The TSN Favorites: Free Activities for High Schoolers

We are starting a new type of blog that we will be posting every few weeks: The TSN Favorites! These are recommendations from our network members on a variety of topics that are consistent with our mission to provide affordable materials, support, and community to all occupational and speech therapy professionals.

Let's start with the motivation behind this--working with high schoolers and keeping the content age-appropriate, goal focussed, and engaging can be extremely challenging. Obviously, this shifts a bit as our clients get older and post-secondary transition becomes a central focus BUT our group has some free resource recommendations that are both functional and engaging!

smithsonian Tween Tribune

This website is such a great source for short articles to read and discuss while also targeting attention, wh questions, main ideas, components of the story, you name it! There are short videos and articles that you can break down by complexity and Lexile. Plus, there are articles in Spanish.

planning and online shopping

I know I've said this in my blogs before BUT I love doing trip planning, online grocery shopping, etc with my older students. This is low prep but fun: plan a camping trip and fill a cart with what's needed: list-making, maintaining a budget, shifting attention from a written list to an online shipping platform, problem-solving...so many great targets! Plus, almost every store has online shopping and so you can get very creative with your trip ideas.

DocsTeach

This website is a great way to bring history into your therapy setting, as it contains documents from the National Archives to analyze and then complete related activities. This website does require registration (email, password, educator status) but is completely free! They have some great ready-to-use activities, picture analysis, patent analysis--it's pretty cool. You can analyze a picture of Amelia Earhart or analyze the patent for the first "Flying Machine". We won't judge you if you spend your weekend on this website.

News ELA

This is another free website but does require registration (no card required). There are so many great articles on here--including short stories broken down into separate parts to allow for completion over multiple sessions. There are opinion articles, pro/con articles, multimedia materials, and more.

Minute to Win It brain breaks

It's no secret that our therapy (generally) becomes less fun as our clients get older. These minute to win it games can be a great brain break between some tedious therapy activities. Plus, many of them don't require a computer or extra materials which is great for providers that travel between multiple locations for services.

Cool Math Games

This website contains a good amount of online games that are great as reinforcements during the therapy session. Chess, Snake, Word Games, Puzzles--there's so much to do, and all are great for engagement during virtual sessions. There are some games for younger ages, too, so we recommend trialing your game first to confirm it's age-appropriate.

K12 Reader

This website has materials and printables for all ages that are focused on literacy skills. This website is a go-to in the academic environment when working on sounds in reading, reading comprehension, answering questions, or when reviewing carryover of skills into academic activities.

Financial football

We highly recommend this website as a fun therapy activity that addresses functional skills. This "Madden-like" game requires the answer to financial questions before making your next play. Plus, this website has lessons that can be used to discuss finances but also target language goals, problem-solving, and post-secondary transition.

Still struggling with new material ideas? Join our network and gain access to our material center and material request form (where we make materials that meet your needs) for only $15.99 a year.

Happy therapy!

-Elise and The Therapist Support Network Members

What Having a Child with ADHD Taught Me as a Provider.

It's Attention Deficit and Hyperactivity Disorder (ADHD) Awareness Month!! I want to start by saying that my teenager that will be discussed in this blog gave me permission to post this stating, "It never bothers me if people know about my ADHD."

Background-I had my son at 18 and was a single mom the first few years of his life until I met my husband. That's another blog for another day BUT I share that information to showcase the unique relationship I have with my oldest. While I was in school studying to become an SLP, I was also getting notes from his daycare discussing his running off, fighting the fact that he was always in the "red pocket", and adamantly denying that he could possibly have ADHD. It took several years of recognizing his unique sensory needs and differences in hitting developmentally milestones before I entertained the idea that he could have ADHD. The fear of the stigma ruled until I could no longer deny his neurodiversity.

He's now fifteen and at an age where he can start advocating for his neurological needs along with his medical team. He has great support in school, he's an amazing runner, and he has the most unique brain and sweet heart.

This journey from ADHD diagnosis to management to embracement truly shaped who I am as a Speech-Language Pathologist.

Here's some things I now know:

Comprehension Does Not Include Whole-Body Listening

I know I've discussed this in other blogs, but I continuously advocate for removal of whole-body listening goals/expectations as a mother to a child of ADHD and as an SLP. My son listens better not making eye contact and usually is tapping on something or moving his feet. When redirected and asked to make eye contact, he focusses so much on the eye contact that he doesn't hear any of the message.

The idea of whole-body listening is an unrealistic concept for many clients and I now focus on advocating for how my client/student best listens AND teaching them to advocate for themselves.

Many Parents Are Unaware Of School Resources

I am one of these parents and I work with schools! I can't tell you how many times I stated, "Oh, he won't qualify for any services" thinking specifically of an IEP. However, with his medical diagnosis and noted feedback from teachers, he was able to qualify for supports such as extended test times, preferential seating, etc under his 504 Plan. This 504 Plan has become huge asset as his curriculum has advanced.

