Professional Issues Class Post 10: So now what?

Yup.  That's the topic for this last blog post.  So now what.  Those are 3 loaded words.  I have spent a long time preparing for this new career of mine.  Class, research papers, internships, externships, accumulating a set of textbooks that have a net worth more than my house....

For starters,  I already have a job lined up.  I guess I am better off than a lot of folks about to graduate with their masters degree.   I had a choice of a couple school districts in the area and I hope I made the right choice.  It was a combination of location, schedule, demographics and size that sold me.   However, I don't know where I will be placed.  I have been told its either going to be elementary or middle school.  

So now what?  

Just because I picked a public school for my first job, doesn't mean that is where I will stay.   This field is ripe with choices.  Honestly, I cant decide.    I'm currently working in a Skilled Nursing Facility and while I hated it at first, those elderly folks are growing on me.  I mean, they aren't all Betty White, but I've grown quite attached to my current and former clients. 

I really want to try working in a hospital so I can do Modified Barium Swallow Studies.   I would get feed people stuff filled with barium and watch the food and drink go down on an Xray machine.  How cool is that?  

The private clinic setting is more relaxed than a school with way less paperwork.  Home health.   Early Intervention.  Voice work.   Hippotherapy.   Llama Camp.  There are way too many choices  And I want to do them all!  

So now what?

Oh and did I mention that I also want to work overseas?  At the top of my bucket list is living in another country for at least a year.  I want to immerse myself in another culture in a way that vacationing doesn't allow.  I want my kids to expand their horizons.  Speech Language Pathology opens that door to me, as SLPs are in demand most everywhere.  From International Schools to DoD schools on overseas military bases to reciprocal agreements between ASHA and their counterparts in other English speaking countries, the opportunities are out there.  I do intend to jump on one of them at some point.

So now what?

Oh and don't think I am done with school!  I have big plans.   First, my BCBA certification so I can learn how better to unlock the magic that is inside the autistic brain.   I have even researched a PhD program in Neuroscience at Georgia State University.      There is so much I don't understand about the brain and my son is my inspiration.  This degree has only whet my appetite for additional learning.    But first, I have a few student loans to pay off.

So now what?

I guess, for now I will just keep on trucking with my last class and my last externship.  I will finish up with this semester on July 25th and start my job on July 29th.  I will complete my Clinical Fellowship Year in 2014.  I will get my ASHA CCC's and become a bonafied Speech Language Pathologist.  I will make an effort to balance my new career with my family.  I will laminate a lot of stuff. I will take a break from reading peer reviewed journal articles for at least 6 months. I will take my kids to Walt Disney World for putting up with a stressed out mom for the last 4 years.  I will start contributing to my retirement again.  

Oh yeah, and I will have fun.  

Professional Issues Class Post 9: Bootcamp

The assignment: Our Web 10 students are coming to Bootcamp next week.  Think back to that time for you.  How did it or didn't it shape you?  Residential or campus students don't have an intensive training period like that. Is that good? Are there some aspects to intense clinical training that are better?  Do you think that you might have learned as much or more throughout the process had you been a traditional student?

My masters degree program is comprised of three parts.  All of the coursework is done online, via live Abode Connect chats with the professors and my classmates.    The second part is an in person, 6 week "Bootcamp" at Western KY University in Bowling Green, KY where we worked in their Communication Disorders Clinic seeing clients.  The third part (that happens while we are still taking classes) is the 3 local externships that we secure ourselves and attend for 40 days each, under the supervision of an ASHA certified SLP.   

Bootcamp kind of served as that segue between being a classroom student and a "practicing in the real world" student.    The name is apt, because we were all thrown together onto a team, from far corners of the earth (no really, someone came from Morocco), with no idea what we were doing for the most part and all came out of it changed.  

Our supervisors did have better "personal space" skills.

For me, it was also the first time I had been away from my home & family for such a long time.   I had to leave my kids behind, with my husband and the babysitter responsible for everything from breakfast to bedtime, hair brushing to sunscreen application, endless My Little Pony marathons to endless sibling bickering.  Yup.  It might as well have been a spa vacation!

OK, so maybe I haven't had too many real spa vacations.

