Thursday, April 16, 2020

Remote Learning Packets

Hello! I hope everyone is staying safe and healthy in this "pandemic!" It's a crazy world out there right now. I remember when I said I was so glad this baby wasn't going to be born during flu season. But now it's looking like he'll be born right in the thick of all this! Ugh!

Anyway, I wanted to talk about remote learning. I know a lot of school districts are rolling out tele therapy programs to serve their students right now. However, I live in an incredibly rural area and tele therapy just isn't an option for many of the students around here. It often has to do with internet access. In fact, until about a year ago, I couldn't even get reliable internet access at my own home. And now that we have it, it's pretty expensive in comparison to some of my friends in more populated areas. Therefore, a lot of the school districts around me are using "remote learning packets" to make sure these kids are being served.

The district we live in is currently doing this, as well as many of the districts my friends work in. Basically, our school district has a packet pick up time two times per week. Each teacher prepares a packet for each student in their class. Service providers add additional activities to the packets for the kids they serve. The parents can pick up the packets when they come to pick up their food distribution for the week. Or they can pick up the packets during one of the two allotted times. If they don't pick their child's packet up by the end of the week, it is mailed to the child's home. They can return it the next week when they pick up their new packet or mail it back to the school.

While it definitely isn't as interactive or supportive as being able to see your students through tele therapy, it's better than nothing for those kids that wouldn't be seen at all. I'm not saying that every family completes the packets or even looks at them. But it is a great resource for those that do!

Anyway, I thought I would round up a list of TPT products that would be good for this type of learning - some from my store, but many from other people's stores. I have seen lots of lists for tele therapy materials, but not as many for remote learning. Hopefully, you find something that you can use!

I'll start with preschool language.

Here are some preschool articulation ideas.

Elementary language ideas.

Elementary articulation ideas.

Social Skill Ideas.

All of the resources I linked are either no prep or partially no prep. You can just print what you need to add to each child's individual packet!

This whole process is crazy! How do possibly prepare for an entire school shutdown?! But, yet, here you are. Making this whole process look easy and making sure your students have everything you need. You all really are superheroes! 

Sunday, February 2, 2020

Speech Therapy in the School vs. Pediatric Outpatient Setting

Recently, I mentioned that I had made the switch from schools to a pediatric outpatient setting. I have found that there are LOTS of differences between the two, but I have loved my new position. I have been at my "new" job for about 18 months now, so I feel like I have a good understanding of all the responsibilities and expectations at this point. I feel like I made the best decision for me and my family. But I also know that everyone's situation is different. I thought I would write about some of the differences I've encountered so that others looking to make this switch or trying to decide between the two for a first job could have some more information.

1.) 1:1 Ratio - In schools, I did push in therapy in the preschool classrooms. Pull out therapy was typically in groups of 2-4 kids. My school was short staffed, so I was way over the state limit on students. At one point, I had 96 kids on my caseload. I usually had around 75-80 kids to see in a week. At the hospital setting, I only do pediatric outpatient with one patient at a time. I can give my undivided attention to that one patient. I only see about 28 patients per week (I work 32 hours per week).

2.) Parent Involvement - In schools, I may never meet some of my students' parents. If they didn't come to the annual IEP meeting or parent-teacher conferences, I didn't see them. I tried to make an effort to communicate with them via parent handouts, but who knows if they actually saw them. Because a caregiver has to bring the patient to the hospital, I get a chance to touch base with them at each session. Some parents come back to the therapy room and participate in the activities. If I send home a parent handout or homework, I know the parent got it because I hand it right to them after the session.

3.) Insurance - In schools, if a kid qualified for services, they got the service. That's not so much the case in hospitals. Someone has to pay for these services. If their insurance won't cover it, they don't get it. Insurances will often have a set amount of visits that they will pay for. If your patient hasn't met their goals yet, you can request more. But no promises that you'll get them. That can be frustrating when you know a kid needs a little more help. You also have to meet deadlines and what not with insurance, much like IEPs.

4.) Patient types - In schools, you typically work with a specific age range. For the first few years that I was in schools, I worked with preschool - 3rd grade. When we became short staffed, I had preschool  - 8th grade. My pediatric setting sees patients aged 0-21. I currently have no patients in middle school or older. However, I know that this is a possibility in the future. Also, because we see patients under 3, the hospital required that I get my Early Intervention certification upon hire (paid for by them). This often allows us to bypass insurance for those little bitties to ensure they get the services that they need. I had not worked with patients that little before, so it is definitely a learning experience for me.