What this means to me as a provider: if I get a referral for language and the student doesn't qualify, I often bounce it back to the counselor and/or process coordinator to discuss 504 Plans eligibility.

My Sessions Can Look Differently And Don't Have To Be Seated

I believe the largest change I have experienced as a provider having a child with ADHD, is implementing sessions that can be unique and don't involve sitting at a table. I've embraced "Dance and Freeze", on the floor sessions, kinesthetic activities, and movement with fidget spinners as a routine a part of the therapy space I create (even with teletherapy). I know through our journey that many children require some kinesthetic output to best attend.

Embracing Having a Neurodivergent Child Takes Time

I applaud the neurodiversity movement and taking the outlook of "brain differences" mindset over "disordered". With that said, I would be completely dishonest if I said that I didn't grieve this diagnosis as a parent. It doesn't mean that I didn't see his unique brain--it meant that I was grieving that unique brain functioning in a neurotypical world.

As a provider, I've seen parents present grief in many different ways--anger, blaming, bargaining, extreme sadness, frustration, denial--and I've learned not to judge. A grieving parent doesn't mean they won't come to fully embrace neurodiversity and I've learned not to try and rush or shame the grieving process.

I Can't Judge Medical Decisions

Here's the deal--half of 8th grade my son was not medically managed because of weight loss. He had grown and so his current medicine was no longer effective BUT we couldn't increase it because his weight. I'm sure many teachers formed opinions about his medical management BUT we really were at a cross roads.

As a provider with a child with ADHD, I know that I cannot judge decisions about medication. Many parents/guardians want to pursue alternative treatment, often neurologists take a good amount of time to get into, or there may be physiological reasons why medication wasn't chosen at that time. It's not my place to judge or give lesser treatment because I'm waiting for the medication adjustment.

Advocates Are Needed

I wish I didn't have these stories, but I do: I've been told my son just needs discipline, I've been told that ADHD is a symptom of ODD and isn't a primary diagnosis (this was a medical [professional), I've been asked if I could remove him from medication so "he can try", I've been shamed for deciding medicine, I've been shamed for not medicating earlier--the list that my son and I have both heard is quite long.

I've seen Facebook posts stating that " a belt" would be a solution. I've seen horribly inaccurate and stigmatizing things on all forms of social media. I feel confident saying most parents of children with ADHD and most adults with ADHD have been exposed to statements that are discriminatory, shaming, and inaccurate.

Although it's improving, there remains a stigma and misunderstanding of ADHD. There is never too much advocacy from us as providers. I know as a provider that I cannot advocate enough for my student/client learning needs and neurodivergent strengths.

As my son says when he advocates for himself, "My ADHD is harmless." I absolutely love his brain and I love how it shaped who I am as a provider. May this ADHD Awareness Month be full of advocacy and celebration of those you love with ADHD.

-Elise

The Therapist Support Network: Not Your Typical Founder’s Story

I have been wanting to share the story of how The Therapist Support Network (TSN) and the recent remodel, I like to call it TSN 2.0, came to be for quite some time now. Having been in the start-up world before, I've been exposed to so many great founder stories--stories of companies founded across the table of a peer, stories of one child's needs inspiring development of a now large company, etc.

The TSN's story isn't quite like that and our initial offerings and pricing looked completely different than the product that we now offer. However, the intent of being a place for provider support fueled the company every step of the way, and I could not be more pleased with how the company has evolved to address that intent.

The Beginning

I founded The TSN (1.0): empowerment, support, and community (which has now changed to materials, support, and community) in 2019 after leaving a corporate teletherapy position. I made the difficult professional decision and came to the reality that being in management and a corporate role was no longer for me, but I knew I wanted to stay active in the therapy community by offering consulting services: enter TSN 1.0.

The initial vision for The Therapist Support Network was consultative in nature. However, through that consulting, I was exposed to pain points in our industry such as:

*the cost of material sourcing which was TYPICALLY an out-of-pocket cost (many providers reported spending over $1,000/year)

*the difficulty in streamlined sourcing of materials for multiple populations, such as pediatric and adult populations

*the difficulty for many therapists to locate another provider to collaborate or connect with outside of social media sites

*the difficulties that managers faced in providing materials to their hired therapists.

I looked into these pain points and decided that I wanted to spearhead the creation of an affordable space to meet the above needs.

The Transition of the Company Mission

Here's the part that is slightly unorthodox--when I first discovered these pain points, I actually spoke to other companies to help build this vision. I knew that the creation of an affordable material center would require a good amount of "boots on the ground work" because outsourcing vector image creation, platform location, etc all would increase the pricing, and I didn't want this to be expensive for providers. Call it imposter syndrome or a shake in confidence, but I was genuinely concerned that I couldn't pull this off. I had done nothing like this before and feared spearheading it alone.

Respectfully, in my discussions with companies, I found that companies didn't want to prioritize funds and team members in hiring someone to build this out, particularly someone whose background is in teletherapy and management.

