Category: Reflections

Join the Fun – A Guest Post by Lori Yauch MA CCCSLP

Join the Fun – A Guest Post by Lori Yauch MA CCCSLP

Join the Fun!

WELCOME TO THE NOVEMBER 2013 EDITION ~

This month the Road to Reminiscence takes another detour, this time to Illinois for The American Speech-Language Hearing Association (ASHA) Annual Convention.

We packed are our bags, boxes and Guidebooks to the Classic Movie Musical and heading to Chicago. November 13th – 16th.

Come visit us at McCormick Place for 3 days of fun and information as we share Booth #2210 with our friends from Clinical Colleagues Confidential.

The Movies and Music Guidebook will teach you how to utilize 12 classic movie musicals to promote communication and engagement in your clients.

Turn watching a movie into a great interactive event that will have your clients engaged, laughing, talking, reminiscing and dancing in their seats. Foster increased communication, conversation and long-term memory.

If you’re thinking…I haven’t the time to prep such an activity! Movies and Music has prepared all 12 activities for you! Just gather your residents in front of the DVD player, pop in the DVD, grab your guide and go! Nothing is simpler or more fun!

“This is one of the simplest and most entertaining activities I have ever done. I highly recommend it to clinicians working with adults/geriatrics, regardless of the setting. You will not be disappointed”.
Lisa C, M.S., CCC-SLP, New Bedford, MA

At MassCap in October, an activity specialist was heard to say, “I don’t show movies to my residents because they fall asleep”. After visiting Movies and Music and discovering that movies could be source of engagement and that the Guidebook could provide an entire year of programming for 3 dollars/ month she became a convert!

Become a Convert! Visit Booth 2210 and join the fun!

— Lori

PS: While you’re visiting like us on facebook (https://www.facebook.com/pages/Movies-and-Music/196819043698265) and follow us on twitter @MoviesandMusic2. You can register for a chance to win a Movies and Music promotional prize.…

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Conflicting Emotions

Conflicting Emotions

by Marguerite Mullaney, MS CCC-SLP and Lisa Yauch-Cadden, MS CCC-SLP

This entry of REFLECTIONS brings the founders of this website together once again following some disappointing news…

Lisa Yauch-Cadden and I met in 1999 when the SNF world was freezing to death in the new ice age of PPS. I was doing per diem with every company operating in MA because all the full time positions vanished between midnight December 31, 1998 and 12:01 am January 1, 1999. Lisa was the SLP Regional for a company that no longer exists and whose name is better left in the past.

My life was in a spiral. Lisa doesn’t know, at least she didn’t until she read this draft, how close to pulling the plug on my own life I was that winter day in 1999 when we spoke by telephone. The telephone was one of those super heavy Nokias which could be used as a weapon if some ruffian set upon me. I was in more danger from the internal bully egging me on to end my temporary misery with a permanent solution.

I was in the front seat of my car watching the gentle waves of Dorchester Bay near Castle Island in South Boston. Lisa was driving somewhere in southeastern MA. She was giving me a quick run down on what PPS was all about and how it would impact my service delivery.

To be honest, I was only half listening. My mind was stuffed with grief over my father’s death just 19 months before and all the things he left undone: a distraught and broken wife, a physically handicapped son, a mentally ill son, an incarcerated son, and very tiny grandchildren who needed every adult in their little lives who could feign normalcy, to do so. Then there were his bills. Hundreds of thousands of dollars with nobody to pay them except my sister and me. So, the collapse of healthcare and the resultant destruction of my steady, reliable paycheck could not have come at a worse time. Yet, there I sat in the frigid cold front seat of my car, having decided that today I would not just walk into the sweet Atlantic and end it all, listening to the confidence Lisa expressed about the future.

Surely, she was a mad woman.

Her advice resonated though. It made wonderful sense in a world of senseless new rules. The advice was, in fact, brilliant. It gave me a path forward from the professional and personal hole I was being consumed by.

“Just treat your patients. If we all just take care of our patients then everything else will flow from there.”

So, I decided that this SLP radical I was talking to, while she tooled around in the land of Lizzie Borden, might be on to something. And, if she wasn’t, I could always walk into the sea on another, warmer day.

That year, following Lisa’s ‘just treat’ advice, I made more money than in the previous two years or the following year as a full time employee for one company. The success of it went very far in restoring some stability in my still overly complicated life.

Lisa and I didn’t touch base for a few years following that call. The company she worked for folded and her supervisors opened a new group. They were planning to do it right. Patient care first. I initially inquired about work with them but the office manager was kind of … difficult and the pay rate was a little less than ok. But, then after a few months they advertised for a per diem at a place less than 15 minutes from home. I could take a few dollars less and a snippy receptionist for a clean SNF 10 miles from my front door.

