Center

Speech-language pathologists take their practice to a whole new level thanks to SLP apps.

Describing Dialect
September 25, 2015 9:58 AM by Teresa Roberts

“Do you think that the student’s responses are affected by dialect?” I asked my colleague. We were discussing a student’s performance on a subtest that required generating original sentences given a picture and a stimulus word.

“What dialect?” she countered, “Trailer Park?”

After a momentary pause, I said, “I was thinking rural or mountain dialect.”

Linguist Max Weinreich stated that, “A language is a dialect that has an army and a navy.” Geopolitical forces, land, resources, and military, may determine what we consider to be a distinct language, and what we consider to be a dialect.

All dialects are valid systems of communication with sophisticated linguistic complexity equal to that of any language. No language or dialect is intrinsically better than another. Ranking and social standing of languages and dialects are societally constructed reflecting the speaking patterns and status of groups within a culture.

We all speak a dialect. There is no dialect-free speech. If we think that we don’t have a dialect, it is because our dialect closely resembles the established dialect of “General American English” (Midwestern dialect/newscaster dialect).

In linguistics, descriptive analysis is non-judgmental. It is a focused observation of speech and language describing observed usage. In contrast, prescriptive analysis is codifying and enforcing “correct” or “proper” ways of speaking based on pre-determined rules from the dialect with the current highest societal status.

As Speech-Language Pathologists, we are evaluative. We analyze and evaluate the communicative effectiveness of our clients. We often begin descriptively by recording, transcribing, coding, and analyzing client productions. These preliminary stages are followed by a swift shift to prescriptive, where we make comparisons between client productions and expected norms. We decide what is correct/incorrect, based on standardized testing guidelines, language sample methodologies, developmental norms, clinical judgment (experience with similar clients and demographic groups), etc.

Speaking the dominant dialect has privileges, such as access to opportunities and group inclusion. Communication goals are often based on the dominant dialect. It may be challenging to maintain the objectivity of descriptivism while engaged in prescriptive acts of conducting assessments and providing intervention.

•    Analyze your own dialect and your feelings about its status in society.
•    Compare your dialect to your clients’ dialects: notice similarities and differences.
•    Think about your initial/instantaneous emotional responses and perceptions when you hear common dialects and accents.

o    Do some dialects seem “better” than others?
•    Ask yourself about the origin of these feelings.
•    Discuss dialectal differences and social register with clients and families in neutral terms:

o    “We have different ways of talking depending on where we are and who we are talking to.”
o     “Your teacher might say it this way”, “Kids on the playground might way it this way”, “At home you might say it this way”, etc.
•    Ask families about home dialects and how they relate to communication goals.

We bring our societal framework into our work. We can question how our own cultural factors affect interactions with our clients.

You Might Also Like...

Disclosing Disability

What healthcare workers need to reveal in a job interview.

Hearing Loss in the Workforce

A clear solution for an invisible challenge.

More Than a Label

Does classifying people with developmental disabilities as severely intellectually disabled deny them opportunities?

Bilingual Care

Bilingual SLP certificate programs are imperative when providing services to a growing population of multicultural clients.

Measuring Trust
September 18, 2015 8:34 AM by Teresa Roberts

There's often a single moment in therapy when you recognize that the client now sees you as a trusted support. As clinicians, we measure clients' progress in skill development in many ways, including daily data collection, judgments of approximations, tallies and percentages of correct responses, levels of scaffolding and modeling, audio/video recordings, analyses at regular intervals, and more. Even with all of these valuable calculations, there is another important data point. We can measure the progression of trust.

In the middle of a recent therapy session, I suddenly knew that the client and I had established trust. I was working with a third grade student on his articulation of /r/. He was in middle of retelling events from class and given the context, the next word that he was about to say would be "reward". He didn't say, "reward" - he stopped talking and looked at me. He stopped himself mid-sentence and stared directly at me.

"You're right," I said, "there are two /r/ sounds. The first one sounds like ‘ree', then there's a ‘w' and the second ‘r' is like ‘ord'." I slowly said the word, separating the syllables and exaggerating the mouth positioning. The student imitated me. He then resumed his story as if nothing had happened.

We had been practicing the /r/ sound for a little over a month. At the beginning of therapy he had reported that he couldn't hear the difference between /r/ and /w/, or between different mid-central vowel distortions for vocalic /r/. We had been making steady progress with ear training, tongue positioning, and self-monitoring. This moment, however, was special. It was a milestone in therapy. It represented trust. The client recognized when he would have difficulty and trusted me to help him.