After months of sitting on this idea, trying to find a company that shared this vision, and battling my insecurities, I decided it was time to act. A dear family relative that is in the graphic design industry made our first round of clipart and supported me as I learned to make these images. I attended webinars and watched tutorials to learn how to make both print and no-print materials. I then took 5 months away from work and built out what is now our ever-evolving material center and website.

The Company Status

I am honored and excited by the members we have obtained since launching our new mission of providing materials, support, and community. I am someone that really respects the seriousness of spending money (a professional way of saying I'm cheap), and so I don't take it lightly when a therapist invests $15.99 in what we have to offer!

The material center is currently at 650 materials, that number growing weekly, and is a combination of adult and pediatric materials--print and no-print. We have options to lease our materials to companies and clinics. We also have a location for collaboration and will be starting optional community-building events this fall. We are growing and evolving with our network members dictating what works and what needs to be expanded on.

Although the Founder's Story behind the TSN is a bit unorthodox, the intention always remained the same: to help support speech and occupational therapists in an affordable way. I'm excited to keep addressing pain points and provide therapists with affordable materials, support, and community.

-Elise

Neurodiversity in School-Based Special Education and Related Services

Can providers incorporate neurodiversity in the educational setting--a setting that revolves around acknowledging a disorder that has negative educational impact? Absolutely!

Nuerodiversity is an emerging topic for many of us that is starting to shake the therapy industry in, I believe, a really powerful way. Neurodiversity is a viewpoint that neurological differences, such as ADHD, Autism, Tourrette's, etc, are differences as opposed to disorders. Being a neurodiverse embracing provider really requires flexibility in thought and a genuine embracement and celebration of individuals that are neurodivergent and their unique neurological capabilities.

With that said, the educational environment is very much still structured in a neurotypical manner. Although there is some change happening around this, standardized testing, norm-referenced grading, and transition planning that all revolve around neurotypical standards remain in tact. So, as a provider, we can find ourselves in a bit of a bind trying to embrace neurodiverse practices while also respecting neurotypical educational standards.

Here's my tips for neurodiverse practices you can incorporate into your therapy session while also targeting goals for educational success:

Remove the Idea of Whole-Body Listening (including eye contact)

I'm starting out my tips with some controversy, but I said what I said. I entered the world of speech therapy with the belief that eye contact in conversation was a must and I was going to remediate that as much as I could. Now, I have a neurodivergent child that listens better when fidgeting. In the past, we tried to work with him on eye contact and it was so uncomfortable for him that he would focus solely on eye contact and completely miss everything we said. Instead of utilizing blanket "whole-body listening" instruction for all students, we must embrace how our students listen best. Some students do learn best after intervention on focusing on a target while listening, for example, but many students communicate best looking at the floor or with some movement added in. By applying eye contact goals, we may actually hinder our students' listening skills.

Instead of blanket whole-body listening goals, you can do two things that embrace your student's brain but also recognize the educational environment: 1.) educate caregivers and instructional staff on how your student best listens (also teach your student to advocate but more on that later) and 2.) offer an equal behavior that is less distracting. I have had some students that have a listening behavior that distracts classmates such as raised arm hand flapping. In this circumstance, we would target moving hand flapping down under the desk, for example, as opposed to targeting no movement during listening.

Keep Your Redirects Goal Focused

It can become easy to find yourself in a continuous state of redirection and prompting when working with those who are neurodivergent in the academic setting, particularly with those with ADHD. I have found that therapy is much more enjoyable for both parties if I simply focus on the goals that I have outlined with the educational team.

An example of this, I have a student right now that loves to meow. Our goals are specific to "wh" questioning, he's not hurting anyone by meowing, and so I'm not going to prompt or redirect that behavior. That "meow" is his way of communicating in our sessions. Honestly, sometimes I meow with him which always makes him smile.

So many of the times our sessions are a break from a loud environment or an overly structured environment, and we best serve our students by giving them a place where neurodiversity is accepted. Our role as service providers is to target the specific things we have outlined that we determined were necessary for academic success with the multidisciplinary educational team.

Use Neurodiverse Therapy Materials and Grouping

We are advocates for our students and clients. It is crucial to incorporate neurodiverse materials in our instruction even when working with clients that are neurotypical. Books such as "All Are Welcome Here", "Nadia: The Girl Who Couldn't Sit Still", "Rosa Loves Cars", and so many more are a great way to incorporate both literacy and advocacy into all of your sessions, even articulation intervention.

Also, challenge your grouping practices as a school-based provider. I currently have a student working on the /r/ grouped with a student working on communicating wants and needs. As long as you can continue to provide specialized instruction to all involved in the group, it doesn't hurt anyone to group neurotypical and neurodivergent students.

Teach Self-Advocacy

One of the great things we can do for our students is teach them to advocate. With advocacy comes confidence. I want to be clear that advocacy does not equal an apology. Simply teach your student to communicate his or her communication needs. Teaching your student to say "I listen better by looking away" is a simple way to address success in the educational environment without trying to redirect a trait that helps your student best learn.