Lisa met me on September 15, 2001. The country was in chaos. I was less suicidal than during our previous conversation but everything else in my life was just as complicated. It would have been the 48th birthday of my brother. He died 10 months before, leaving my sister and me heartbroken and lonely. I thought I was meeting Lisa for an interview. Lisa arrived with the employment forms and launched into my Orientation while I filled the materials out. When I asked her if this was an interview, she looked stunned.

“We already know each other. Why rebuild the wheel? Besides, there are patients waiting to be treated.”

So, that first day was Interview, Orientation, an eval and three treats all wrapped into one. It sounds crazy but Lisa’s confidence in “just treat our patients” made it seem silly not to do it the way we had. Besides, it was great to hear that certainty of the path forward again.

For the next two years Lisa and I developed a model which placed one SLP in each SNF. The ratio of therapists to buildings went from one therapist to nine buildings to one therapist per one and a half buildings. We were flourishing and growing. It was amazing. We started a CF program and launched the careers of some truly remarkable therapists. We established clinical relationships that flowed into lasting friendships. So much so, that my Facebook list of friends and family has almost fifty people I met through the company. I am super selective about work people being on my feed because I don’t like to blur lines, so it stunned me when I counted them up yesterday. It was such a period of exciting professional growth that I think of those days when I personally struggled with a family in crisis as some of the happiest days of my adult life.

But, all good things end.

The cash flow wasn’t enough for profit margins. The owners, who once prided themselves with answering the phone in the mornings, hired somebody to GROW the business. That is a euphemism for driving revenue to increase profits at all costs. The new management person quickly ended the homespun, family business approach. All communication went through her. The owners were not allowed to talk directly to staff. They stopped answering the phone. Which was easy for them to do because their sole office staff swelled to more than twenty full time people. Lisa left before me. I wandered away from the management end but lingered to treat. Eventually, the cultural shift drove me away completely.

It is easiest to describe the environment the company became like this: staff in the company office, which they dubbed corporate even though it was not a corporation, behaved as if their jobs would be better if there were no pesky customers and annoying therapist to call and cause them trouble. And, decisions about direct care which are best made by treating therapists and people who actually see the patients were being challenged by people in an office miles way reviewing records. The challenges were never to provide less billable units.

One conversation I had went something like this:

CORPORATE TYPE: The patient needs 50 min by all three therapies today.
me: Can’t do it.
CORPORATE TYPE: It’s your job, you will do it.
me: The patient is sick. I can’t do any minutes with her and neither can the others.
CORPORATE TYPE: Did you check to see if you can do education.
me: I did more than that. I held her hair back while she vomited and I got her a cold cloth for her forehead. None of that is billable. Maybe you should go up and see if she has stopped projectile vomiting yet.
CORPORATE TYPE: I’m not going to do that.
me: Somehow I knew you’d say that.

None of us saw our client that day for treatment. We all spent time with her trying to keep her comfortable which was nice for both her and the nurses. She passed away that night. So, the minutes not given to treatment didn’t matter even one little bit. I called the corporate type to let her know. She was unmoved by the news.

So, why am I babbling about a job I left in 2007? The FBI raided their offices on Thursday.

I met some of my best friends at that company. Lisa is not only a friend but she is a business partner and mentor and all around reasonable voice in an unreasonable world. The work she and I did there was life changing for staff and patients alike. The care model we developed is still being used by the national companies who won contracts at the homes our former company lost. So much to be proud of. So much to be grateful for.

Yet, today I am embarrassed to have the name of that company on my résumé.

It is unreasonable to feel this way. I left long before the rumors about ethical decline really picked up steam. My story pales in comparison to some of the war stories others have told.

Still, I don’t like how close my name sits to their name on the annotated history of my career.

It has yet to be determined if there is anything to the allegations. The FBI under the direction of OIG is investigating. There have been no findings to date. We are a country of laws. Innocent until proven guilty is the cornerstone of our due process. I firmly believe this to be true.

But, I feel betrayed by the news of the investigation.

I am left wondering how a company that started with the goal of doing it right, and was so single minded about patient care that it pulled me back from the brink of self annihilation, could end up with armed FBI agents storming in the front door to remove boxes and computers.

How did the owners let all those good people I met there, who they had the good sense to hire, down? How did they lose the key to greatness? How did they let themselves be lead astray from just taking care of our patients?

How?

And the answer to that question of course is…MONEY. Money lead them astray and locked the door to greatness. Money let down the staff and the supervisors. Money tried to tell clinicians how to treat their patients. And Money forgot that patients and clinicians are people and need to be treated with respect.

