Tag: CCCSLP

Empathy and the End of Life

Empathy and the End of Life

Sometimes in our line of work, our patients do not get better.  Sometimes, despite our best efforts, they get worse.  And sometimes they die.  This month  has been a difficult one, as the majority of my hospital caseload has included patients at the end of life.  I have also had a graduate student working with me. Needless to say, we have experienced many “teachable moments” together this month and my twitter feed has been surprisingly supportive (see posts/retweets @CCCSLPNET).

What  I have learned/tried to teach is:

The  importance of  understanding the patient’s goals and perspective.

The importance of withholding  my personal feelings/judgements while providing the most accurate information I can to explain the patient’s deficits.

The importance of alternatives, knowing that if ‘Plan A’ does not meet the patient’s goals, there needs to be a ‘Plan B’, and possibly a ‘Plan C’.

The importance of teamwork

I am fortunate to work with a wonderful team of physicians, nurses, dietitians, case managers and a great Palliative Nurse Practitioner.  Through these collaborations I have learned that the Palliative Care conversation, that “first conversation” can happen early, before the end of life, to help clarify the patient’s goals for care in  order to mitigate unnecessary care and  avoid unwanted returns  to the hospital. I have learned to avoid blaming the patient for their informed choices by endeavoring to eliminate the  term “non-compliant” from my documentation.  If after education, the patient decides not to follow my recommendations, that is their choice.  They are not non-compliant.  They are choosing a different course of care based on their goals/values.  I need to respect that.

My biggest contribution to my team has been in providing education regarding what alternative nutrition (G tubes) can and cannot do for chronically ill patients at the end of life. Knowing that G tubes are contraindicated in patients over 75, with advanced dementia, advanced/chronic illness, low BMI, previous aspiration and UTI and that there is no evidence that tube feeding in patients with advanced dementia prolongs survival, prevents aspiration pneumonia, reduces the risk of pressures sores or infections, improves function or provides comfort has helped our team in its quest for compassionate care.

It is always an on-going process.  Each patient is different and it is never easy, but we strive. I remind myself that it is an honor and a privilege to  assist in the care of these patients at this stage of their life…. That helps.

For more information regarding Palliative Care and PEG tubes see:
Plonk Jr., WM. To PEG or Not to PEG. Practical Gastroenterology. July, 2005.  pp 18-31.  Great summary with multiple additional references.

About the Author

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 Do You Count Success?

How Do You Count Success?

by Lisa Yauch-Cadden, MS CCC-SLP

Here at ASHA 2013, I am not standing on my soapbox, I am standing on a mountain peak. The journey to get here started when 2 friends began chatting about work, needing an ear to listen, a shoulder to cry on. That conversation grew into a website, a Facebook page and a Twitter feed. Now we have 1000 friends who can share ideas, frustrations, successes and be an ear to listen and a shoulder to cry on.

The climb up this mountain was not easy, but we persevered. We have much more to do, but the view is awesome and we can’t wait to see what awaits us. We invite all of our colleagues to join us in a conversation about our favorite subject: Communication disorders. Nothing is off limits, because there are no limits when we work together. Welcome to cccslp.net. Join us as we continue our climb.

About the author

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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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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12/14/12

12/14/12

To all our colleagues working in the schools, love and good thoughts to you today and in the coming days.

Your tasks are huge. Educating students to the 3 R’s isn’t enough anymore. You create a safe place with food and support and watch over them to ensure they are well physically and emotionally. Too often, you have to act on their behalf when those that love them do not. And, at least during the last election cycle, you listened to overpaid wind bags discuss how much you don’t contribute to the Nation’s bottom line.

Yesterday, we saw once again, how much teachers are willing to sacrifice to our Nation’s bottome line. They ran toward the children in their care when danger erupted. They shielded them with their own bodies. They hid them using what little tools they have available; closets, bathrooms and their own wits. And six, stayed with the children in their care and died with them.

To all our Clinical Colleagues in the Schools and teachers and school support staff, thank you for all that you do. You are saving our world one child at a time. I am proud of the work you do for all of us and so very grateful for your dedication.

peace and love and all that stuff,

mullaney…

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Support the Supporters: Helping Caregivers of People with Aphasia

Support the Supporters: Helping Caregivers of People with Aphasia

By Lisa Haynes, MS, CCC-SLP, Clinical Consultant, Lingraphica

In our experience working with those with acquired language disorders, we have found that one of the most challenging issues is assuring carryover and functional use of an AAC/SGD once a device has been determined to be appropriate and purchased. How many times have we set up/trained a patient with a device only to find that once the patient is discharged from treatment, the device ends up collecting dust in a closet? Luckily for us, we met Lisa Haynes of Lingraphica at ASHA 2012 and she agreed to guest blog for us about this very issue. It seems that Lingraphica has some systems in place to support users, caregivers and therapists that may keep those devices out of the closet. Welcome Lisa!