I stress the unapologetically part. We don't want our students to feel like they have to continuously apologize for how their brain works. Instead, we are empowering them to educate others on their preferred communication needs. Advocacy can start at a very young age and can be your student's greatest tool as he or she navigates primary and secondary education.


I do believe that we are able to embrace neurodiverse practices in education. With that said, I don't believe the word disorder is going away any time soon for the educational environment. and we still have to qualify students with educational disorders due to our norm-referenced structure. However, that doesn't mean that we can't break the mold of what educational intervention looks like and celebrate our students neurological differences while also giving them the tools needed to succeed academically.

-Elise

Therapy Activities When Working with Older Teens!

I am really excited for this blog! Many of you who have interacted with me, or have seen some of the cognitive-linguistic intervention materials I have made, know that I love providing meaningful intervention to teenagers. One of my favorite things about working with the older teenage population is being a part of the transition from a focus on academics to a focus on functional life skills (which often includes academics still).

With that said, buy-in can be difficult with teenagers and finding ways to keep engagement high while addressing functional skills can be a challenge.

Here are some of my favorite activities to use with older teens that can be modified regardless of target areas so you can obtain data while still providing meaningful intervention.

Plan a Meal and Grocery Shop Online (Even With a Budget)

I thoroughly believe that online grocery shopping will be the modality the majority of our teen student and clients use for shopping. I enjoy setting up meal ideas consistent with a theme (e.g. camping), creating a menu, and then filling an online cart while adhering to a budget with my client. I use this activity when working on planning, sequencing, fluency, conversational speech, and pragmatics. There are many different modifications you can make to this activity to make it applicable for designated goals.

If you're a TSN member, our Cognitive-Linguistic Section of our Therapist Support Network Material Center has some fun grocery store maps that can be utilize for planning and visual scanning in conjunction with this activity.

Discuss the News (-ish)

I absolutely love to discuss the news (-ish) with my teenage clients/students. Obviously, this does require some filtering, hence the -ish. However, I have found that articles on weather changes, eclipse happenings, sports news, and vacation destinations make for a great conversational topic, attention activity, visual scanning activity, or stimulus for voice/fluency intervention.

Complete a Job Interview

This is another functional activity that I enjoy completing with my older teenage clients. I have used this activity in many different ways: from self-advocacy with my students to planning and answering questions in an organized manner. I also have found that practicing for job interviews is something we all could benefit from as it helps decrease the nerves!

"Cook"

This activity can be used to address planning, sequencing, organization, fine motor skills, and comprehension of written directions. I put this in quotes because many of us in schools don't have a kitchen to get creative in. However, there are trail mix recipes out there that can be utilized without any equipment. If you have the luxury of a kitchen, puppy chow (I feel like there's a more professional word for this that I don't know), popcorn on the stove, etc can be made with relatively little equipment.

Have some extra time? Combine a grocery store/budget activity with this cooking activity.

Plan an Age-Appropriate Trip and Make a Suitcase List

I have gone all kinds of places with my older students and clients. This activity can be utilized to address organization, planning, and other executive functioning skills. For my clients that are preparing for college, I often have them utilize an app such as "Notes" or the free app called "To Do" to make packing lists and make this activity more functional.

Calendar Activities and Setting Phone Reminders

If your client is getting ready to graduate for college or the workforce, there is so much significance in knowing how to utilize a calendar to assist with organization, recall, and planning. If you have a client that is leaving for college, he or she will have to know the best way for him or her to remember when tests or other projects are due. You can utilize your intervention time to assist with use of calendars/reminder apps/etc while also addressing your short and long term goals.

In the Therapist Support Network Material Center, we do have some calendar activities. However, I prefer to utilize digital calendars in many cases with my teenage clients as most colleges and/or work force environments utilize an e-calendar system.

Map Reading and Bus Route Navigation

By map reading, I definitely don't mean using a map to get from one city to another--I believe we all have digitized this skill. However, many downtown areas, malls, universities, and hospitals still utilize maps to show where offices, stores, and restaurants are. This can be very daunting for someone who struggles with visual scanning, attention, recall, and executive functioning skills.

Personally, for my clients that are off to college soon, I like to get the university bus route and discuss navigation from building to building, how much time to prepare for the bus, and pair that with alarm setting. I then take data on whatever skill I'm wanting to see independence in whether it's recall of the bus information, ability to sequence, etc.

ABOVE ALL, you can find functional activities often by talking to your client and/or their caregiver. What does your client love? Fortnight? Awesome! They communicate with other players on there and voice activities can be pulled from there.

The fundamental piece to note while providing functional intervention to this age range is that you need to mold your intervention to mimic times in your client's life where he or she needs to use whatever goal you're working on. This is one of my favorite things to do as a provider and truly makes my job satisfaction higher because I see a direct correlation between what I'm doing and improvement in my client's daily living.

Happy treating!

-Elise

For access to the materials in our Therapist Support Network Material Center, join the network for only $15.99/year to receive access to the Material Center in addition to other network perks.

Get Moving in Speech (Even with Telepractice)!