5.) Work at home - I have literally NEVER brought work home from the hospital. I have stayed late at work to finish things before, but I am paid hourly so no big deal. And it was never REQUIRED of me to do that. In schools, I was contracted to work from 8-3:45. I often got to work at 7:30 and worked until 4:15-4:30. And still brought stuff home. I was salaried, so I didn't get paid for all that extra time. The full time SLPs that I work with are salaried. If they stay late, they aren't necessarily getting paid for that. But our hospital recognizes that and will make concessions later. For example, if their last patient of the day cancels, they can leave early without taking vacation time.

6.) Productivity - The hospital does have a "goal" of 75% productivity. So, if I am at work for 8 hours, my goal is to be doing something billable for at least 6 of those hours. It can be hard in outpatient. When the weather is crummy, you often have a lot of cancels. However, the productivity is averaged across the month. So you'll have other, busier days that will balance it out. It is important to note that I feel like my hospital has a very reasonable productivity goal. When I talk with therapists doing inpatient at other hospitals or SNFs, I find that they are often at the 85-90% range. Furthermore, our hospital treats this as a goal. If you meet it, great! That will be reflected in your annual review and performance raise. If not, that's okay - unless of course you're at some ridiculously low amount. I have never had anyone question my productivity, even when it was lower.

7.) Paperwork - There is so much less paperwork at the hospital - which really shocks me! In schools, I did a daily note for each student. We had an annual IEP. Every three years, we went through the evaluation process again. Then I had a separate area where I went in to bill Medicaid for students. There was progress reporting to be done each quarter. At the hospital, I still write a daily note. However, the insurance billing is built into that program. So it takes me a few seconds to bill. We evaluate annually, but you don't have to have so many meetings and do so much paperwork just to get permission to evaluate. I do progress reports when their insurance asks for it. One insurance company that we work with wants a progress report every 12 visits - around every 3 months. That is the most frequently that I have to do them. Plus, not every patient's report will be due at the same time.

8.) Possibility of inpatient - When I took this job, I knew that there would be a possibility of covering inpatient in an emergency. We have an inpatient SLP and a PRN SLP that does inpatient as well. We are never "on call." However, if the inpatient SLP has an emergency and the PRN SLP can't cover, I know that I might have to cover. This has happened once since I started and that was only because our PRN SLP was on maternity leave. I don't love doing this, but I am comfortable with it. Not to mention, it is highly appreciated by my boss, the doctors, and the inpatient staff.

9.) Frequency of therapy - In schools, I often saw kids for 20-30 minutes, 2 - 3 times per week. In hospitals, I see them for 45 minutes to an hour, 1 time per week. Most insurances will only give enough visits for 1x per week. I can see them more times per week if their insurance will allow me. There is no hospital rule against that. It just usually comes down to insurance and parent availability.

10.) Scheduling - Scheduling in both places can be a nightmare. Schools are hard because there are so many kids and so many restrictions about when you can take them. Then a new kid moves in, another kid moves out, you pick up 5 more kids, and discharge one kid. It is always changing. Hospitals present a different set of challenges. When you're working with school aged kiddos, it's hard to find a time that they don't miss school. Many of mine are under 5, so that makes it easier. But you are still counting on parents to bring them in for therapy. Parents may not be able to get the time off work or have reliable transportation.

11.) Caseloads - My state has a cap of 60 students per SLP. However, if a student needs it, you are often required to provide the service whether or not you are over your cap. Since you are federally mandated to provide those services, that often outweighs that state cap. We were short staffed, so I often had 75-80 kids on my caseload. The attitude is very much that if a kid needs it, you figure out how to get them the service. Even if that means sacrificing your prep or lunch or whatever. In the hospital setting, I pick up new kids until my schedule is full. At that point, the patient goes on a wait list. When we have a new opening, we call the first person on the wait list. There is no scrambling to squeeze them in somewhere.

12.) Teamwork - I am lucky that the hospital I work at has a whole pediatric outpatient department. I work with 2 other SLPs, 3 OTs, and 2 PTs. Our desks are centrally located, giving us a chance to catch up and share info throughout the day regarding patients that we share. However, I still feel like I miss a lot by not being able to regularly talk with my patients' teachers. We can get releases to talk with them, which we often do. However, it's a lot different than being able to quickly check in throughout the day. Some of patients do not receive any other services, so I really don't get a chance to collaborate as much with those kiddos. Our state's Early Intervention program allows for collaboration between professionals seeing that patient without releases. They also allow you to bill up to one hour per month for these conversations.

13.) Vacation time - When I made the switch, I worked in my contract to have every Friday off. I work 9-5 Monday through Thursday. This comes out to 208 days a year if I never take any vacation or holidays. In the schools, my contract was for 185 days. So I work about 23 more days a year. I also get vacation time, even though I am considered "part time." My vacation time is based on the number of hours I work. At the end of each pay period, hours are "deposited" into my vacation bank based on the hours I worked during that pay period. Right now, I earn about 4 hours per 60 hours worked. That will go up the longer I work there. Our outpatient therapy setting has a pretty relaxed policy about time off. I have never had an issue with requesting a day off. In schools, I got two personal days and 10 sick days per year. More time was able to be rolled over in the school. When I left I had about 50 sick days, but still only 2 personal days. As I am getting ready to face maternity leave, I am missing those 50 sick days! So hospital = less time total, but the time can be used for anything.