When I began in the company, it was as Marguerite described: owners with simple, straightforward ideas about how to build a better mousetrap. Establish strong relationships with your contracts and staff. Do the right thing. Treat the patients according to their needs. Follow the rules. When you make a mistake own it and when your staff make a mistake, stand behind them.

When I spoke with Marguerite over the phone all those years ago, I believed what I said. If you treat the patients, the rest will follow. I still believe that. The best way to make money is to do a good job. If you want to make more money, do a better job and if you want to make the most money, do the best job of all of your competitors. What this means to me is that you understand your patients’ problems, you know how to treat them, you exhaust all possibilities in your quest to help them get better and you understand their funding source as it applies to your services.

I think where people may go astray is in their determination of how much money is enough. How much do you need to be successful? How many corners can you cut in the name of efficiency? When do your cuts compromise patient care and how long will it be before those cuts compromise your integrity?
And that is the slippery slope on which so many clinicians have found themselves.

The changes in healthcare have made it harder for clinicians to stand against the tide. I think this is particularly true for SLPs. Rarely is our supervisor in any setting an SLP. When we have a concern, who is there to stand up for us? Who understands our perspective?

A few years ago, I was looking for a new job. I did a phone interview for a large rehab company. I was told that none of their regional supervisors in New England was an SLP. My immediate, uncensored reaction was “That’s outrageous!” I suspect that the OT that was interviewing me at the time did not share my view because I never heard from that company again. But it is outrageous.

When Marguerite talks about the systems we set up, the programs we created and the staff we trained, one of the things we prided ourselves on was making sure our staff knew that we did not want them to do anything they were not comfortable doing, and if someone was asking them to do something that didn’t seem right, they needed to:
1). not do it, and
2). inform us so that we could look into it.

But that is harder now. Our economy requires job security. It is not so easy to walk out defiantly and directly into another position. And healthcare is changing. But that shouldn’t mean our core values have to change.

I sincerely hope that the investigation into our former employer turns up empty; that the founding principles of the company to which I devoted so much of my career remain intact. When I left, I was proud of the work I had done.
No one can take that away.

About the Authors
Marguerite Mullaney was born and raised in and around the Boston area. She continues to make her home in the Commonweath and rarely finds it necessary to travel beyond the 128 belt. Her undergraduate program was completed at Bridgewater State College and she attended Northeastern University for graduate school. Adult neurological disorders has been the primary focus of her clinical practice. Her vast knowledge of the field, thoughtful, pragmatic approach and incredible sense of humor have enlightened and inspired her patients, staff and colleagues for over 20 years. Contact Marguerite at mullaneycccslp@comcast.net.

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com. ……

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Bedrock Leadership Beliefs

Bedrock Leadership Beliefs

by Lisa Erwin-Davidson, MS, CCC, SLP

It is our privilege to have Lisa Erwin-Davidson join CCCSLP to share her thoughts on leadership. I have known Lisa for over 20 years as a dear friend and colleague. Her exceptional talents and skill as an SLP, her passion and drive to advance what is best in our field, and her caring and compassion for her patients, students and staff make her a true leader in our field. Welcome Lisa and Happy Birthday!

Friday morning of November 16 I met five of the top SLP leaders in the country. Thanks to a research study and national search, we now know a little bit more about the conceptual brain patterns of SLP’s who lead.

Dr. Wayne Secord, Dr. Elisbeth Wiig, Dr. Robert Fox, and Michael Towey were curious how SLP leaders got things done and if they shared similar bedrock beliefs. Out of the University of Ohio, a short answer questionnaire was created, but before that was sent out, these researchers solicited nominations from each of the state’s speech & hearing associations, and asked for names of the top SLPs in their state. Then, those nominated SLP’s were emailed a questionnaire entitled the “Clinical Leadership Questionnaire.” Responses to these questionnaires were organized and statistically analyzed, then core leadership values were plucked out from all the responses, and out of hundreds of responses, six SLP’s were chosen who had inspiring stories to tell, and who shared similar ideas of leadership. None of these SLP’s knew their leadership beliefs were being analyzed, or that their names had been submitted by their state leadership – I should know, I was one of these SLP’s.

Dr. Robert Fox, who was inducted as an ASHA fellow at this November ASHA, put our “bedrock leadership beliefs” to statistical analysis, and created a visual concept “cloud” identifying the primary mind activities shared by the six SLP leaders from around the USA. I must admit, the purpose of such an analysis seemed rather enigmatic, but after reading Mark F. Goldberg’s article on “Leadership in Education: Five Commonalities”, I began to see the rationale. Mr. Goldberg had conducted 43 interviews since 1989 with eminent individuals, and extrapolated their “ big picture” characteristics. As a new graduate school instructor, and a long time clinical mentor for SLP students, I could see the value of nurturing such characteristics and inspiring others to be catalysts for change.