We have all been there as providers to young children--the group of kindergarteners comes to speech and they are absolutely wired, won't sit still, won't keep their hands to themselves, and you are struggling to provide productive therapy.

Background: when I first started telepractice in 2015, more than 50% of my caseload was under the age of five. This was my first time doing telepractice and I quickly learned that sitting still at a computer the entirety of the session was not a realistic expectation of much of my caseload.

With that said, in speech we need to get a certain number of targets and it can be VERY difficult to target phonological processes with a child running around the room.

Here's our top activity ideas, telepractice modifications, in addition to a free printable! Happy moving!

Smash Pads, Roll and Say, and Other Fine Motor Activities

These aren't HORRIBLY active but they keep the little fidgeting hands at bay which is often what young children need. There are some children that get over-stimulated with the addition of the gross motor muscles but adding in a fine motor component seems to do just the trick. For smash-pads, I personally prefer utilizing Play-Doh because they really engage those fine motor muscles BUT circle markers are also a great addition.

Telepractice modification

There are many environmental materials that you can request be brought to therapy such as shoe laces the child can spin around, Play-Doh that can be shaped during rest times, beads the child can place on a string, for example. Stress balls, fidget spinners, pop-its are a great way to keep a child engaged during seated therapy, simply inventory what your e-helper has access to and ask that individual to send it to speech with the child.

"The Floor is Lava"

This was one of my favorites when I first worked with that young caseload I mentioned. Simply place some sort of maze of safety on the floor and have your students/clients jump around. You can utilize floor discs, stability discs, OR if you're a Therapist Support Network member, we have printable pads you can laminate and place around the room (see freebie). Once your client stands on the safe space, have them produce the desired target.

Teletherapy modification

My main experience with "The Floor is Lava" is in teletherapy. I've had parents place pillows around the room my client is in OR have had my students set up the maze for me using paper, etc. Be mindful of device carrying! Personally, I have the facilitator place the device on a table that rolls with the child OR place the "safe spaces" where I can still see the mouth while the student jumps. The maze can also be set up to where the child goes and gets the stimuli by jumping and jumps back to the computer for target production.

FREE PRINTABLE! Test out this activity with these CVC Printable mats.

Simon Says, Red Light Green Light, and Dance Then Freeze Games

These are some classic, no-materials needed games that can easily utilize movement between stimulus and therapy targets. Simply get your students/clients up and start playing. Worried about uncontrolled madness? Place tape circles on the ground and tell your student/clients that they have to stay in that circle. You can make up "only move your legs" rules, as well, to keep hands from going astray to fellow group members.

Telepractice Modification

All of these activities can be done via telepractice. If possible, have your e-helper place a perimeter on the floor and tell your students not to leave the perimeter. If not, ask the student if they're on a tile floor and have them pick a tile to stay on during the activity.

Change Body Positioning (and Talk to an OT)

Often times, getting your student/child away from the sitting at a desk position can assist with decreasing distracting movement during the session. Standing, sitting on a stability disc, sitting on a balance ball, laying on the stomach, jumping on a mini-trampoline, sitting on the floor are all alternative positions that can assist with engagement in therapy. I have received most of my advice from OTs! They typically have some great suggestions for regulation in therapy so you can get your targets in!

Telepractice modification

When I have supervised other providers in teletherapy, I gave the recommendation to change a young child's position to increase attention during the session often, because I've seen how powerful a simple positioning change can help. By the time I ended the school year with my first caseload I mentioned, my students were either jumping on a small trampoline during therapy, laying on the floor during therapy, laying in a play tunnel, or sitting on a stability disc. The majority of students/clients join sessions from a portable device--ensure the device is safe in whatever the position they choose and then let it happen!


Moral of the story--there are ways to activate the fine motor and gross motor muscles while still getting a certain number of targets and structured instruction in.

TSN Members-check out the Therapy Support Network Material Center for some of these activities OR complete the "material request form" if you think of materials we can make to help you with these populations that we can make for you.

Not a TSN Member? Join us now for only $15.99/year and receive access to our material center, collaborative space, and material request form. https://thetherapistsupportnetwork.com/become-a-tsn-member/

The Ways that Providers May Inadvertently Violate Copyright and How to Avoid It!

Let's chat Copyright and Terms of Use! Some providers may have greater knowledge on this area than I did, but I found a steep learning curve when I initially decided to add a material center to The Therapist Support Network.

In all transparency, the month after I decided to add a material center to our offerings, I started making a large amount of materials on a graphic design platform utilizing the images and templates there. After an embarrassingly large amount of creation, I discovered that those images or templates could not be used for commercial or resell purposes, which the TSN material center is. I ended up starting from scratch and creating our images to eliminate any risk of inadvertently violating a designer's terms.

So, that's not only a month of my life I can't get back, BUT it also really opened my eyes to the little knowledge I had regarding these legal terms despite being in a profession that is exposed to Copyright and Terms of Use a good amount.