I lived in a studio hotel apartment, got to wake up and get ONLY ONE person ready for the day.    I came home to a quiet room that was in the exact state in which I left it.  I went out every Thursday night with my friends for drinks and dinner.   We hiked the caves, we formed our own Hotel HotTub Club, we shared meals and lots of laughs.  It was amazing!  

Oh yeah, I did learn some stuff about speech therapy, as well.  

Sadly, Bill and Tom's conversations seemed to go nowhere.

In that short month, we had to review files, create lesson plans, write up daily SOAP notes, prepare behavioral management tools, familiarize ourselves with assessments, work in teams, work in pairs, track down our supervisors for feedback, interact with parents...oh yeah, and hang out in a room with a kid for 45 minutes while being observed through one way glass and attempting to "therapize" said child!   Actually, the kids were the least scary part of the process. 

What it feels like to be watched behind one way glass.

SLP students at a traditional graduate program will pick up 1 or 2 clients over the course of an entire semester.   There are some pros to the intensive immersion program. With Bootcamp, we were constantly under pressures of deadlines for lesson plans and treatment summaries and assessment reports.    With only 3 clients (2 of which had both group and individual therapy), I felt like I was always running around, prepping or writing paperwork.   I wondered how on earth I would manage a caseload of 50!   I didn't have the time or resources to print ideas of Pinterest, so I had to learn quickly how to use what we had in the clinic to make the most of my therapy sessions.   I had to chase down supervisors to answer questions, which I have learned is very typical of the real world.  I would rush around behind the scenes getting ready and then appear composed when I walked out that door to meet my client.  When taking over a client for a classmate, I sometimes ended up with back to back to back sessions, so I had to plan early for the entire morning.    Sometimes I desperately needed blue construction paper and all we had was green, so I had to switch gears and change my craft from the ocean to a tree!  It was crazy, hectic and busy, but very much like the average day of an SLP. 

However, one major con to the intensive program is that we didn't really get to see much change over the course of the month.   We were just finishing up treatment plans when we needed to start working on our final summaries.  For one child, it took the whole month to get through a PLS-5 assessment (and the language sample, oral exam, hearing screen, etc) and I had no chance to work on the goals I had to write for him.    Bummer, dude!

I can't say I was totally prepared for my first externship.   First of all, each setting (I have done a public elementary school, a private speech clinic and a skilled nursing facility) has its own guidelines for paperwork, lesson planning and client contact.   Each setting has access to different materials and requires different levels of planning and creativity.   It's really been in that externship process that I have found myself as an SLP.  But I don't think a traditional campus clinic setting would have been much different.    It's really merely a taste of what's to come.  

I walked out of the Bootcamp experience like a person who just jumped into a freezing cold pool.  Shell shocked, wondering what just happened and a little embarrassed at the end results.   But some of those big hurdles had been conquered...like talking to parents, meeting a kid for the first time, overcoming a child's reluctance to speak, working with a nonverbal child.  Which gave me the confidence to jump over more hurdles in future settings. 

Or trip over the hurdles. 

Of course, now that I am externing all day and coming home to a messy house, loud kids, an empty fridge, piles of laundry and a profound lack of a hot tub...I am definitely missing Bootcamp!   

Professional Issues Class Post 8: Social Media

The assignment:  Discuss the role of social media in your education.  Then talk about how (if?) you anticipate using it professionally.  Are there more disadvantages or advantages? What are the cautions for you, your clients, and the professions?

Facebook.  What is that?  Oh, yes.  It's that social media site that represents the downfall of society.  The scapegoat of the everything that is wrong with America and beyond.   Facebook is why children can't multiply, why we are obese, why men throw clothes on the floor next to the hamper and no one writes Thank You letters anymore.  I also have it on pretty good authority that Mark Zuckerburg secretly runs the TSA.  

 

Ok, so I may be exaggerating a wee bit.   Zuckerburg only runs the IRS.   But really, a google search of "facebook is bad" returns over 3.8 million hits from sites as varied as Cosmopolitan to US News & World Report to WebMD and a myriad of techie and parenting sites.  