Interestingly, but not surprisingly, all six of us shared common stories. Even though we grew up in different states from all sections of the country, we had parents who served as examples of leadership, even though their actions may not have resulted in immediate change. All six of us had faced a problem, or a set of ongoing problems, and basically said, “That’s the last straw!” There was usually a “catalyst” , and something that pushed us to engage others, solve problems, and change how things were done in our field, our state, or with an individual client. All of us worked for the betterment of working conditions every day, we rarely took “no” for an answer, and successfully developed programs, systems or activities that were goal directed and that improved the lives of people.

My personal “bedrock leadership beliefs” were formed by my upbringing, then nurtured by wonderful mentors, and finally honed throughout my 25 years of working as a speech language pathologist. Most of the time, I was not trying to lead, but merely trying to actively listen, then listen again, until I really understood what needed to be changed.
Only by being an accepted voice for those who could not speak, showing compassion, keeping perspective, and persevering despite great odds, did anything change.

Describing leadership qualities across individuals is not new information by any means.

Historically, military leaders have had their leadership qualities sung or written about and their skills extolled. Political leaders, activists, CEO’s and religious leaders have all been analyzed for their leadership qualities. Mark F Goldberg identified “large-minded qualities”, such as the “courage to swim upstream , possession of a social conscience, seriousness of purpose, and situational mastery”. There were these “bedrock beliefs” that kept leaders on a path with purpose.

Leadership abilities can emerge within any socioeconomic class and requires no specialized education. People have emerged as leaders even when placed in horrendous situations, such as Malala Yousufzai, the young Pakistani education activist, shot for having seriousness of purpose.

If I learned anything from being a part of the ASHA Short Course: “Leadership & Clinical Excellence: Up Close & Personal”, it was that other SLP’s need to be inspired. It is easy to become negative when fighting to justify one’s existence to the insurance world. It is easy to become complacent. One may have reasons that make it difficult to make “big changes” , such as fear of losing a job. There are, however, smaller changes which can be made with “seriousness of purpose” to improve our clients’ lives or our working environment. Most importantly, those SLP’s who are new to this field need to understand that despite challenges, time pressures, and stress, it is a great field, and if they believe in a cause, and wish to right an injustice, they should be mentored through the process of change.

My advice is to Lead On but be smart about how you wish to make a change. Avoid impulsive decision making, examine the ramifications of the change you wish to make, and who it ultimately affects. Be respectful and avoid getting caught up in emotions. Keep your “eyes on the prize”. Envision the goal, select people who are like-minded in that goal, and can envision the change as well. Choose people on your “leadership team” who offer different but necessary talents to achieve that goal. Try not to sway from that goal, and persevere despite the odds. Your timeline may need adjustment, but lead on anyway. Most importantly, maintain a sense of humor.

About the Author
Lisa Erwin-Davidson, MS, CCC ran for the Vermont State House of Representatives in 2010, was chosen as 1 of 3 top clinical SLP leaders in the nation this November, started the first SLP department in a northern VT hospital in 2001, and is active on the Northwoods Stewardship Center conservation board in beautiful East Charleston. She has held numerous professional & community leadership & activist roles. Her younger brother, Dr. Eric Erwin, an elementary school assistant principal, will readily tell people his older sister has always been “bossy”. Lisa likes to remind her brother that she is a Black Belt in TaeKwonDo. This usually keeps him quiet.
Contact Lisa at l.e-d@comcast.net…

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When Rehab Came to Long-Term Care

When Rehab Came to Long-Term Care

For this entry of REFLECTIONS, the founders of this website decided to take a moment to reflect on our own careers in the field of Speech Language Pathology, particularly that portion that brought us together.

Way back in the very late 1980s/very early 1990s, we were both moonlighting as contractors in long-term care.  We had both come from in-patient rehab settings working with brain-injured adults and were looking to expand our skills.  Back then, SLP’s were required only on an ‘as needed’ basis in nursing homes. PT’s were required 6 hours a month and OTs were regulated to 4 hours.  There were no rehab teams, because rehab didn’t happen in nursing homes.  Nursing homes were for custodial nursing care.  If a patient had a problem, the home would call us. We would swoop in, do an evaluation and leave a long (sometimes very long) list of recommendations for the nurses to carry out.  We didn’t treat the problem.  Follow up was PRN – at the request of the nurse – if the problem didn’t resolve, given our extensive recommendations.  Thinking back, it is shocking how much we didn’t do.  Even more surprising was the fact that the head injury facility where one of us worked full time (in a department that included two other full time SLPs and two full-time SLP-As) actually occupied three wings of a four wing long-term care facility, and in five years of providing full time care, our department was called to the nursing home wing only once.