The majority of us know that we aren't supposed to scan evaluations, test forms, etc BUT with the rapid increase of digital products and platforms ON TOP of the increase in online material sourcing platforms, it's a good idea to scan through these areas to confirm ultimate compliance with a developer's legal terms.

You may be inadvertently violating Copyright if you are...

Uploading Materials Into a Teletherapy Platform or General Shared Space

When I first started teletherapy, I utilized a basic, videoconferencing software. Now, there are platforms designed specifically for teletherapy. In addition, the COVID-19 pandemic forced several brick and mortar companies to shift to online platforms that can be accessed by providers such as Google Drive or OneDrive.

Let's start with the positive-This is so amazing! The increase in digital usage in our field is helping streamline and enhance service offerings, in my option.

However, many of these platforms have a space to upload materials which can be accessed by other providers. The majority of these materials have single use terms attached to them and this then becomes the digital equivalent of scanning a material and distributing it to fellow providers.

Solution:

The majority of material creators recognize the shortcoming that is affordable material sourcing for providers. Many creators have additional licenses that can be purchased upon discussion. The Therapist Support Network has options for companies to lease out materials and uploaded in that companies/schools/clinics shared space. There are many options that developers are open to that start with a discussion!

Selling or Commercially Utilizing Materials with Clipart with an Unknown Source (or source that doesn't allow that)

Ahhh the month I will never get back. This is what almost got me in hot water! Clipart images, pictures found online, and other vector images typically have some sort of terms of use attached to them.

Now, providers making a quick material specific to your caseload, you're likely fine. However, uploading that material into a shared space, utilizing in a commercial fashion (e.g. on a teletherapy platform), OR selling your material--you may be violating terms of use specific to that image.

So, you can do all of the right things with your actual material and create the bones from scratch BUT if you utilize images that you found in a graphic design platform, for example, then you're potentially violating a terms of use.

Solution:

Many designers sell their images OR let you utilize them at no cost as long as they're referenced. Don't utilize a picture OR clipart image for commercial or resale purposes unless you know the source.

Sharing One Password to a Material Source Per Team

So much of the inspiration behind my business design is to address AFFORDABLE access to materials. I recognize the intent behind this one--we are in a field where many providers are responsible for purchasing their own intervention materials (cringe) and that can be very expensive. However, purchasing one license to a subscription type setup and then sharing that password is most likely a violation of that creator's terms of use and is theft.

Solution:

Many authors and developers offer group discounts. It likely won't be as affordable as multiple providers sharing one password BUT it's aligned with legal terms.

I will end with an admission that I never realized the time that goes into material and clipart creation, in addition to not quite understanding the nuances of copyright when I first added the material center to The Therapist Support Network. There's a reason these terms exist and they can be SO EASY to violate in a digital era. My hope is that this blog assists providers with checking some areas that place them at risk of violating legal terms.

-Elise, TSN Founder

To learn more The Therapist Support Network material center OR our corporate material leasing program, visit http://www.thetherapistsupportnetwork.com

A Guide to Supervision of School-Based SLPAs

Our top tips for providing compliant, effective, and supportive supervision (plus a freebie)!

Many school-based Speech-Language Pathologists will find themselves in a supervisory position at some point in time. Check out our tips below to make the experience compliant, supportive, and effective!

Know the Requirements

This is arguably the most important part of supervision. Credentialing and licensing bodies have outlined the ethical practices and procedures required for supervision. These procedures and policies vary state by state. Here are some examples of outlined areas of regulations.

Supervision Duration requirements

The majority of states have a statement on how much to supervise. Something to note is this is the bare minimum requirement and there are times where you will have to increase the supervision efforts (more on that in a bit). Here are a few examples:

Missouri Department of Secondary and Elementary Education requires direct supervision for each initial contact between the SLPA/student and 1 hour per week after.

Minnesota Department of Health outlines the supervision requirements based on the amount of days into the supervision, e.g. for the first 90 days, the SLP must supervise 30% of events.

Direct VS Indirect Requirements

Several states have breakdowns on direct vs indirect supervision requirements. Direct supervision is observation of the SLPA performing services (this is LIVE, some states have specifications if teletherapy is acceptable for this or not). Some examples of indirect supervision include review of documentation and/or supervisory meetings. ASHA has a breakdown of direct vs. indirect supervision. However, they defer to state regulations when they apply such as in Colorado SLPA supervision requirements.

Years post-grad and amount of slpas under your license

ASHA requires that SLPAs be supervised by an SLP that has completed two years of supervision after ASHA certification.

Another area to be mindful of is the amount of individuals a therapist can supervise. Texas, for example, does not allow for an SLP to supervise more than 4 SLPAs/interns at one time.

CEU REquirements

As of late, continuing education has become a regulated aspect of supervision. Several states have mandated guidelines BUT one of the most notable requirements is ASHA's requirement that SLPs complete 10 CEUs prior to or concurrent with the first supervision experience.

WHOSE CASELOAD IS IT?

I had a colleague that would stop me any time I would say "the SLPAs caseload" (shout out to Liesl) and she was 100% accurate. This is your caseload. This caseload is under YOUR license and that's why being an expert in the regulations in your state is so very crucial. It's important to play an active role in the supervisory process to ensure that intervention is effective, necessary, and what modifications may be required.