November was National Caregiver Awareness Month and many took the opportunity to express their gratitude, thanks, and appreciation for caregivers who devote themselves to helping someone else. November has ended, but at Lingraphica, we make it a point to support caregivers year-round.

Lingraphica’s mission is simple: Help adults with aphasia re-establish communication with family, friends, and community. We do so by offering speech-generating devices (SGDs) communication apps (SmallTalk tm), and our recently released speech therapy apps (TalkPath sm). We know from our years of experience that when it comes to re-establishing communication or reacquiring speech, this lengthy process is more manageable when the patient has the dedicated assistance of a caregiver — whether it’s a spouse, child, friend, or paid assistant. This is why Lingraphica offers unlimited, free support and training for all of our SGDs — for as long as the patient owns the device.

When the goal is to help those with aphasia better communicate, training on their devices is an essential component to success. As such, we extend our complimentary support to everyone involved with the care and treatment of the patient, including:

• Caregivers: Our technical support team is available to answer any questions a caregiver may have regarding the use of the SGD. Caregivers can contact us via phone or email. There is no charge for the extra service and our technician will spend the necessary time to resolve the issue and ensure satisfaction.

• Speech-language pathologists (SLPs): We offer free device trails and training for any SLP who thinks a Lingraphica device is a good fit for a patient. We can help them make that determination and set up one-on-one, remote training to ensure the SLP has the training to help the patient use the device effectively.

• Patients: Everyone involved has a role in the process, but at the end of the day it’s about how well the patient is able to use the device to communicate. This is why we offer online, remote training and telephone assistance for patients, as well.

Those caring for someone with aphasia have a difficult job and communication can be a challenge. It can be even more frustrating if they are unable to assist their loved one with the learning curve involved with any SGD. Lingraphica makes every effort to arm caregivers with the support, training, and information needed to be a helpful resource at home.

So, if you haven’t yet offered your appreciation to the caregiver of someone with aphasia, now is the perfect time. National Caregiver Awareness month may have ended, but it is never too late to support their efforts.

In your case, Lingraphica makes it easy to offer that assistance — simply start a free device trial and we’ll take care of the rest.

About the Author

Lisa Haynes, MS, CCC-SLP, is a Clinical Consultant at Lingraphica applying her expertise as an AAC specialist to clinicians and caregivers using Lingraphica speech-generating devices or beginning a free device trial.  Contact Lisa at lhaynes@lingraphica.com

Information contained herein does not necessarily reflect endorsement by the web host.

Do you have expertise or a product we should know about?  Contact us at media@cccslp.net to inquire about guest blogging.  We’d love to here from you.

 …

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10s   by Gene Pizzolato, MS CCC-SLP

10s by Gene Pizzolato, MS CCC-SLP

1. Cookie of choice (for bedside swallow exams)
Lorna Doone

2. BDAE or WAB (for language testing)
BDAE

3. PICA +/- (for scoring)

+  Love the PICA!  In fact, I’ve used it for over 30 years with therapy plans and I call it a “Prompt-Cue Score” (PCS) system. After years of applying this format to my plans I considered it to be my own creation, until the PICA comparison was made by this web site’s Co-founder!. In any case my PCS provides me with great data to monitor progress.

4. Muppets or dwarves (for entertainment purposes only)

Muppets

4a. Favorite individual muppet

Fozzie Bear

5. Worst treatment moment of your career.

Medicaid Audit

6. Best advice you ever ignored.

“Don’t ever accept Medicaid payments”

7. Favorite, most reliable and practical treatment strategy.

I find that visual information organization strategies work well to support
information processing, comprehension and expressive language therapy.

8. Why SLP and not world domination?

Less stress

9. Would you do it all over again exactly the same way?

Absolutely not…… well maybe ….. actually “yes” with some adjustments.

 

10. What one thing do you still want to do before your career goals are completely achieved?

To organize my best therapy practices into a package that could be easily shared.