If the sarcasm wasn't patently obvious, I love Facebook.   It allows me to reconnect with old friends, stay connected with new friends, learn what kid-friendly events are happening in my town, read funny blog posts written by fellow frazzled special needs parents and has allowed me to form a bond with my fellow distance learning classmates, despite us being flung to all corners of the US.  I feel so much closer to my classmates in this current online program than I did to most of the people I sat next to in a traditional setting the first time through college in the early 90's.   

Of course, I am a little nervous about entering a job in a public school setting and worrying about whether I can still drunk-post from the karaoke bar without fearing a loss of my job.  On one hand, I have been told to just avoid accepting coworkers as FB friends and yet on the other hand, I have been told that there are no privacy settings that can keep someone away from your info if they really want to see it.   

Sharing some of the gritty details of my life is what allows me to connect with others.   Sometimes being a stay at home mom, a special needs mom, a student in a distance education...can be lonely.   As an extrovert, I crave contact with others and social media allows that.  I share about a bad day with the kids, other moms commiserate, we laugh, we cry and we keep on trucking and sharing funny pictures like this:

So I have not yet decided how I will handle my potential for over-share on Facebook once I am gainfully employed.  I predict references to vodka will reduce by 79%.

I suppose I could switch to LinkedIn and be all professional-like.  But LinkedIn is kinda boring.    It seems to be all resumes and recruiters.    Which is great if you're job hunting, but not what I am looking for in day to day online camaraderie.

I suppose I could finally learn how to Twit, er rather Tweet or whatever they do on Twitter that includes all those ###'s.     Those SLPeeps looked like a really fun group at the 2012 ASHA Conference.  They even did a Flashmob!

I do know that I will not give up on Pinterest.  Pinterest single handedly got me through my first two internships with great therapy ideas that kept me laminating stuff late into the evening.     I appreciate all of the SLP's who are out there blogging and sharing ideas, and putting documents up on Teachers Pay Teachers for download.     Maybe one day, this blog will serve as a place for me to share ideas and tools, so that I can pay it forward a bit.  

Hopefully the Facebook group that my classmates and I have been posting on together for 2 years now will stay active and we can support each other as we enter the "real world".   I am sure not having deadlines and group projects to keep up with on a regular basis will slow the activity down a bit.    But in the end, I am thankful for all of the amazing ways that social media makes this world a little friendlier, a little smaller and a lot more colorful. 

(From Having Fun at Chelle's House)

Professional Issues Class Post 7: Counseling

The assignment:  Counseling is a critical part of the SLP’s scope of practice but not a large part of the curriculum. Consequently, many of us are not comfortable with this topic. Why is that and what can you do to feel comfortable with the interpersonal aspects of the profession?  Should the department and/or ASHA focus more on this topic?  If so, how?

Speech Language Pathology is a very inter-personal career.   As SLPs, we don't just jump in and start working on that stutter or the lisp or the swallowing challenges brought on by a stroke.  We have to consider the entire "package" that contains the stutter, lisp and swallowing problem.   That package is a human being with social, emotional and cognitive needs.  

• An adolescent girl who is falling behind in her class academically because she has an auditory processing disorder. 
• A retired teacher in the early stages of Alzheimer's. 
• A middle aged woman who attended a weekly coffee klatch with her friends, but can no longer eat safely after her throat cancer treatment.  
• A 10 year old boy with Asperger's who wants desperately to make friends but cannot.  
• A 2nd grader who is being teased because her /r/ distortion makes her "sound like a baby".  
• A father of 3 who is slowly loosing his ability to speak due to ALS.  

These are just a few examples of situations in which the SLP may be called upon to provide more than just speech/language/swallowing therapy. 

But do we need additional classes or training to handle this?  I don't think so.  I think this profession, like nursing and social work and other "caring" professions, attracts people who bring a level of compassion and understanding to the table already.    Or in other words, if you don't have those skills, no class on earth is going to be able to teach them to you.   Furthermore, if you don't have the ability to empathize with your clients and see the bigger picture, then you wont last long in this business!   

I also don't think it's rocket science.  It comes down to Respect and Kindness. 

Every client, as well as every parent or loved one of that client, deserves our respect.  We should never look at this person in front of us as "the stutterer" or "the biter" or the "grumpy old man" but rather maintain their humanity in everything we do.   