SEE ALSO: Treating the Family 

Throughout the intervention process, clients may be moving through their own stages of understanding, as if their acknowledgement of the need for help with communication is its own version of the grieving process:

  • Initial awareness of challenges
  • Readiness and comfort describing challenges to clinician
  • Expression of desire for change
  • Responsiveness to therapeutic techniques and strategies
  • Prediction of areas of difficulty
  • Seeking support from clinician
Clients may initially report that they don't have any communication challenges and we may spend early sessions discussing the importance of therapy. Recognizing and verbalizing that you have any difficulties is an emotional process that often requires vulnerability and a sense of safety. Subsequently looking to another person for help involves trust. Clients show us in different ways when they are ready to turn to us for guidance. Requests may be direct or indirect, and sometimes clients ask for help by not saying anything at all. Our awareness and perception of clients' progression of trust allows us to measure their level of understanding and their participation in the process. Development of trust alone indicates substantial progress.

You Might Also Like...

Software Uses in Speech-Language Therapy

SLPs and educators must select the most appropriate modes of instruction for learners.

New Options in Speech Therapy Software

The ultimate goal is not to replace the need for therapy, but rather to enhance its effectiveness.

iPad Use for Children With Apraxia

Parent and SLP observations exploring the impact.

All About Apps Resource Center

Speech-language pathologists take their practice to a whole new level thanks to SLP apps.

Search That Fact
September 14, 2015 2:01 PM by Teresa Roberts

Imagine a contemporary trivia game show with teenage contestants pitted against each other to see who can find information the quickest. The host asks a series of factual questions across content areas (history, literature, science, music, etc.). Contestants type key words on their cell phones, which appear on large monitors placed above their heads for the audience to view. The winner is the one who is the most adroit at using a search engine to pinpoint the correct answer.

The ability to memorize has given way to the ability to search. A search engine is a database of web documents that are sorted using a mathematical algorithm to determine relevance. Search engine research requires an individual to determine the most salient characteristics of the fact needed, and the key words that the database will have pre-coded as relevant. 

For example, in science class you learn that crickets tell the temperature, as the rate of crickets chirping mathematically corresponds to degrees. You can’t remember the equation and want to find it online. There are a minimum number of keywords needed to type (or speak) into a search engine to find the equation. You don’t need to compose a full question: “What is the equation for the rate of crickets chirping to temperature?”  You need to generate two or three key words, or parts of words. The minimum for the crickets may be “cricket chirp temp”, which will provide you with the equation on the Farmer’s Almanac website (count the number of chirps within a 14 second time span and add 40 to get Fahrenheit).

SEE ALSO: Teaching With Mobile Technology

Specific skills are needed to find, evaluate, and share information using a digital medium. A student needs to complete a series of sequential tasks:

•    Recognize the information required
•    Formulate a question
•    Identify the key words from the question
•    Distill the key words to the minimum needed for search engine recognition
•    Type the words into the search engine
•    Scan a series of results
•    Evaluate the top results for relevance (disregarding non-relevant results)
•    Navigate to the webpage with the expected answer
•    Scroll the webpage to locate the answer (ignoring non-relevant information)

Perhaps we could help students evaluate their own ability to locate information. We could provide cross-curricular questions and practice identifying key words. As a group, we could identify the minimum number of key words needed to determine the answer. Each student could offer key words. We could compare key word suggestions for similarities and differences and discuss interpretations of relevant concepts. We could test the key word combinations using a common search engine. Further lessons could target rapid scanning of webpages to locate information. We can address language goals of identifying key concepts and vocabulary, and locating relevant information digitally. There are numerous important lessons around the use of virtual mediums, including safety, authenticity, social media, etc. We can begin with the search.

What We Actually Do
September 4, 2015 10:59 AM by Teresa Roberts
A colleague told me that during the first Special Education staff meeting of this school year, an administrator pointedly asked her, "What is it that you actually do?" The principal was questioning team members about their individual roles and the services they provide for students. Members of the team were responding by listing curriculum kits and standardized intervention approaches.

As my colleague attempted to explain the fundamentals of articulation therapy and language therapy, she became distressed and uneasy. The principal stared at her and said dismissively, "That all sounds wishy-washy to me."

Education and Speech Language Pathology, like most disciplines, use a high level of jargon. People outside of the field will not have a sense of the breadth of services and supports offered. A complete description of the work that we accomplish across skill domains would be too extensive to provide an unfamiliar listener with a clear understanding.

