Tag: speech language pathologist

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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Access Your Records Securely Anywhere, Anytime

Access Your Records Securely Anywhere, Anytime

by Bob Bond

As busy clinicians, our professional thoughts most often focus on our patients/clients. How can I best meet my patient’s needs? What can I do to help them excel? What will we do today to meet their goals?, and what will we do at our next visit? Always looming in the background however, are questions about efficiency and productivity. For clinicians in private practice, those questions likely loom as large as the clinical ones. This month, we introduce you to Bob Bond of WriteUpp.com, who has some suggestions for private practitioners on how to cut down on paperwork time and improve productivity.
Welcome, Bob!

How’s this for a scenario?
● One place for all your patient related information, including: notes, appointments and assessments, scanned paper records and bills
● No software to install
● No data to keep backed-up
● No specialist hardware required – run it on PC, Mac, iPad, Android Tab etc
● Collaborate with team members
● No paperwork to lose

It’s now more “do-able” than you might think…

Tipping Point
These days most of us are pretty accustomed to using technology in our personal lives but until recently, cost and complexity tended to put the majority of technology solutions out of reach of most SLP’s in their professional lives.

Of course, some SLP’s will always prefer pen and paper and that’s just fine.

But those of you that have dipped your toe in the water have probably had to bolt together a mish-mash of products (such as Email, MS-Office documents, Google Docs and storage platforms like Microsoft Live “SkyDrive,” Amazon’s “Cloud Drive,” Google Drive, iCloud, Dropbox or SugarSync) to manage your practice.

Thankfully though, time’s are a-changing!

A new breed of simple, affordable “cloud-based” Practice Management Systems (PMS) is coming to the market. These products combined with fast internet and increasingly ubiquitous WiFi are transforming the way SLP’s work and collaborate.

What does a Practice Management System (PMS) do?
Obviously different systems do different things but the core functionality you should look for in a PMS should include the following:

Patient Database
At the heart of every PMS is a secure patient database that is accessible to all authorised users. The PMS acts as a hub for all your patient-related information, including: Appointments, Notes, Assessments, Documents, Attachments and Invoices.

Diary Management
Manage your diary anytime, anywhere (as long as you have internet access). Schedule different appointment types (Initial, Follow-up, Travel, CPD etc.) with different durations (and where required different costs) and reconcile all of your appointments to the appropriate patients – a real time-saver when it comes to billing!

Clinical Notes
Write up and securely store your patient notes which are time/date stamped and locked-down after 24 hours in accordance with HPC best practice. Insert images, videos or annotated images directly into your notes.

Assessments
Access a library of Speech-specific assessment templates which can be completed and attached to the patient’s record. Some providers will even convert existing paper-based assessments into electronic forms that can then be used within their applications.

Documents
Some systems allow you to create templates for documents that you create on a regular basis such as Patient Letters and GP Letters. These are then pre-populated with the appropriate information such as the patient’s address or the GP’s details so that all you have to do is enter your comments/professional opinion etc.

Attachments
Sadly, none of us can go 100% paperless. Doubtless you still receive letters or reports in paper form. With a PMS these can easily be scanned and attached to the patient’s record so that everything is in one place and securely accessible from any location.

Invoices
Different systems offer varying degrees of complexity when it comes to billing. Some provide the kind of detailed functionality that you might expect to see in accounting system, whilst others simply generate invoices based on appointments attended and supplies/goods provided to your client (where appropriate).

What is “the cloud”?
In the context of a Practice Management System it means the software is web-based, so there is no software to install and all of your data is stored in a secure data centre “in the cloud”.

You can securely access the PMS from any location using a web browser (such as Google Chrome, Internet Explorer, Apple Safari or Mozilla Firefox). All you need to do is enter your own unique URL into the address bar (such as http://yourpractice.writeupp.com) and login with the credentials, both of which are provided by your chosen software provider.