SHAMELESS SELF PROMOTION IN 30 WORDS (there actually is no word limit really so say whatever you want).

Gene Pizzolato, MS CCC SLP is a graduate of Columbia University and has been in private practice for 30 years. Specializing in working with school age children and adults with developmental disabilities, Gene has been a pioneer in the collaborative approach to treatment. Always a man of vision, Gene has been able to adapt his practice to meet the changing needs of the healthcare and school based communities as well as to continue to expand his clinical skills. As a mentor to countless students and new clinicians, Gene has entertained and inspired us as we endeavor to follow his lead.

Given this opportunity for shameless self-promotion, Gene would like to share with you some sage words of advice:

  1.  Be careful who you stand behind when scheduling your college courses, you may end up pursuing that line of study.
  2. If your business is based out of your home, a mudroom helps facilitate communication with itinerant therapists. You can leave them notes, schedules, reports, etc. And they can leave you cookies.
  3. Professional relationships, (all relationships, really) work best if they are based on mutual trust and respect.
  4. When asking for favors, it helps if you are charming and look like someone famous.

Contact Gene at: genepizz@gmail.com…

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Thank you!

Thank you!

I am standing on my soap box right now and shouting out a big THANK YOU! to anyone visiting or returning to our site. We have been away a while but we have not forgotten about you or our craft. We continue to toil every day in our jobs, often alone with little to no recognition. So I am here right one to say THANK YOU to you for all that you do. For all of the endless hours you spend working with your patients, and thinking about your patients, and planning your treatments. For all of the follow-up that you do with families and physicians and teachers and payors- thank you for all that goes unnoticed and unacknowledged. You deserve a pat on the back and probably more. But right now, my words will have to suffice.

I hope this site will help you find support and be a place for your voice. And if you are in a position to thank someone for their work or their help, please do so. We don’t hear enough of that as professionals (or probably as people). My colleague just started a new job. After her first few days, she was sincerely thanked by her boss for her efforts and the contributions she had already brought to the team. She was appreciative, but also realized that the last time she had been thanked for her work was when she worked for me, and that was 10 years ago! That’s a long time to go without recognition, wouldn’t you say?

So before you start that e-mail, or note, or conversation or performance review, remember to say thank you, the person on the receiving end has probably done something worthy of recognition and might be happy and likely much more cooperative if you noticed it.

About the author

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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R-E-S-P-E-C-T

R-E-S-P-E-C-T

By Lisa Yauch-Cadden

“R-E-S-P-E-C-T”

As someone who grew up in Motown, I know a little bit about Aretha Franklin and her mantra. As a clinician who has been around awhile, I know a lot about why it is so important.

In our business, we deal with all kinds of people: patients, families, physicians, nurses, therapists, case managers, social workers, insurance representatives, students, etc. Like any business that involves personal interaction, everyone has a perspective, an agenda, a point of view. In our role as a diagnostician/therapist, we may need to bring all of these perspectives together, and if we can’t bring them all together, we certainly need to appreciate them. Every person that works with/interacts with our patient has a perspective about that patient, and those perspectives may be important to us. When I evaluate a patient, I always try to ask them what they think the nature of their problem is. I also ask their family members: “What problems do you see?” “Why do you think they are occurring?” I canvas the nurses and the CNAs. I consult with the physician. I ask the treating clinician (CFY, SLP-A) who may be working with them. All of these people invariably know the patient better than I do and their insights are important to me and to the patient. When I come to a conclusion, I let patients/families know, “Here’s what I think”. I seek confirmation, when I can, (e.g., “Does this make sense with what you see at home?”). It provides for a better recommendation, usually leading to one the patient can live with (think: modified diet/thickened liquids).

I also have used this approach as a manager and find that staff generally do a better job when you treat them with respect. I know, novel concept. Having worked for managers that don’t share this philosophy, however, makes me think that this is may not be an intuitive strategy for some people. The concept, however, is simple. People have their own opinions and perspective, as do you, and like you, people think that they are right. As a manager, you need to appreciate that, and sometimes solicit that perspective, in order to come to a shared conclusion. Like you, people need to be validated. Once you let them know that their perspective has value, they are much more likely to hear your side of the story. And when that side doesn’t necessarily agree with theirs, or doesn’t give them what they want, you are less likely to have problems afterward, as long as you’ve told them the truth.

