Author: Elise

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.

Better Speech and Hearing Month 2020

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

This is candid. This is raw. This is a result of months of reflection on my part. This is what I wish someone would have told me years ago as I graduated from graduate school.

For those of you who don't know me--I enjoy working and creating and organizing, and those passions make it quite easy for me to take on too much. I have historically worked over 60 hours a week, I returned from my maternity leave 4 weeks after having a baby and worked with him on my lap, and I'm known for never actually unplugging on vacation. This was not because any company I've worked for asked me to--but a result of my passion for what I was doing. So, I'm not an expert on this yet but I'm growing.

Recently I took a spa day and finally used the gift cards my husband bought me two years ago to try to get me to take a day off. As I was sitting in that sauna, all of this hit me and I realized I had done a serious disservice to myself, my loved ones and the companies I worked for by working too many hours, taking too little vacations and not setting boundaries between my personal and professional time.

This is the blog that I wish I would have read years ago and I'm hoping that someone reading this--feeling me virtually shaking them by the shoulders--will be inspired to set boundaries and maintain a healthy balance between personal and professional time, all while still doing an amazing job for their company.

Increasing Quantity of Work Doesn't Increase Quality

I will spare the "you're working for free" lecture for those of you who are salary, although you are and it's bad, and tell you what I wish I would have known years ago--you are less productive, more likely to make errors and less focused every hour you work over 40. There is a large amount of research to support that our productivity decreases as we work over 40 hours. My favorite article, though the math throws me off a bit, can be found here. I thought that I was helping by going above and beyond, throwing how many hours I worked to the wind, when the reality was that I was decreasing my own performance. In addition...

You're Setting a Dangerous Standard for Your Team

It is significantly difficult for colleagues when one individual works long hours, doesn't take vacation, etc. I always enjoy the reference that it's easier to fall into a crowd than walk against it--applauding the workaholic lifestyle, making it to where someone is praised for working late at night or coming on weekends when they've worked all week--that sets a standard for the entire team to live up to. The focus shifts to the time spent on the job over the work produced and you very quickly have an overworked team which results in burnout which results in turnover. If you are a manager, it starts with you--it starts with you firmly setting working hours, pushing for your employees to take vacations and leading by example. Your colleagues will then attribute your performance to what really is causing you to excel--the fact that you're awesome--not the fact that you work all the time.

Use the PTO Without the Guilt

A company that provides paid time off (PTO) has calculated that into your compensation when they offer you a position. So, we all know that not using PTO is giving away money. However, it's easier said than done when there is no coverage for your position. Yes, what you do is unique and valued. No, it is not your fault if there's a staffing shortage when you're out. In addition, you should be extremely concerned if you're working for a company that will crumble with you being gone for a week. Set a vacation reminder letting everyone know when you'll be back to conquer the world and take.that.time.away!

Set Yourself Up to Love the Job When You Leave

The reality is--there's an end date at this job--whether retirement or leaving for a different position. Right now it may seem like this is where your professional journey ends and every sacrifice of your personal time is worth it. However, life changes, bosses change, company policies change, offers come and where you are now may not be where you are in a few years. You are killing yourself for something that may be completely different six months or six years from now.

If you push yourself too hard and if you give all your time away then you will likely leave exhausted and burnt out with little time to experience the beauty that comes with the closure of leaving something that's been a big chapter in your personal story.

The moral of the story--if you want to be the best for your company and your team then you have to take care of yourself and you have to set boundaries. You will be a more productive employee, you will be proactively fighting the risk of burnout, you will not be working for free and you will be a better team member to your colleagues.

-Elise

If you need strategies for decreasing workload, increasing prodcutivity and increasing work life balance email elise@therapistsupportnetwork.org

I didn't start getting into shopping during Black Friday until recently. I still have not actually gone to a store on Black Friday--the fear of trampling has always kept me away. However, I have embraced the shopping tradition now that I can do it from the comfort of my own couch. I've done some digging and have compiled my favorite holiday deals (or soon to be announced deals) from my favorite resources. Let's dig in--from the comfort of our couches!

My Top Ten Favorite Holiday Deals

Super Duper 20% off ASHA sale: Code 2019ASHA

This isn't Black Friday specific but the coupon code is only valid until 11/30 so this is a great time to update your material bag (or virtual material bag if you're a Blink Session user).

Private Practice Bundle by Jana Castro-Casbon

This one is on my "favorite list" because it's an amazing tool for therapists in private practice who are navigating necessary forms, marketing, etc. This amazing Black Friday bundle includes over 25 templates that speak to legal needs (e.g. HIPAA notice) and includes the social media content calendar. Check out the list of all that's included here.

