Person Centered Care (PCC)

Three words that make so much sense it’s a wonder they’ve take this much time to become part of the main street conversation in speech therapy. Having completed an online course by Sarah Baar at SpeechPathology.com it’s clear Person Centered Care will be a centerpiece of neurogenic disorders therapy moving forward. Sarah Baar is both an authority and advocate for PCC and her work presents  a passion and a sense of inevitability with respect to the direction neurogenic disorders therapy must now follow.

In her course Sarah defines the role of a therapist as one of a teammate where patient and therapist work in tandem on agreed upon goals. Within this model therapy activities and goals are defined by the life experience and personal interests of the patient. Sample goals might center around;

  • Operating a coffee maker
  • Responding to a phone call
  • Organizing a grocery list
  • Making a date to play golf
  • Alerting a friend you may have an issue with speech
  • Going through the steps of writing an email
  • Re-learning a work task

The current medical model of treatment bases it’s therapy in universal teaching contexts which may or not be relevant to a patient’s life. In this model therapy success is defined by results on a standardized test or a predetermined performance standard.  In contrast Person Centered Care breaks from this more traditional model the therapy to structure goals around the functional needs and interests of the patient. If you need groceries – how might you order groceries online or by phone. If using a phone is problematic practicing phone conversations in real life contexts may be in order with possibly the first goal alerting the listener you may have a problem with speech.

Therapy is suddenly personal, meaningful and pertinent. Therapy materials which filled closets for in some cases decades are out the window. ST’s longer work to improve numbers measured by a standardized test but performance on an everyday task.

Therapy materials are formed around the everyday interests and needs of the patient which in turn powers ST’s to be creative. This approach to therapy presents a unique therapy challenge. It’s not as much about thinking outside the box – but understanding the box sitting in front of you and that’s the real fun. In a very real sense we’re helping a person find and be themselves.

Sarah Baar cites studies by (Hinckley & Yones, 2014) (Rutherford & Childs, 2015) which finds PCC patients;

  • Are less likely to be readmitted
  • Show more trust and motivation
  • Are more likely to adhere to treatment regimens
  • Show better recovery, quicker rates of generalization, improved self-awareness
  • Demonstrate better emotional health at follow-up
  • Require fewer diagnostic tests and referrals

Sarah goes on to indicate insurance companies are very much on board with PCC and that Medicare actually now includes PCC as part of their annual goal and five year centered vision plan.

This approach to therapy makes so much sense it’s surprising it has taken this long to become a thing in speech therapy. If you are Speech-Language Pathologist, or person concerned with the topic of speech therapy for neurogenic disorders, we strongly suggest a visit to: HoneyCompSpeechTherapy.com  and the words and works of Sarah Baar to learn more.

The Role Of Patience In Speech Therapy

Realizing your child has a developmental issue that may require speech therapy can be a difficult experience. Just my presence on the scene means a family is no longer alone and that a professional has arrived to help. I often feel the concerns which led to the call for help as I walk in the door

One of the first questions I’m asked is the length of time it will take till everything is ok.  As a therapist my role is to assure those concerned I am clinically competent with respect to their child’s issue and that over time things will improve – the key phrase is “over time”.

The dictionary defines patience as:

“The capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.”

When discussing speech therapy programs with families, I liked discussing not getting frustrated, or discouraged by the events of the present. The acquisition of speech and language is a an evolving process. It entails both the formation of cognitive, neurological, and  physiological processes. For a word to be said, all the above processes (which by the way are invisible) have to act and coordinate in a manner they may have never done before. Given this multifaceted nature of speech, one of the most important elements for its acquisition s patience.

 

The Role of Confidence in Speech Therapy

Speech Therapy.org
“If a child thinks they cannot say a sound or word, chances are they won’t” Speech Therapy.org

At a speech therapy seminar several years ago a presenter said, “If a child thinks they cannot say a sound or word, chances are they won’t”. After many years in speech therapy I’ve come to appreciate the wisdom of these words.  Children speak words they know and feel comfortable saying. For example, if I know a toddler says the word “car” and I ask them to repeat my model or identify a “car”, most often they say “car”.  If I ask that same child to say a word or sound they have not said before said, most times my request will be met with silence.