We can answer questions about our work with a variety of examples distributed over time. Having a sentence that encapsulates one aspect of the field may help others understand how communication is inherent in learning and social relationships. Prepared sound bites may work like snapshots, giving another person a quick glimpse into all that we do. We can describe our activities in a succinct and confident manner.


  • Provide services for the five domains of language: (1) semantics (vocabulary), (2) syntax (sentence structure), (3) morphology (word forms and grammar), (4) phonology (sounds), and (5) pragmatics (social language)
  • Collaborate with Special Education teachers to use curriculum extension activities to increase skills in the language areas of semantics (vocabulary) and syntax (sentence formulation)
  • Co-teach lessons with Special Education and General Education teachers targeting pragmatic (social language) skill development for peer interactions


  • Offer literacy intervention in oral comprehension for students with language/learning needs
  • Lead whole class lessons in kindergarten and first grade on phonological awareness
  • Co-teach activities with the kindergarten and first grade teams for story narratives and sequential markers for story organization


  • Teach students placement of the articulators of the mouth for correct sound production
  • Partner with teachers and families for carryover activities to practice speech sound production


  • Teach students techniques to shape rhythm and smoothness of speech production


  • Teach students vocal health and hygiene fundamentals, and safe vocal use

Augmentative and Alternative Communication:

  • Partner with students and staff to provide meaningful opportunities to use dedicated voice output devices for interactions throughout the school day

Autism Spectrum Disorder:

  • Teach students social expectations, organizational systems, and conversational strategies for peer and academic situations

There are many more domains and examples to be shared. We can subdivide elements of our roles into manageable pieces, sharing tidbits throughout the school year. We are highly trained and we are specialized. We are able to speak with authority about the discipline of Speech Language Pathology. Every time the team meets, we can share just a little bit more about what we actually do.

Belonging in Competition
August 27, 2015 1:58 PM by Teresa Roberts

Competition may be inherently divisive and alienating, as people are sorted into predetermined roles based on “winning” and “losing”. People handle competition in different ways, and some types of responses are more successful than others. Ideally, we gradually learn to manage our frustration when we don’t win a game. Recently, I was touched by one student’s empathy, and his attempts to resolve a situation when two of the other students in the group began quibbling about the game.

This student’s initiative prompted us to put together a short book about “How To Be an Awesome Game Partner”. We examined competition from three different angles, (1) mindset or cognitive framework of the concept of game, (2) resilience and positive self-talk, and (3) self-regulation and problem solving. How you view a specific situation may shape how you interpret the outcome of events. The ability to self-soothe and provide oneself with affirmations may be a key part of resilience and the ability to attempt new and challenging activities. Self-awareness of one’s own state of being and generating solutions to manage emotional states is part of self-regulation.

Students offered suggestions based on guided prompts.

Cognitive Framework: “What are different ways to think about what happened in a game?” and “What are different ways to think about winning and losing?”
•    Remember it’s just a game. It’s not real life. It’s not like the “Hunger Games”.
•    You gotta believe you’ll have a chance. If not today, then maybe another day, or maybe in a little bit.
•    Sometimes people get lucky in a game so it’s not always fair.
•    Think about the times that you’ve won before and know that you will win again.
•    Think about things you’re good at.

SEE ALSO:  Building Sounds One Block at a Time

Resilience: “What could you say to yourself to feel better?”
•    You’re doing good.
•    At least you did your best.
•    Second place is good.
•    You gave it effort.
•    You’re still a winner inside.

Problem Solving: “What could you do if you get upset while you are playing a game?”
•    Take a short break
•    Take a walk
•    Write it down
•    Talk to the teacher about it
•    Stop the game

As a group, and as a team, we created guidelines about how to view competition. The collaboration involved in the project established a sense of unity toward a common goal and a shared understanding. This new sense of community may have helped students feel that the entire game experience is a part of group belonging, instead of a solo act. As clinicians, we infuse multiple objectives within single lessons, with long-term goals around developing successful life strategies. Sometimes the lesson we had planned becomes less important than the lesson that emerges.

Beginning With Goodbye
August 21, 2015 9:50 AM by Teresa Roberts

There’s always a small thread of sadness mixed in with the happiness when a client completes therapy.

Our relationships with students are temporary. Sometimes they last a few years, and sometimes they last a few months or less. Yesterday, a student who has been making excellent progress on her articulation asked me, “What happens when I’m finished with my R’s?”

“You don’t need to work on any other sounds. Your R’s will sound awesome all the time. You’ll be a rock star!” I replied.

I think that she was really asking me if we would ever spend time with each other again after she finished with her R’s. Perhaps she already knew the answer.