The Initial Meeting

Regardless of if you've supervised your SLPA the year prior, your SLPA has years of experience, or you both are brand new to this experience, you'll want to start with an initial meeting.

Topics to address:

Scope of Practice

This isn't necessary annually but I typically review the scope of practice with the SLPA my initial time working with that SLPA. Oftentimes, the reason I do this is that the school district will make requests that are outside of the SLPAs scope. In every single supervision experience I've had, an administrator has tried to get the SLPA to attend an impromptu meeting, complete Medicaid billing forms, write progress notes, etc. Confirm that your SLPA feels comfortable with stating his or her scope in these circumstances because many school staff members are unaware of the differences between the two scopes.

Supervision REquirements

Something that I have experienced is that many SLPAs may not be aware of exactly how much he or she is supposed to be supervised. Laying it out there gives the SLPA transparency around your role and protects both parties.

Feedback on support preferences

Once I discuss the supervision requirements and scope of practice, I then ask some questions specific to the supervisee's needs: how do you prefer feedback? what populations do you feel really comfortable with? what populations are you most nervous about? This will help you provide a very individualized supervisory experience.

Caseload specifics

Finally, I end the meeting by going through the caseload with the SLPA. I typically do this when going over the schedule. This can help you both identify any flags with grouping, students that may need extra supervisory support, material needs, etc.

Ongoing Support Tips

material support

One of my motivations in founding The Therapist Support Network is to address the expense and difficulty in material sourcing for large and varied caseloads. Identifying materials for a caseload of 50 is a tall order and, as the supervisor, you'll want to assist your SLPA and confirm an effective intervention material bank is made readily available for him/her. Some examples include plenty of books for quick intervention strategy for all populations, a Therapist Support Network membership (shameless plug lol), demonstration on the use of a whiteboard, adding on to your license of materials on TPT, quick grab reinforcements etc.

FEEDBACK

SLPA specific feedback: It is important to provide SLPA specific feedback, particularly in the first few months of supervision. As the school year expands on or you supervise your SLPA for multiple years, service-specific feedback may not be necessary each session BUT praise on service can assist with rapport building. When completing your supervision-specific CEUs, you will most likely hear great tips for providing feedback, such as utilizing the sandwich approach (positive, negative, positive) or self-monitoring forms. One thing I encourage is to replace the "good session today" with "I really liked the reinforcement you used today"--keep the praise as specific as possible.

Caseload specific feedback: Caseload specific feedback is a crucial part of supervision and is one of your largest jobs as the SLP. You'll notice in the SLPA Scope of Practice that SLPAs are unable to refer for other services, provide clinical interpretation, or modify a treatment plan and so it is crucial that the supervising SLP be familiar with the caseload and recommend modifications, etc as appropriate.

attend meetings

Again looking at the SLPA Scope of Practice, SLPAs are unable to "participate in formal parent conferences, case conferences, or any interdisciplinary team without the presence of the supervising SLP or other designated SLP". I have worked with many schools that push back on this. However, asking an SLPA to represent you in a meeting is outside of his or her scope of practice.

it's ok to directly intervene when you need to

I had a student added to my caseload, who was supposed to be seen under the SLPA model, who had a very severe case of Childhood Apraxia of Speech. I worked directly with this student for several months, with my SLPA assisting, prior to transitioning that student to the SLPAs schedule. Why? Because I had specific training and experiences that I knew could jumpstart and expedite progress.

In addition, there are circumstances when caseloads are overwhelming, populations are outside of the SLPAs scope, etc and you will have to step in and justify the increase in supervision and/or the need for you to become the direct intervention provider.

document, document, document

I'm going into my 6th year of supervision and I have yet to have to prove any sort of supervision to any credentialing or licensing body, but I can!

It is so important to document both direct and indirect supervisory activities. One reason for this is for record-keeping should an audit take place, in addition to helping you keep track of the percentage of supervisor activities you've completed that month. When you supervise more than one SLPA, this becomes increasingly difficult to keep track of.

Another thing to be mindful of is that it is within the SLPAs scope of practice to "seek employment only in settings in which direct and indirect supervision are provided on a regular and systematic basis by an ASHA-certified and/or licensed SLP." Routine documentation of what you're doing allows the SLPA to be in compliance with his or her obligations, as well.

I personally document the following: a general percentage area of supervision each month, any sort of supervisory meetings and what was discussed, and then a breakdown per student per month (this last one is how I give feedback specific to the student but some districts or platforms offer a spot for this).

Here's both an excel file and Google file (forced copy so you can modify and relocate) of the Record of Supervision I keep. Feel free to download, modify, and utilize as desired!

Supervision of a school-based SLPA can be a very rewarding experience for both parties and the students involved, in addition to being a wonderful way to address service provision in areas of provider shortage.