Regardless of your location (you could be at home, on holiday or in your clinic) you will be able to access your diary, notes, assessments, attachments, documents and invoices.

The Benefits
Its worthwhile pointing out that a PMS may not be for everyone and not all PMS’s are equal. Most of those that have come onto the market are aimed at mid-to-large practices and as a result they are very feature-rich, which may not suit smaller practices.

If you are a sole practitioner or a small practice and you are open to embracing some simple technology, the benefits you will enjoy from adopting a PMS are likely to be:
● Centralisation of all of your patient-related information in one place
● Accessibility anywhere (with an internet connection)
● No need to jump from one system to another
● Reduced administration time
● Improved collaboration with colleagues
● Faster billing and quicker payment

Considerations
If you are considering a PMS there are a few things to bear in mind:
1 Test the product in your own environment before you commit. Most providers will allow you to try out their software for 30 days or so
2 Keep it simple. If you are a small practice you don’t need lots of bells and whistles
3 Verify the credentials of your chosen provider. Where are they, what’s their track record? Have they worked with any government approved bodies?
4 Gain specific assurances around data security. At the very least data should be backed-up and encrypted real-time but ideally your provider should replicate to an alternate off-site location
5 Don’t pay for features that you don’t need

Try Before You Buy
There are a number of web-based practice management systems on the market however most are aimed at mid/large clinics (i.e. 5 clinicians+).

WriteUpp is a very simple web-based practice management system aimed at sole practitioners and small practices. It provides all the functionality necessary to run an efficient, paperless clinic and includes a number of SLP assessment templates.

It costs as little as $24/month and a free 30-day trial is available if you go to WriteUpp.com and click on “Try WriteUpp Free”.

About the Author
Bob Bond is the CEO of WriteUpp.com, a web-based practice management system based in Europe. He has extensive technology experience having worked for Oracle Corporation and SAS Institute Inc. and is also the Founder of Pathway Software, a leading provider of systems to therapists in the NHS (National Health Service).
Contact Bob at:bob.bond@writeupp.com
http://www.writeupp.com/
https://twitter.com/WriteUpp
Skype: WriteUpp
Phone: +44 1422 399525

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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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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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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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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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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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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A New Tool for the Inner Clinician

A New Tool for the Inner Clinician

The space reserved for the idle and often stray thoughts by Marguerite Mullaney, MS CCC SLP.

A New Tool for the Inner Clinician

After a very long time away, we are back!  CCCSLP has returned and I could not be happier.  There are so many challenges facing Speech Language Pathologists and Audiologists and Assistants and Speech Scientists but there seem to be fewer and fewer places for professionals to share ideas, hopes, and frustrations.  Sometimes, it feels like we are all alone in our careers.  When the inevitable roadblocks and red tape frustrate our efforts to care for our patients all to often we have nowhere to turn for advice, conversation, or venting.

Venting?  Yep, that is the building block of all great ideas.  If people were 100% satisfied with all they encountered America would never have been colonized.  But, the art of complaining will be a future article.

Today, I want to share a new option for refreshing the professionals’ spirits.  CCCSLP has a YouTube channel.  Currently, there are six videos which are under three minutes each.  They are not about articulation or swallowing or hearing or language.  In fact, there are no words.

The videos are of the beach.  They are by design, quiet moments of a lovely view.  Sunrise, blowing sand, crashing waves, seagull calls; short clips to ease an overly burdened day.  It is literally a few minutes at the beach without leaving your desk.

I hope you follow the link to our YouTube Channel and enjoy a chance to virtually relax.  We all need it in the crush of busy day with demands from every angle.  We all deserve to do something for ourselves within tight schedule of our high pressured careers.

About the author

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.

……

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I have all the answers but nobody is asking me any questions

I have all the answers but nobody is asking me any questions

By Marguerite Mullaney

“I have all these answers but nobody is asking me any questions!”