Then things changed.  In order to cut costs and defer care away from high priced hospitals, insurance companies and the federal government’s medical insurance plan, Medicare, began to reimburse nursing homes for rehabilitative care.  It was pretty much a pass through arrangement which allowed nursing homes to charge a fee for rehabilitation services which Medicare then paid.  This opened up huge opportunities for nursing homes and contract rehabilitation companies that provided rehab staff
(PTs, OTs and SLPs) to nursing homes.  This was now the mid 1990s and we found ourselves setting up departments and policies and feeding programs and language therapy in facilities that had never had them.

A population we always thought we’d just dabble in, in a setting no one ever liked, we began to love.  And then we started to teach other people (students and CFYs) to love it.  Senior citizens are awesome.  They are wise and hilarious and generous and aggravating. They allowed us into their home (the nursing facility) so that we could care for them.  It was a joy to see them improve, heartbreaking when they didn’t and an honor to shepherd them through difficult times as they approached the end of life.  The process transformed traditional nursing homes where people went to die into skilled care facilities where people lived, got better, sometimes went home or stayed and lived their lives in a place they could call home.

Then came more change.  Enter the Balanced Budget Act of 1997.  The Balanced Budget Act of 1997 was an omnibus legislative package enacted to balance the federal budget by 2002.  The Act resulted in $160 billion in spending reductions between 1998 and 2002 with Medicare cuts responsible for $112 billion of that total.  This became the real test of our love of long-term care.  We now of course, had to do more with less, but this is also when our programs started to grow and coordinate with nursing and our fellow rehab professionals.  We were a smaller more mobile band of therapists working hard to treat a population that viewed the nursing home as a short-term stop on their road to recovery. Before our entry into rehab in long-term care, no one would have ever thought that a patient would return to the community once they entered a nursing home.  Now today, most rehabilitation following surgery, strokes or general hospitalization happens in nursing homes for people over 55.

As we look back/reflect on this part of our careers, we are pleased to have been a part of the group of professionals who changed how healthcare was provided in the US. Our work extended care to millions of neglected older Americans warehoused in institutions. We improved their lives in terms of survival and opportunities to return home. In fact, you would be hard pressed to find a nursing home in the U.S., accepting Medicare dollars that does not have an SLP as part of their team. It has been our privilege to participate in this leap forward in service delivery to provide a better quality of life for our Nation’s most valuable living treasures: our parents and grandparents.

About the Authors

Marguerite Mullaney was born and raised in and around the Boston area. She continues to make her home in the Commonweath and rarely finds it necessary to travel beyond the 128 belt. Her undergraduate program was completed at Bridgewater State College and she attended Northeastern University for graduate school. Adult neurological disorders has been the primary focus of her clinical practice. Her vast knowledge of the field, thoughtful, pragmatic approach and incredible sense of humor have enlightened and inspired her patients, staff and colleagues for over 20 years.  Contact Marguerite at mullaneycccslp@comcast.net.

Lisa Yauch-Cadden was born and raised in the Detroit, Michigan area. She has a Bachelor of Science degree in Biology and a Master’s in Speech Language Pathology from the University of Michigan. She has worked as an SLP in nearly all facets of the field: skilled nursing facilities, home care, acute care, transitional care, medical offices and schools. Throughout her career as a therapist, manager and business owner, Lisa has never strayed from providing direct line service, including state of the art evaluations using FEES/FEESST and MBS. While she needs no accolades to do her job, she is deserving of many. Her tireless efforts to advance the best clinical practices in Speech Language Pathology have changed lives for her patients, her clinical fellows, and those of us lucky enough to work with her on a regular basis. Contact Lisa at lycslp@gmail.com.

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How may I assist you?  Life as an SLP-A

How may I assist you? Life as an SLP-A

by Christine Botelho, BA

I have been a Speech Language Pathology Assistant for over 20 years, licensed in Massachusetts for 4 years (not all states require licensure). Use of Speech Language Pathology Assistants is not allowed in all areas of the Speech and Language field and it is not an easy position to acquire. I have been fortunate to have met Speech Language Pathologists who have given me the opportunities that I have had. I have worked in acute rehab settings, nursing homes, day hab programs, schools and private practice.

As an SLP-A , I have always worked with Speech Language Pathologists. Initially it is difficult to work with a new, unfamiliar SLP because of different treatment styles and expectations. I have found that the speech and language field can be extremely subjective.  A patient, given the same tests and acquiring the same results may have different goals and objectives created by different therapists.  The therapists may desire the same outcome yet approach the treatment from different directions.  Having had the opportunity to work with numerous Speech Language Pathologists has given me countless treatment strategies to refer to while I am working my patients.  Every SLP has their own style of treatment and each patient is an individual- what works for one patient may not work for the other.  It has been helpful to have multiple strategies to try.