Kindness, in my opinion, just means being nice.  For the sake of being nice.   

 

I would hope that if I ever found myself lacking in these two areas, that I would reassess my current job and decide if I am in the right place for me at that time.   I understand that while it sounds simple to break it down to two words, it will not always be easy.    We are all human and get affected by stress, deadlines, Seasonal Affective Disorder and IEP season.  And if I falter in giving my clients the best care possible, I hope those around me can send a little Kindness and Respect my way.   I promise to pay it back!

Professional Issues Class Post 6: Dreaming of a speech room

The assignment: At the beginning of class, we talked about what would make a person happy or satisfied in a position. Often what brings you happiness is not directly related to your profession.  What do you want – interior hall, lots of windows, solo practice, teamwork, variety, continuity, change, stability, something new every day, routine? Those are just examples to guide your thinking – the only thing that would get your entry not approved is if you reference speech-language pathology. I want you to think about the environment more than the specific duties.

Did my professor just give me free reign to peruse Pinterest for Speech Room Organization ideas for the next 4 hours?   I think so. 

brb...

OK.    That was fun.   I went here and here and then over here and then hung out here for awhile. 

Really, I dream of having my own speech room.  Right now, my "office" is a corner of a home office I share with my husband.  And since I am one of those creative types, it's not very organized.     The only thing I can pretty much find right away is the laminator.   Everything else is buried somewhere.    I look forward to the day I get my very own, real live SPEECH ROOM that I can decorate.   Bulletin Boards...y'all!  

OK, so obviously, a space of my own is important.   With a door.  Windows are optional.  I am easily distracted.

Squirrel!

Technology?   I know a lot of schools are using Smart Boards these days.   There are a lot of great ideas for using smart boards in speech therapy and if I had one, I would definitely take some time to learn how to integrate that technology into my therapy plans.    However, I don't think tech is necessary for speech therapy.   Kids are inundated with tech every day.   I doubt anyone in the 4-10yr old demographic is even impressed at the sight of an iPad anymore.   

 

He'll master Angry Birds Star Wars before his mom changes the next diaper!

But they sure still do get excited over a game where you pick up /l/ cards with a magnetic fishing pole.  Seriously...this was the biggest hit ever with kids of all ages last semester:

This is my kid, doing hi-tech home speech therapy.   "Look mom, paper clips!"

Teamwork.  I like collaborating with peers.   <--That's a fancy way of saying I realize I barely know what I am doing and like surrounding myself with smart people who do.    I hope I end up in a setting where the SLP is considered a valued member of the educational team, and not someone who just pulls kids away from their "real work" to play games.    I wouldn't last long in an adversarial environment like that. 

I went to grad school just so I can get paid to play this!

Change.   This is a major draw to this field as a whole for me.   I love the variety!   The very idea that my day is comprised of 10 (or so) segments of therapy, in which no two will ever be the same, is right up my alley.  I could never work an assembly line.    Doing the same thing, every day, week after week is not my style.  

SLP work before the unions came along?

Autonomy with accountability.  I've heard of school Principals requesting the SLP's lesson plans every week.   I don't mind someone checking on me and making sure I am doing my job to the best of my abilities, which will happen naturally in my Clinical Fellowship year, but I also don't want to feel like someone hired me but doesn't trust me to do the job at all.   I don't have a problem asking for help when I need it and learning from others.   I just don't think I need someone looking over my shoulder every day.    That makes me nervous! 

Now if you'll excuse me, I have more speech rooms to go drool over....

Professional Issues Class Post 5: Ethics

The assignment:  What do you think contributes to ethical lapses in the profession and how can they be prevented?  Have you seen anything in your externships that could lead to ethical lapses?  One component of the Code of Ethics is that you have to report it if you think there is a violation.  Not to do so, is in itself, a violation.

A lot of people like to distinguish between what is Ethical versus what is Legal.  I think the conventional wisdom is that "legal" is the bare minimum and as humans with functioning frontal lobes, we tend to do the right thing for higher reasons...or rather just because something is legal, doesn't mean it's ethical.  In other words,  the principal of "ethics" is what separates us from the lower life forms who just do the right thing to avoid negative consequences.