Target: 50% off games

According to Target's Black Friday sneak--the following games will be 50% off: "Throw Throw Burrito, Mr. Pop, Home Alone Game, Watch Ya Mouth Ultimate, Disney Frozen II Surprise Slides, Lucky Ducks, Torch Run, Shark Bite, Disney The Lion King Pumba Pass, Say Anything, Dragon Snacks and Charles Wysocki 300 large pieces puzzle." Hello, future reinforcements!

Speech Therapy PD: Continuing Education sale

I truly enjoy SpeechTherapy PD as a continuing education option: interactive and engaging videos, podcasts, founded by an SLP and they provide ASHA reporting. According to their team, any therapist that signs up for the mailing list will receive a "significant discount" on Cyber Monday! You can do that on this page. It's just in time for getting last minute CEUs completed before renewal time. **victory dance**

Teachers Pay Teachers

Teachers Pay Teachers has not announced yet BUT historically they have given some sort of Black Friday or Cyber Monday discount. Keep your eye to TPT and get some great resources that also support fellow therapists. My favorite therapist-run TPT stores: The Whimsical Word and Crazy Speech World.

Swivel Scheduler: Discount Code for Black Friday Featured on IG!

Schedule your students, add their goals, automatically get a generated schedule AND get this great resource at a discounted rate on Black Friday! This is a wonderful tool for therapists with large caseloads and a significantly large amount of goals to keep track of. Navigate over to Swivel Scheduler's Instagram on Black Friday for that discount code and enjoy some peace of mind.

TheraPro: Knocking some prices down to 1999 Prices on Mondays/Thursdays

TheraPro online is turning the big 2-0 and to celebrate they're knocking down the prices on certain products to the price that they were in 1999. To stay updated, check their Facebook on Mondays/Thursdays until December 19th!

Lakeshore Learning

I love Lakeshore Learning products--as a therapist and as a parent. If you're interested in purchasing gifts for loved ones that are also educational in nature, this is a one-stop shop. Lakeshore has stated they are doing Black Friday/Cyber Monday deals and will be announcing it shortly on Facebook. Cliff hanger!

iPad and Tablets: Technology for Therapy

It may be because I was a teletherapist, but I incorporate my iPad into 85% of therapy. If you're like me and need a technology upgrade OR you'd like to incorporate more technology into therapy, now is a great time to purchase that tablet. Best Buy has iPads up to $100 off, Target has Galaxy's $60 off--there's several options. Personally, I recommend the iPad ESPECIALLY if you're providing teletherapy and can screen share to an iPad---therapy.game.changer.

Total Wine: Save 10% and Treat Yourself

You deserve it. Treat yourself. If anyone questions it, tell them there was a deal!

Happy Shopping!

-Elise

Changing therapy environments can be a thrilling time for a therapist: new exposure to a wide scope of practice, new schedules, new management, and a position that will, hopefully, better meet your needs. With that said, deciding to switch can be daunting, overwhelming and a difficult decision. Here are some tips while considering the switch to ensure that you are making the right choice!

1.) ANALYZE PAY:

Some therapy environments offer good compensation on paper and it becomes easy to let that sole number be the deciding factor. However, many considerations make that number higher or lower when you factor them in. Travel, vehicle wear and tear, per session vs per hour compensation, benefits, bonuses and productivity are all external variables that can change that number on paper.

Let's look at an example (skip this if you get the picture): let's say you're an SLP that is considering switching from home health to a contract, full-time school-based position that's going to pay $45/hr. You take $45 X 180 (average days of school) X 8 (full-time hours) and you get=$64,800 gross. Now, add in the ASHA CCC's reimbursement, decrease ____ for gas, add in any PTO and so on and so on--despite $45 likely being less than your home health hourly number, the two may end up being closer together than you realize when you add in or subtract external variables.

(Disclaimer: the author of this blog is an SLP that fits the stereotypical mold of being bad at math and cannot be held liable for any mistakes in the formula above 😀. )

2.) BEGIN CONTINUING EDUCATION

It's time we all admit the hard truth that graduate school was a minute ago for the majority of us. Even when considering a position, it's a good idea to begin taking some continuing education revolving around the new population or environment you're working with. Not only will this allow you to throw out the latest evidence-based practice terms during interviews (as someone who has interviewed MANY therapists, this is a good thing) BUT it will give you exposure to the population(s) you're about to work with before making the swap.