My overall responsibility as an SLP-A is to comprehend the recommendations, goals and objectives of the supervising SLP and implement the treatment to maximize the patient’s success. An SLP-A needs to have a basic understanding of the disabilities they are working with. However, their greatest strength is in knowing what materials are available, with an ability to modify and create novel ones in order to motivate their patients.  I feel the optimal use of an SLP-A is to accomplish the “drill work” needed to attain the goals the SLP created.  Therefore, the needs of the patient and their rate of progress determines the ratio of SLP to SLP-A treatment.   ASHA has guidelines for supervision of SLP-A’s and I believe it is important to adhere to these in order to assure the best outcomes. In addition, as this website shows, it’s lonely out there! We need SLPs to bounce ideas off of and to make sure we are on the right track. Our training and experience only gets us so far. The SLP has the education and the responsibility to drive the treatment plan.

Often I look back over my career and remember my patients from the early days and think how much more I could help them, knowing what I know now. If my career has taught me anything it’s that we have to have an appreciation for what we don’t know with the courage to ask questions and continue to search for answers even in the most challenging situations. It is becoming too easy to blame the patients and families for a lack of progress instead confronting our own limitations. I enjoy learning new things in order to help my patients. One reason I like being an SLP-A is that you always have someone to consult and brainstorm with. It is harder to feel defeated when you are part of a team. My best experiences have been working with SLPs that share my ideology and philosophy.

As our field continues to grow and change, I would like to see SLP-A’s working with SLP’s all settings with services reimbursed by all insurances in order to reach as many patients as possible. After all, I bet everyone could use a little assistance.

About the Author

Christine Botelho is an SLP-A with a Bachelor’s Degree in Communication Disorders from Bridgewater State College. When not amazing her school based caseload with a variety of original materials, fun reinforcers and tireless energy, Chris can be found in southeastern Massachusets enjoying time with her family and learning archery.
Contact Chris at sb01@comcast.net.

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The Universe Tries To Right Itself

The Universe Tries To Right Itself

By KT Leary

The Universe Tries To Right Itself

On August 6th 2009, my daughter, Erin, died at 11:15am, as a seat belted passenger in a car driven by a friend on the way to a mall. Erin and four friends were trying to purchase one more concert ticket for a friend, so they could all attend a Blink 182 concert that evening. The vehicle was speeding, being driven erratically and it hit a guardrail, rolled over, hitting the cement median also. Two passengers died, Erin and her dear friend Jason, both seated in the rear. Erin had just turned 16 and Jason was 17.

Erin had been ill for four and a half years with aggressive colitis and had survived the removal of her large intestine in January 2009. She was finally healthy, off all medications, and excited to embrace her life. She discovered what most teens in Hull, MA knew. That jumping off the A St. pier into the bay was a summer right of passage. She did well in school, was loved by her friends, and knew the meaning of resilience and compassion. She volunteered for many causes, and especially loved helping at the Paragon Carousel.

To say that her older sister, Shannon, and I are devastated is an understatement. Our world forever changed; we would reel from this blow every moment of our lives. Shannon needed to leave for her first semester at college three weeks after Erin’s accident. Due to a shortage of dorms, some students were housed in studio apartments, as Shannon was. She struggled to adjust to this greatest of losses, being alone in a new place, and the workload. Four months into school, Shannon decided she wanted a cat to keep her company, and help her through her emotionally battered days. She and I adopted a young calico cat from the ASPCA.

We brought the very magical cat home from the shelter, and named her Aylen. She is sweet, gentle and affectionate, and reminds us so much of Erin, in some otherworldly way. In trying to acclimate Aylen to my home during Shannon’s winter break, we introduced Aylen to our two dogs. They were fine together, until I without thinking, put the male dog’s food bowl down. Aylen rushed over and the dog attacked her, flipping her and breaking her leg. It was terrifying – could our loss be compounded by another so soon? How had I let this sweet animal be injured?

We rushed her to our vet. Then to the animal hospital where it was determined she wouldn’t die. Both Shannon and I cried in the waiting room: for Aylen, for Erin, for ourselves. We tried to explain our emotional state to the emergency aide. We were told Aylen needed either to have a splint or be operated on for two broken leg bones. The difference in price was $1,000 versus $4,000. We chose the splint and lesser price out of necessity. We went home numb.

I remembered I had planned to meet three friends for dinner that evening and I joined them for a short while to tell them what had happened and explain why I was so late joining them. I briefly explained about Aylen. We talked about Erin. We drank tea.