However, some folks can use the Ethical versus Legal debate to justify doing something technically illegal, but for the "greater good".   They may use it to justify the idea that while laws are great for the most part, sometimes you may have to bend the law a little in order to do the right thing.   Sort of a modern day Robin Hood.

I feel there could be a risk of ethical lapses in my future profession when it comes to insurance and billing.   Rules, regulations, Medicaid/Medicare changes, therapy caps, pre-existing conditions, benefit limits, copays, deductibles, paperwork and more paperwork.   SLPs (and other "helping professionals") get into this business because they care about people.   We want to help.   We forge relationships with our clients and their families.   It gets hard when you just want to help a child, but are up against regulations that state you can't, because a client has run out of visits, or that their speech therapy isn't "life sustaining" or that the copay has gone up and the parents just cant afford treatment anymore.    It would be tempting to fudge a little paperwork, trump up a goal or two or some other "little white lie" that would not really hurt anyone, other than a faceless insurance company or government entity. 

I imagine this kind of thing comes up more in a private clinic setting, where the clinician is directly involved with billing.  However, even in a school setting, I can see how one might be tempted to embellish an assessment score to make sure a child qualified.  Maybe  you think a child may benefit from your services but the numerical data is not falling within the required range in order for you to qualify them.   

While I haven't had the opportunity to experience any situation like this, I am not going to fool myself into thinking I wont be faced with such dilemmas at some point.  I hope that I can keep the profession as a whole in mind, and continue to uphold the standards we are asked to represent as SLPs.   One embellished test score or trumped up goal may not seem like much, but is it worth it to taint the whole industry?  Will we really be able to continue helping the thousands of children we currently help if we give the impression that we have to lie to make a difference? 

Turning away that one client may break my heart into a million pieces.   But what can I do? I can compile a list of resources of where they can get help.   I can point those families towards Babies Cant Wait, or FOCUS or Parent to Parent of GA.    I can continue to advocate through ASHA or GSHA for insurance and Medicare billing policies that allow us to help those we want to help.  

But definitely not this:

Professional Issues Class Post 4: Join all the SIGs!

The assignment:  As noted a few times, ASHA offers Special Interest Groups.  Review those on the ASHA web site. Suppose a kind soul were to pay for you to join one.  Which might you join and why?  Or might you say to the kind soul, use your funds for something else - I'm more of a generalist right now.  If the latter is your choice, why do you feel that way?

ASHA offers 18 Special Interest Groups (SIGs) and as a student, I can join these SIGs for the bargain price of only $10, versus $35.    Then why haven’t I jumped on it like a set of NWT Hanna Andersson Christmas dresses for $2.29 at Goodwill?

 

Because I can’t decide!   Maybe I am the generalist described above.    This field is so broad…from the NICU to hospice, from figurative language to lisps, from schools to hospitals, from accent reduction to transgender voice issues, from tracheostomies to cochlear implants…we have the potential to work ANYWHERE and with just about ANYONE! 

For someone with the kind of ADHD that makes them shut down in the face “where do I start?” then you can see how this is a problem for me.   Looking at the list and trying to choose one is like looking at this room and trying to figure out where to start cleaning:

Most likely, if I *had* to pick one, it would be SIG 1,Language Learning and Education, because it seems to be the most general, and if I end up working with children, the most applicable.   But I also have a special interest in SIG12, Augmentative and Alternative Communication.   I love the idea of using technology to give a voice to someone who was previously nonverbal.  One day I hope to travel the world and spend some time as an ex-pat working in another country, so SIG 17, Global Issues inCommunication Sciences and Related Disorders might be a good fit for me.   Then of course there is SIG 16, School-BasedIssues, since I will likely work in a school.   But what if I decide to work part-time at a hospital or SNF, which means I should join SIG 13, Swallowing and Swallowing Disorders (Dysphagia) and SIG15, Gerontology and SIG 2, Neurophysiology and Neurogenic Speech and LanguageDisorders! 

 

...and money!

So I do nothing. 

Or rather, I will just take the stance of Generalist until that kind soul hands over a credit card to hook a girl up.