3.) ASK FOR COMPANY REFERRALS

Do not be afraid to ask the company to provide some referrals. I will say that those referring therapists may be biased (or have a recruiter perk they get) but, even if they do, it is valuable to talk to "boots on the ground" of the organization you're considering joining.

Also, I always recommend therapists turn to Indeed, Glassdoor or other anonymous locations to read reviews. Be cautious as often with anonymous reviews you see the extremes--the disgruntled employee or the elated employee--so don't take these tools as a completely perfect picture of the day-to-day in the organization but they still provide insight.

4.) TWO WORDS: SOCIAL COMPENSATION

Social compensation involves aspects of the potential new position outside of monetary value: your feeling of self-worth, your stress level, your happiness, your time and so on. Social compensation can make leaving an environment you're in or staying in an environment, despite something monetarily better, completely worth it. Social compensation should be one of the top considerations when making a change. My list when considering a change is: 1.) Will this pay the bills? and 2.) Will this give me more time with my family? Social compensation is #2 for me when deciding on change.

5.) OUTLINE "THE WHY"

When considering leaving your current setting, put down 1-3 objectives with what you hope to accomplish from leaving. When making the consideration for a change, any motivating factor that doesn't fall into one of these objectives needs thrown out as it's a distraction.

The reason I say this is that something luring like wage can get us to swap settings BUT if it isn't answering "the why" of you wanting something more flexible, you'll likely be back to wanting to change again soon.

6.) MY OBVIOUS FAVORITE: ANALYZE SUPPORT

Therapists need support. We have too wide of scope of practice to not have support. The difficult thing about certain environments, particularly 1099 positions, is that support can be limited. If you are changing settings--and with that change comes a change in populations--take support, or lack thereof, into consideration as you make the switch.

If it is a 1099 position or comes with limited support, reach out on social media or (shameless plug) the Therapist Support Network to line up mentorship for your first month or so. Going in without support can make that initial experience a negative one and a bad first experience with a job is hard to get over.

Summary: I applaud any therapist as they embrace change, pursue new avenues of being a therapist and continue on their amazing professional journey. Take these things into consideration and, as always, let me know if I can help! -Elise

Anyone who has worked closely with me knows that I'm a bit of a fangirl when it comes to occupational therapists. I have worked with and managed OTs that could make something therapeutic out of a cardboard box. However, my awe, if you will, actually started with "that one OT". One of my children struggled with hyperactivity when younger and we Googled how to help and came across a good amount of strategies--weighted blankets, cushions on his chair, etc. Unfortunately, those strategies did nothing in the school-based environment. Luckily, we had received an OT consult for an evaluation and, although, he ended up not qualifying, that brief conversation with an OT changed his multidisciplinary team's perspective and overall approach to assisting him. We actually learned that his needs were vestibular in nature and no amount of weighted objects would ever resolve that. She educated us on vestibular needs and showed us some tips. I still remember that Occupational Therapist and how much she helped me and his educators at a time when we all felt pretty helpful.

Now, let's look at the story from the OT's perspective--well, we can't because she moved and I couldn't find her on Facebook (embarrassingly, I tried). I think it's safe to assume that to that OT it was another day. When I think of my experiences as an ST--there are those unbelievably moving experiences that make me so proud of myself as a therapist--the child that first speaks using a device, the man that gets regular consistency milk in his cereal for the first time in five years, the baby that waves for the first time, etc. A therapist walks away from these moments in their work days with no doubt that a life changing impact was made. As therapists, we know, though, that our caseload primarily consists of life changing moments but that are in smaller scale and don't leave that immediate "I just changed someone's life feeling". Other job stressors like productivity, reimbursement laws, high caseloads can mask the feeling that comes from changing someone's life--especially if those changes come in smaller ways.

I am here to tell you that to that OT--that was likely a normal consult. That was an evaluation, no recommendation, some tips and on to the next thing. That OT likely didn't leave feeling like she just accomplished this ground breaking/move mountains therapeutic moment--that was likely monotony in her day.

To me as the patient, though, that was a moment I will never forget because it made my life as a parent easier. It gave me the skills needed to better support my child and to educate others on how to better support my child. Her likely monotonous advice was my forever tool. I put a lot of my passion for the field of occupational therapy on that moment--on her monotony.

It is easy at times to feel monotonous and undervalued. However, I am here to tell you that there is someone on your caseload, I guarantee it, that will always remember you for the services you're providing. You are the person that is going to equip them with tools, you are the person that is making an impact, you are the person navigating their deficits with them, you are their person--you are THAT therapist.