14.) Pay - I was working in schools in a state that had very poor education funding. For those extra 23 days a year I am working, I am earning about $35,000 more per year. Worth it. Right now, I am getting raises 2x per year. I will get a "years of experience" raise for 3 more years at the anniversary of my hire, assuming that I am in good standing. I have also gotten a cost of living + "success sharing" raise each October of 3%. This number can change from year to year. We also typically get a "success sharing" bonus in October if we meet so many of the hospital's goals. The amount changes from year to year, but this year it was $500. At the school, I received a 3% raise each year. I could also increase my pay rate by moving across the pay scale as I took more classes.

15.) Benefits - My health insurance is way better and way more affordable than what was offered at the school. The difference saved my husband and I about $350 per month in insurance premiums. We do not have co-pays if we use a primary care doctor within our health system. I feel like we spend less on health related expenses. We'll see how this year goes with having a baby! We also get short term disability insurance and life insurance paid for by the hospital. The hospital currently gives me 3% of my salary into retirement whether I put anything in or not. This amount will go up by 1% every 5 years that I work there until it hits 7%. They will also match your contribution for the first 3%. So right now, if I put 3% into retirement, they will put 6% in (3% match + 3% years of service contribution). My state required a 9.4% contribution into their pension system. I was required to put the full 9.4% in.

Overall, the benefits have outweighed the risks for me. However, it is important to note that when I made this switch, I didn't have any kids. I know that being on the same schedule as your children is invaluable to some. I also want to reiterate that I was coming from a school that was incredibly short staffed. A lot of extra responsibilities were being dumped on me with little to no support to handle them. It wasn't necessarily the school's fault. There is a shortage of SLPs almost everywhere. Plus, I worked in a high poverty school that people weren't exactly banging down the door to come to (but I LOVED it dearly). And our administration was locked into a union contract that was atrocious for SLPs. Since then, they have re-worked that union contact successfully. This has allowed them to fill some of those vacant positions.

If you are thinking about switching settings or trying to choose between the two, I hope this helps you! Make sure you ask lots of questions. Ask to talk to other SLPs that work there. Ask to observe the working environment. A place that has nothing to hide will let you do that. My direct supervisor was the one interviewing me, so I got a chance to get a feel for him, too. If it's not your direct supervisor doing the interviewing, ask to meet them. A great job can be ruined by a crummy supervisor. I also got to meet the person who would be mentoring me those first few weeks and ask her questions. Like I said, a place that has nothing to hide will have no problem with you doing that!

Good luck! :)

Sunday, January 12, 2020

Big Changes!

Hi -
Long time, no see. Sorry I've kind of abandoned this blog lately. Life has been a bit crazy, but I made a New Year's Resolution to post here more regularly. So, here I am! I thought I should do a little update on all the new things going on in our life!

1.) I switched jobs! This isn't really a NEW thing, as I made the switch about 18 months ago, but I never wrote about it. I switched from a school setting to a pediatric outpatient setting. It's a lot different, but so amazing. I work part time now (about 30 hours per week) and don't work on Fridays. But I gave up my summer's off and Christmas break. I loved my school job, but more and more responsibilities were getting dumped on me. I really felt like my quality of therapy was suffering. This new job sort of fell into my lap and it was too good of an opportunity to pass up. I feel like I have the time and resources to be a better therapist. Maybe sometime I'll write more about the differences between the two settings.

2.) We're remodeling our home! I am thankful that my husband owns his own construction business and is doing most of the work on his own. We are adding two bedrooms, a bathroom, some storage, and a dedicated office space to our tiny little home. It's adding about 550 square feet! I'm so excited to have a little more breathing room and to start decorating!

3.) Perhaps the most exciting, we're having a baby! Our little guy is due in May! We are so excited and so in love already!

Thanks for stopping by! I hope all is going well for you and that 2020 will be a year full of blessings!


Monday, March 19, 2018

Easter Speech-Language Therapy Plans

For the next two weeks, I'll be doing an Easter theme in my speech therapy room. I know a lot of districts do not allow for an Easter theme, but I am still allowed to in my district. Many of these activities could be spring related or a bunny theme. Anyway, here's what I've got going on! 

1.) For my early elementary/pre-k articulation kiddos, we will be doing an Easter Sensory Bin. I use this interactive articulation activity from The Speech Attic.