The next afternoon Shannon and I went to get Aylen and the same helpful aide took us aside to tell us that an anonymous donor was willing to cover Aylen’s surgery costs if we chose that for her. We both started to cry again. Disbelief. Kindness. Incredible Kindness. What was happening? Who knew where Aylen was being treated? Who could afford to do this? Why did this feel so strongly that it was mixed up with the loss of Erin?

The aide, Megan, took us into a private room so we might compose ourselves and try to comprehend what she was offering. We needed to decide quickly while the doctor could fit it in her operating schedule. What did we want to do? I asked Shannon to decide. In tears, Shannon said, “Maybe the universe is trying to right itself,” and then she said yes to surgery and a greater hope for full recovery of Aylen’s limb.

Aylen came home with six pins in her leg and two blue bars holding them in place. After six weeks they were removed and she went to live with Shannon in Boston. She is fully recovered. I have visitation because I fell in love with her too.

We honored the donor’s right to remain anonymous, asking only that the vet mail a letter from us, with Erin’s picture, Aylen’s picture, and our immense gratitude expressed inside.

About the author

KT Leary is the mother of two residing in a tiny, coastal community just south of Boston. She is a chef and volunteers for many worthy causes including Lakota Kidz http://www.lakotakidz.org/ She was kind enough to share this poignant story of her enormous loss and the small, subtle ways the Universe tries to comfort us. I’m certain she would be most grateful if anybody reading this article was motivated to go out and commit a random act of incredible kindness in memory of a really good kid, Erin Leary. Please feel free to send updates of your Random Acts of Incredible Kindness and I will forward them to KT and Shannon. mullaneycccslp@comcast.net

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The Switch

The Switch

By Michelle Sachs Clapp, CCC-SLP

Back in 1998, I was working with the geriatric population in a SNF setting. The pay was good and I enjoyed my job- at least the direct contact with my clients and the camaraderie with my coworkers. What I didn’t like was the growing amount of redundant paperwork required of me and the increasing demands and tightening criteria of what counted as “direct” or billable time.

I was forced out of this setting by the changes in Medicare standards and the fact that I was a “dinosaur” in the field- I had over 15 years of experience as a speech/language pathologist and it cost agencies or facilities a lot more to keep me on or to hire me than a more recent graduate with less experience. After being “offered” a 33% pay cut along with the promise of a pink slip in a few months, I re-examined my career choice within my chosen field. The job market was not promising for me in light of my years of experience and the pay had been cut drastically, due to the new methods of reimbursement ( direct, billable time as opposed to salaried). I had two young children and although I didn’t have to work full time, I did still have to work to help pay the bills. I decided to apply for a position with a local early intervention agency that was advertising for a speech/language pathologist.

At my interview, I feigned great interest in working with little children, even though I felt that I had little patience for this population. I played up the experience I had from years and years ago working in the Head Start program and with elementary school children. Sure enough, a position was offered to me- 2 days after I was offered a per diem position with 3 SNF’s in a not-too distant town. I accepted the per diem position. Within 2 days on the job, I knew it was a mistake. Criteria for who qualified for my services severely restricted who I could work with, regardless of my professional opinion of who would benefit from my assistance. I could see that I would be spending a lot of time with minimal financial reimbursement. And the paperwork was quite overwhelming as well.

I called the early intervention agency that had offered me a position and indicated to them that I was still interested in them, if they were still interested in ME. They called back and our partnership began.

For the first year of my new career with little ones, it felt like I was paddling upstream; it had been years since I had worked with pediatrics and I was behind in skill, knowledge, lingo, etc. I worked directly with the children and their families during the day and studied and read up on pediatrics on my own in the evenings. After my first year there, I finally felt comfortable enough to start widening my knowledge base by taking on a more varied caseload, reading additional materials about non-speech/language issues with this very young population, and really listening to and doing co-visits with my non-SLP co-workers.

To summarize, I am now completing my 11th year working in early intervention! I love what I do. I feel like I rediscovered my field of work and put my heart into what I do. I feel very alive in my daily work and the rewards are priceless. The pay may not be as much as it is now in SNF’s, but the benefits (being paid with hugs, kisses and holiday photos) more than make up for the lack of monetary compensation. Way back when, when I was applying for this position, I thought that I was faking my enthusiasm about this population but much to my surprise, I discovered that I love love LOVE working with these little ones and their families! I have plenty of patience for them; I guess it was my OWN kids that I had the lack of patience with! Although, as I get a bit older, it gets a bit harder getting up and down off of the floor from my visits, I will continue to do so for as long as I can and will continue to learn about and take on the various challenges that working with the 0 to 3 year old population holds for me.