Wishing you a wonderful supervisory experience! -Elise

In need of school-based materials? Check out The Therapist Support Network material center and receive access to hundreds of materials, in addition to the ability to request material creation specific to your caseload needs, for only $15.99 a year.

Virtual Service Provision: A Response to COVID-19

A Message From Our Founder: Moving services to a virtual modality during these unprecedented times.

"I have never seen anything like this," is something I find myself saying daily during these times as I hear of new closures and measures being taken to reduce the rate of spread of COVID-19. The Therapist Support Network agrees in entirety with these recommendations to help reduce the curve and help our medical and service workers prepare for the spread, knowing that these recommendations will save many lives.

In the mean time, many therapists are turning towards virtual service provision, e.g. teletherapy or telepractice, as a potential solution during times of quarantine. Although it can be done in many circumstances, organizations and therapists have a continuing obligation to ensure that virtual services are aligned with on-site service standards. Here's our recommendations when considering to change services to a virtual modality.

What clients are appropriate for teletherapy?

I will preface this by saying that I have supervised or provided services to individuals with complex needs virtually and felt the services were comparable to those received in-person. With that said, this is one of the biggest questions that I get when an individual is switching to teletherapy, "Who is appropriate for this?" I always recommend therapists replace that question with "Do I have the capability to modify the environment to make this parallel to on-site services or not?"

Here are the categories that the American Speech Language Hearing Association and other governing bodies recommend assessing prior to servicing individuals virtually. I recommend having a checklist that you complete every intake before the swap to virtual: client/student cognitive/behavioral skills (IQ, attention, motivation), physical abilities (ability to sit, ability to access a keyboard), environmental resources (access to internet, access to a facilitator, and a device), communication (ability to understand directions, native language), and literacy skills.

Now, if an individual has a deficit in above areas--that doesn't necessarily mean they aren't appropriate for virtual services. A deficit in these areas means that you as a therapist or company need to asses to determine if you have the capability to assist with that deficit. Some examples include troubleshooting internet connections and providing alternative solutions, changing therapy to a more active teletherapy session outside of a sit down setting for a child that has attention deficits, having a hands-on facilitator to assist with Alternative and Augmentative Communication (AAC) intervention, etc. There may be times when you or your organization don't have the capacity to make the necessary modifications--and there may be times when you do--but the metric of success is the confirmation that the intervention itself is equivalent in effectiveness to if the individual received services on-site.

Be ready to train caregivers

This is anecdotal in nature, but facilitators, i.e. the individuals on-site with a child during service provision, have always been the key to success in my services I've provided virtually. As a therapist, if you're moving to virtual services during this time, you will need to be prepared with a facilitator training that is transparent and easy to follow. There may be times where the facilitator is passive in nature and strictly there in case of emergencies or need for technological troubleshooting. There are also times when the facilitator will be active and acting as your hands or helping gather materials. I recommend outlining what your expectations are of the facilitator and providing that to all involved--of course, email me if you'd like me to send you list of typical expectations.

The Laws involved

My biggest concern when I think of a large amount of individuals switching to virtual services is not only the risk to fidelity BUT the risk of compromise to laws in place. Let's start with HIPAA/FERPA--ensure that the platform you're using is a secure platform. In addition, ensure that you are providing your services in a secure location without other individuals present.

Another consideration is licensure laws-- if your client decides to leave the state, you have a legal obligation to obtain licensure in that area unless that state licensing body allows for temporary provision, which you would need to get in writing directly from that governing agency. The same goes if you as a therapist decide to stay in a different state than licensed during this time. Licensure where you and your client/student are located have to be addressed prior to getting on-camera.

One final consideration--and a discussion that needs to be held if you're a school therapist considering moving your caseload to online--is the discussion around IEP services when a school is closed. If your school is moving to online, this is an easy discussion. If your school is closing, then your obligations to FAPE and IEP services are now very different. Turn to your state governing body and school to look for their recommendations but prepare to not provide any services until you hear a plan of action for opening.

Get Support

I know the majority of us know that virtual service provision is not simply taking your clients or students and moving them behind the computer. Virtual service provision is a wonderful solution in times like this but it does require some planning and preparation. If you're a therapist being asked to switch services online but you have no experience doing this ask for support and ask for training.

A final consideration, pursue a platform that helps during this time. Many platforms, in addition to adhering to privacy laws, also come with built-in materials that can help decrease therapist burden.

In summary, virtual service provision can be an answer to ensuring services go with as little interuption as possible during this time. However, support and education is essential to confirm therapists are well-equipped to make that transition with no compromise to quality of services. As always, I'm here to support during this time: elise@thetherapistsupportnetwork.com or  (417) 501-5853

A More personal note:

In times of heightened tension, I automatically go to a place of "how can I fix this" which can appear very robotic in nature, so I wanted to take time in this blog to have a more personal conversation to therapists. I know that many individuals are experiencing a reduced pay or without pay right now. My heart hurts for anyone going through that during this time and my hope is this is done soon--answers are found soon--the curve is flattened soon--and there is little impact on your family.

Stay safe and healthy-Elise