I put the cards in my rubbermaid with some green Easter grass and the kids LOVE it! I usually throw in a few eggs with tiny objects hidden inside. 

2.) For my older articulation students, I will use this Easter NO PREP Articulation Packet. It contains a variety of worksheets for each sound. I can use some in therapy and send some home for practice. 

3.) I picked up these confetti-filled eggs on clearance after Easter last year. I think we will take them outside for an egg-toss type game with some of my social skills groups. I think it will be a good chance to practice team work, problem solving, winning/losing gracefully, etc. 

4.) For my language students, I will use this set of language worksheets. They are mostly low/no prep. I can use them with nearly every language student on my caseload. You can also buy the open ended game separately here.

5.) I also have some fun games and activities planned. We will play Jumping Jack and color chalkboard eggs. The little booklet is part of this packet of push in therapy books for the whole year.

6.) We will also be reading some great books like "There Was an Old Lady Who Swallowed a Chick" and "Creepy Carrots." Those are my two favorites for Easter time. There are tons of great book companions out there for "There Was an Old Lady Who Swallowed a Chick." Do a quick TpT search to find something that would work great for your caseload. 

And those are my Easter therapy plans! I hope you find something you can use in your own therapy room! :) 

Tuesday, February 27, 2018

Food Themed Speech and Language Lesson Plans

For the next couple of weeks, I will be doing a Food/Cooking Themed Unit in my therapy room. The skills and vocabulary covered in this unit is beneficial for so many daily life skills. They can apply so much of what they learn in the real world. But we can also have TONS of fun with this theme. Anyway, here are my plans.

1.) For many of my articulation students, we will do some interactive articulation activities. I love these activities because they are motivating, fun, and they usually incorporate some kind of fine motor work as well. I have two that I use with my Food Theme. The first one is "Grill It Up!"

The kids can "grill" their burgers and hot dogs. They can "flip" them with a little spatula. I just use a cooling rack to serve as the "grill." You can find it here.

I also have a cookie version that the kids LOVE. It pairs well with the book "If You Give a Mouse a Cookie..."
You can find it here.
2.) For my language kiddos, I use this packet that contains a TON of worksheets to target various vocabulary, concepts, wh questions, categories, verb tenses, pronouns, social skills, Tier 2 vocab, listening comprehension, and more. It also contains a quick parent handout and a bingo game to use with any flashcard set.

This packet is a life saver! I can use it with nearly EVERY student on my caseload. Most activities are black and white, no prep worksheets. But there is a nice mix of color flashcards, a bingo game, and a pronoun activity that you can prep once and use again and again. You can find it here.

3.) I also love some good games in therapy! We will play these games throughout the next couple weeks.
I will pair these games with articulation and language card decks just to make therapy more motivating. I also have These Candy Town Language Cards from Jenna Rayburn at Speech Room News to pair with Candyland. I own both language sets and the phonology set. They are great! I know there are some good companions available on TpT for Yeti in my Spaghetti as well. I just haven't purchased one yet to give a recommendation. And, perhaps the most favorite game in therapy, Pop the Pig! 

4.) We will use so many books in therapy! Here are just a few of my favorites!
That "Healthy Eating" Mini Book is from this resource. It's an awesome packet of themed mini books for push in therapy. And I love them!

I also have a felt pizza set that I pair with Barney Bear's Pizza Shop as well. I guess I just don't have a picture of it. But I do love using this resource with it as well. I have no idea where I got it, so if someone knows let me know and I'll give them credit! But it's great. I use it for categorizing and basic vocabulary. 

We will also use the "If You Give A..." series of books. I have a great companion for "If You Give A Dog A Donut." You can find it here.

5.) I also love some good picture scenes. These are the ones I use. They are both from sets from Katrina Bevan.

6.) Interactive books are WONDERFUL with my minimally verbal students or any student that benefits from some visual support. I have this packet of 5 interactive books that I use a lot. 

7.) I like to use the Peekaboo Fridge App with my students using symbol support to communicate. It's also great for kids with lower vocabulary levels. I pair it with some Boardmaker symbols to work on answering questions and commenting (I see ______). 

8.) And, of course, play food for DAYS! You can get so much language with a good play food set! I have the Melissa and Doug wooden sets. They are a bit more expensive, but so worth the money. The velcro ones that can be cut apart are awesome and highly motivating for kids. We work on requesting the knife, counting, color words, turn taking, etc. I also have the sandwich sets, which are fun. We work on seeing who can make the "tallest" or "biggest" sandwich. We also stack items "on top" or "under" sandwich pieces. I also have a set of play dishes that we can use as well. If you are doing inclusion, most Pre-K classrooms already have this stuff in them. No need to buy anything new! 

Those are my plans for my Food and Cooking Unit. I hope there are some ideas you can implement. What are some other fun Food Themed ideas??