Students may move, our job positions may change, and hopefully, in many cases, students graduate from speech. As clinicians, we understand and accept that these relationships are transient and that is reflected in our very title of “Itinerant”. We work quickly to establish rapport, which means that we make a meaningful positive connection with another person (each client). We are skilled at developing the clinician/client relationship because we care and our feelings are genuine.

 SEE ALSO: Summer Camps Address Speech and Hearing

There are many different ways to conclude these relationships and to say goodbye. Most of us celebrate the accomplishments of our clients, and the ending is marked as a new beginning. We make assumptions that many of our clients understand the nature of the short-term therapeutic relationship.

We often do not know what our time with clients has meant to us until much later, as we incorporate everything we learn from each session and each new client into our practice, steadily increasing our clinical skills. We may never have the opportunity to know what our time with our clients has meant to them and how it has affected their lives.

Should we begin clinical interactions with the awareness of the limited duration of the relationship?
•    “I’m glad that we’ll be able to spend a little bit of time together to work on your sounds.”
•    “It will be fun to play together for a few months to work on your speech.”
•    “We can do a lot of cool stuff together during this school year (or while you are in X grade) to help you learn new words.”

Should we add closure rituals to the concluding sessions that honor the reciprocal nature of our work?
•    “I’m going to tell you some wonderful things I learned from spending time with you. You can tell me what you learned, too.”
•    “I loved spending time with you. I really thought that it was fun when we (add activity). What did you think was fun?”
•    “It’s been great to see you every week. I’m going to miss your (add positive traits), and I’m glad that we got to hang out together.”

Saying goodbye in any relationship carries an emotional element, whether it is one of many goodbyes or part of a formative time period.

Even after all these years, there’s always a small thread of sadness mixed in with the happiness. How do you say goodbye?

You Might Also Like...

Tele-Therapy for Deaf Children

Internet therapy sessions train parents to foster hearing skills.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Going Online

The untapped wonders of online speech therapy.

The Sky is the Limit

Using technology, SLPs are exploring new territories and reinventing their practice.

Winning the Job Lottery
August 14, 2015 8:04 AM by Teresa Roberts

“What would you do if you won a million dollars?”

A few years ago I was working with an entertaining group of fifth grade students who were practicing producing their speech sounds at the sentence and conversational level. We were taking turns answering social questions from a deck of cards. We turned over the card with the question, “What would you do if you won a million dollars?”

Each of the students shared their fantastical ideas about what they would do if they won the money, then one of the students turned to me and asked me what I would do. I suddenly realized that I wasn’t sure what I would do. Another one of the students smiled and announced to the group, “Well, she certainly wouldn’t be here with us!” and we all laughed.

I’ve often wondered about the student’s comment that I wouldn’t be working as a clinician if I received sudden riches. It’s common for people to daydream about a life without worry that appears to be promised with independent wealth. Waking up everyday and spending long hours balancing client contact, documentation and compliance paperwork, staff interactions, and organization/institutional practices, isn’t easy. Sometimes we see work as mainly burdensome and taxing, instead of seeing the beneficial reciprocal relationships that exist, as we are enriched through clinical interactions.

There are two ways to consider the idea of imaginary, newly found wealth that may provide insight into one’s own clinical values and career identity. Therapeutic services are often within the guidelines of a predetermined system, which is rarely as fully funded as it could be. In times of perceived scarcity, it may become easier to focus on limitations than on possibilities.

SEE ALSO: Metacognition & Success Mindset

Thinking about your work without any limitations may open up freedom of thought.

•    What would you want to change about your job if you had the resources to make many more things possible?
•    In what ways might you change your professional life?
•    How could you improve your daily practice if you had unlimited resources?

Releasing ourselves from superimposed boundaries may help stimulate creativity and identify what we value. Our work includes aspects of altruism (public service), self-improvement (professional development), creativity (materials generation and intervention), interpersonal skills (client rapport), and much more. When we brainstorm about what we would do and what we would change if we had access to financial resources, we might learn where we want to put more of our clinical energies.

Another way of examining the question of what you would do if you won a million dollars is “How would you feel if you could never work as a clinician again?” Having the identity of a practitioner carries meaning. It may even be a source of pride. Our work is often difficult, but it is meaningful and important work. We believe in what we do. Even if we don’t win the million dollars, perhaps we have all already won the “Job Lottery” because speech language pathology is a fulfilling and stimulating career.

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.



About this Blog

    Speech in the Schools
    Occupation: School-based speech-language pathologists
    Setting: Traditional and specialized K-12 classrooms
  • About Blog and Author

Keep Me Updated