Michelle Sachs Clapp MA CCC SLP graduated from University of Delaware with a BA in Communications and completed her MA at Ohio University. Since entering the field, she has worked in a variety of treatment settings but finds her current position in early intervention to be her favorite. In addition to her career in Speech Language Pathology, she has honed her parenting skills over the years raising a daughter, son, and soon to be stepdaughter. Her happy home life is fully rounded out by the love and affection of her cat and dog. She has practiced Kundalini Yoga for the last 9 years which maybe how she maintains her charm and humor when life presents unexpected changes.

Michelle is a good friend and an excellent clinician. It was a distinct privilege to work with her so many years ago when our careers as SLP’s were shaken to the core by PPS. I am honored that she agreed to share her method for dealing with the January 1999 reimbursement changes for SNF’s. These regulations continue to test the patience and ethics of individual practitioners across the country. As we prepare for the next round of changes, Michelle’s experience serves as a timely reminder of all the opportunities our profession affords us.…

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Reflections on a Career in SLP

Reflections on a Career in SLP

By Therese M. O’Neil-Pirozzi, ScD, CCC-SLP

I doubt that there’s anyone who hasn’t been impacted by the January earthquake in Haiti –  maybe you lost someone who lived there…  maybe you spent some time volunteering there…  maybe you were touched by photos that you’ve seen or by articles that you’ve read…

I’ve been following the news about medical teams that have traveled to Haiti, and I’ve read about the minimal technology available to assist them in their provision of care to those in need.  Reasons for this include the limited technology in place before the earthquake because of the country’s economy and the fact that much of the technology that was previously available was destroyed by the earthquake.  Nonetheless, the injured are benefiting from quality care, and the health care providers ministering to them are expressing great pride and satisfaction with the work that they are doing

You don’t have to be providing care in a country that’s just experienced an earthquake to be challenged by limited resources trying to do so-  maybe you’re employed in a school system with no monies to purchase assessments…  maybe you work in a medical setting that doesn’t have easy access to videofluoroscopy or endoscopy…  maybe you volunteer at a homeless shelter where there’s no quiet space to empower parents to stimulate their children’s language literacy development…  Nonetheless, you minister to your students, clients, patients, and “new friends” effectively, with these people demonstrating positive outcomes as a result.

As part of Speech-Language Pathology coursework, many of us completed assignments in which we created our own articulation tests, our own auditory discrimination tests, and our own language intervention kits.  I remember painstakingly trying to draw pictures of common objects and 3-step activities and then showing them to young nieces and nephews to see if they could tell what they were supposed to be.  One of my undergraduate final exams was as follows:  “You and a 7-year old boy are in a room with a table, two chairs, and a window.  You have a pencil, a paper, and a piece of string.  Do a complete speech-language evaluation on this child.”  Although I was sure that that final was going to mark the end of my future as a speech-language pathologist, I passed the exam and continued on…

Since then, I have had to conduct countless diagnostic and therapeutic sessions without the benefit of valuable technology and other equipment and materials that I find useful.  And, in spite of the obvious challenges that this presents, I feel that these experiences have made me a better clinician.  With my eyes, ears, a deck of cards, a free newspaper, and some continually evolving critical thinking skills, I have figured out ways to do what needs to be done to benefit those with whom I am working.  Is it challenging doing this?  Yes!  Is it my preference to do things this way?  No!!  But, I think that the fundamental key to our effectiveness as clinicians is not the tools that are available for us to use with our students, clients, patients, and “new friends,” but, rather, our ability to learn how to problem solve evidence-supported ways to do what we need to do with whatever we do or do not have.

…You have a lollipop, a cup, and a phone bill.  Do a complete diagnostic evaluation on a 57-year old female with suspected cognitive-communication impairments…

Therese M. O’Neil-Pirozzi, ScD, CCC-SLP
t.oneil-pirozzi@neu.edu

About the author

Therese O’Neil-Pirozzi, ScD, CCC-SLP is the SLP Graduate Program Director and Associate Professor at Northeastern University in Boston, MA. She is also a Clinical Researcher and Clinician for Spaulding Rehabilitation Hospital. Author of many research articles, she is a frequent presenter at ASHA’s annual conventions. Her areas of interest crisscross from adults to children, from voice to aphasia, from dysphagia to literacy. If Speech Language Pathology ever had a renaissance clinician, then it would surely be Therese. In addition to her body of work, Therese continues to find time to be a resource to practicing clinicians, an advisor to graduate students, a good friend for those of us lucky enough to know her, and a devoted Red Sox fan. Her email address is: t.oneil-pirozzi@neu.edu

If you would like to reflect on your career in Speech Language Pathology/Audiology, please submit your article for consideration to mullaneycccslp@comcast.net.…

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