And that’s the second part of the equation: Tell the truth. Respect the person you are dealing with enough to let them know the truth. If they know you are being truthful, even if they don’t like what they are hearing, they are more likely to accept it. Isn’t that how you would like to be treated? Imagine what a world it would be if everyone acted this way.

About the author

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. .

If you have something to say, please submit your article for consideration to lycslp@gmail.com. .…

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10’s by Lori Yauch

10’s by Lori Yauch

For our inaugeral column, we have selected Lori Yauch, a Speech Language Pathologist of over 20 years, practicing as an independent Consultant/Clinician in the Tampa Bay Area. Lori has a unique product that she would like to share with her colleagues, but in order to do that, she must first answer the 10 ‘no ifs ands or buts’. We hope you enjoy her responses as much as we did.

1. Cookie of choice for bedside swallow exams:

Lorna Doone

2. Preference for language testing BDAE or WAB:

BDAE

3. +/- or PICA for scoring:

Modified PICA (10 down to 1, but I forget what 2 is. I think it’s the same as 6, so why use it? You get more credit with 6, or maybe you just get egg roll. I can’t remember)

4. Muppets or dwarves for entertainment purposes only:

Muppets

4a. Favorite individual muppet or dwarf:

Elmo

5. Worst treatment moment of your career:

Any moment during my first job. I was a new grad and had to move away from home, living truly on my own for the first time. I lived in one state and crossed the border daily to work. My CFY Supervisor was selfish, unsupportive and certainly, ineffective as a teacher. I think it was her mission to find fault in every move I made, both in the clinical arena and in the building environment. I used a scooter to assist in my mobility and was written up for, among other things, the way in which I moved about the facility. By the end of 6 months I resigned. I heard later, she fell and was in a wheelchair for a time. You know what they say about paybacks! I moved on to greater and greener pastures. Years later I am a respected clinician, having supervised many students and CF’s and am here offering insights into our field Things really do have a way of working out.

6. Best advice you ever ignored:

I don’t typically ignore advice. However, there was a time when I was looking for bigger and better things. A friend suggested I come to her company, I considered it carefully and just as I was about to make the decision to move on, the company called and rescinded the offer. As it turned out, better offers came and when the time was right, I moved on.

7. Favorite, most reliable, and practical treatment strategy:

Masko Maneuver

8. Why SLP and not world domination?

SLP is world domination. One patient at a time.

9. Would you do it all over again exactly the same way?

Yes. If I hadn’t, I would not be where I am today. I learned from every experience. What I want and what I don’t. I have a good career balanced with a good life.

10. What one thing do you still want to do before your career goals are completely achieved?

Publish my manuscript. Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity (which segues very nicely into the next question)

SHAMELESS SELF PROMOTION IN 30 WORDS (there actually is no word limit really so say whatever you want):

As clinicians in long-term care or adult rehab settings, we have all been faced with the necessity of providing group activities to our residents/patients. In an effort to come up with a new and innovative group idea, I decided to bring my passion for classic movie musicals and my job together. In conjunction with the Activity Dept. at the skilled nursing facility in Florida, where I was one of 3 speech pathologists, Movies and Music was established. In running this group I began to realize with the right material and right level of function, watching a movie which was once a sedentary activity, could be quite interactive. The interaction fostered increased communication, use of language, pragmatic skills, conversation and long term memory.

With this in mind, together with further observation that no group like this existed in any of the facilities I visited as a consultant, Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity was born.

The guide is divided into 12 sections according to the calendar year and centers on a specific movie for a given holiday in the month (New Year’s Day, President’s Day, St. Patrick’s Day, etc). The films were chosen specifically for their ability to promote interaction.

The group size is generally 4 -10 patients with mild – moderate cognitive impairment. Diagnoses may include: Right/Left Hemisphere CVA, TBI, Dementia, Parkinson’s Disease or any other diagnosis at the Group Leader’s discretion.

Field testing completed during 2008-2009, yielded positive results with clinicians stating:

“ I highly recommend Movies and Music to any clinician working with individuals with mild to severe communication deficits….I look forward to being able to include this in my future plan of care at my facility.” Jane Fitzgerald House, M.S., CCC-SLP

“Assessment of the group dynamics indicated increased motivation, interest and curiosity which resulted in increased expressive language skills. … Group participants stated it was fun and interesting.” Lisa Mathers, M.S., CCC-SLP

Movies and Music: A Clinician’s Guide to the Classic Movie Musical and Group Activity is available for purchase. Please contact Lori Yauch at moviemaven1@verizon.net.

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