The words echoed down the muggy hallway of an Alzheimer’s unit one hot August afternoon as I was hurrying along to see my next patient. They stopped me in mid step. Many times, a patient has managed to say the one thing I needed to hear at a particular turning point in my career. However, on this occasion, the message was shouted by somebody not on my list with no assigned minutes. His sentiment was so poignant and so common it could be a defining human characteristic; the need to share our expertise. It is a want that resonated deep within me and I took a few minutes, unbillable minutes finding the man and asking him a question.

We spend years becoming speech language pathologists. Studies are not enough to get the seal of approval. There are tests to pass, followed by a lengthy fellowship under the watchful eye of another person already judged to be an expert. Even certification and licensure is a process and requires constant education to renew yearly.

Yet, having completed the all basics and continuing to achieve certification and licensure yearly, I find nobody is asking me the question I so desperately want to answer. If I had a chance to answer one question for the next generation of SLP’s, I already know what I want to tell them. It would be the same message given to me by one of my graduate supervisors.

I was her first student. She was my first supervisor with an adult neurogenic population. We spent the autumn of 1987 driving each other crazy and getting in each other’s way. She wasn’t easy to learn from and I wasn’t particularly bright, but we bumbled along with a minimum of chaos. Then dysphagia struck!
Swallowing was a bit new to SLP in those days. Not every clinician was practicing it. I was lucky. My supervisor was confident enough to admit her limitations. She showed me how to research the information I needed to fill the gaps in my university education. There was no dysphagia course offered in my graduate program way back in the dark ages of the eighties. Filling in my theory short comings was as easy as reading; Logemann and Rosenbeck became my bedtime stories for the remainder of grad school.

But, practical application of that knowledge takes…PRACTICE. You need to do an awful lot of awful bedside evaluations before you get really good. You need to see an ocean on aspiration on MBS before you can anticipate the drowning. How does a supervisor get a new clinician from inexperience to expertise without killing anybody? The answer is not, ‘puree and pudding thick liquids for everybody.’
Have the clinician answer this question just as my supervisor made me answer for each of our dysphagia patients 23 years ago: “What swallowing felony has this patient committed to be condemned to puree and/or thickened liquids?”

Too many times lately, I’ve read reports which did not reflect deficits significant enough to justify diet modification. Then there’s an increasingly popular trend in acute care summaries which apply the safest diet for swallowing purposes without consideration of the ramifications to the whole patient. Expensive MBSs performed in which no aspiration was detected or the trials were less than five swallows or limited trials of nectar, honey, and puree or not one compensatory strategy attempted have been in over-abundance in recent years. Bedside evaluations are sent with statements identifying aspiration to the point you must read them twice to be certain imaging was not conducted. In my pursuit of additional information for some of the more outrageous claims, I have heard such depressing excuses as:

1) I stopped the MBS because I was afraid the patient would aspirate.
2) The patient was coughing so I changed him to pudding at bedside.
3) I didn’t try thin during the MBS because at the nursing home he was already on nectar so I started there.
4) There’s no speech at nursing homes so I put her on the safest diet; puree and pudding thick.
5) A suspected timing delay of the epiglottis might be present and could lead to aspiration even though none was apparent on the MBS but to be safe I recommend nectar thick liquids.
6) I didn’t want to recommend something they might aspirate and get sued.
I wish there was no number 6. Sadly, I think it is the driving force behind many of the recommendations. But, I would spread some words of caution to my peers, especially the younger ones. The only thing that avoids litigation is luck. The thing that wins litigation is expertise and documentation.
If you make a swallowing recommendation in isolation of the needs of whole patient to save him from aspiration pneumonia and he goes into renal failure…that’s a big problem.

If you base your recommendations on what you suspect their living arrangements are and you are wrong…that’s a big problem.

If you are practicing limited trial MBS’s and ending them early because you are afraid the patient will aspirate…PLEASE stop conducting MBS and get more education!

Before you alter another diet ask yourself, “What swallowing felony has this patient committed to be condemned to puree and/or thickened liquids?”

About the author

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.

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