For a spoken word or sound to occur, cognitive and physical connections must be in place first. Often with respect to first speech, we’re asking a child to something new. There is a first time for every sound or word and for something new to be spoken a surprising number of things must work in unison. Things we have no way of seeing, acting in conjunction with processes we can only imagine.  And even if everything’s wired the way it’s supposed to, there must be a certain confidence level in place before a child will even try to say something new. 

A Story About Confidence — Speech Therapy

Michael was an adorable 2 ½ year old with a pronounced speech delay. He could say only a few bilabial sounds but had no voiceless sounds e.g.  /H/, /S/, /P/ and /F/. My goal this particular day was to help Michael build air-flow skills through horn play. It may seem like a simple task, but this was something Michael had never done before. Sitting in a circle with his mother’s help, the plan was for each of us to take a turn blowing the horn. The first time through I blew my horn, then his mother, and then Michael.  He just held it while looking for someone else (anyone else) to blow theirs. After a couple of minutes of this, Michael appeared content to just watch the mom and I.

Then, just as I was having thoughts of moving away from this activity, something surprising happened. On a subsequent turn, Michael stood up and took his horn downstairs (we were on the top floor of a bi-level). Neither the Mom nor I said anything because Michael seemed to be a toddler on a mission. He reached the lower level, and after a brief moment of silence Michael began to toot the horn.  After a few seconds, to our continued surprise, Michael ran up the stairs holding his horn with a wonderful smile on his face. When asked if he had blown his horn, Michael ran downstairs and blew a second time;  this time even louder. I remember telling the mom the goal was for Michael blow on the horn, not that we had to actually see him do it.

For Michael it was just a matter of finding the confidence to try, and in this case he needed some space. There’s a first time for everything!

More Speech Therapy Thoughts

Concern My Child’s Language Development may be Delayed

Language DevelopmentIt’s starts with observation, my child is not talking. This is followed by the thought something may be wrong with their language development.  Then the questions; will this just go away? How long will it take for speech to happen? Will my child ever speak? These are trying times for a parent. There are no instant solutions, only the realization my child’s development of speech and language may be at risk.

For many parents this is a new place. There may be some denial or a wanting for this to go away. Yet as time goes by and comparisons to other children occur, there’s the growing concern: the so called normal acquisition of speech and language is not yet happening.  There is a need to act, a need to better understand what is going on. My child is at a developmental impasse.



What Can I Do?

So something has to done, some calls have to be made, but to who, to where. The good news; there’s a network of professionals concerned and experienced in treating your child’s exact issue with language development. The situation you face is by no means unique. Many and I mean thousands have gone before to find relief from a worry that seems so now encompassing. Places to reach out might include your pediatrician, your local school district, and if your child is under three early intervention center(s) for your area.  

Prior to calling it’s a good idea to organize your concerns. You could note; how many sounds and words your child says. The general clarity of speech, missing sounds, misarticulations. Your child’s overall interest in talking, eye contact, ability to follow directions, identify pictures. How your child interacts with family and children their own age, and other concerns.

There’s a community of caring  professionals just waiting to help.

For more information on help to find the right therapist for your situation click here.

The Role of Fun in Speech Therapy

I remember one of my earliest speech therapy seminars when the instructor Suzanne Evans Morris – laid down the tenet – that one of the prime roles of a therapist was to teach children to “love their mouth.”  The more I practiced the more I came to understand the importance her words during speech therapy sessions.

The Role of Fun in Speech Therapy
If a child is having fun it means that whatever is going on around them has the power to draw their attention and curiosity

Since speech is comes from a child’s mouth – it’s important to consider the mouth from the perspective of child. Away from a mirror, it’s not that visible. It’s also a source of discomfort, it’s the place where teething occurs. A place, with respect to speech, a lot of things are expected and maybe not a whole is happening. A child cannot see their own speech.  Unlike a toy, they can’t hold it, push it or bang on it. And if you’re having problems it’s kind of like being at a tennis match where everyone around you is playing but you. Its easy for a little one to be frustrated and take a step back from expected speech goals.

The mouth and it’s speech is a phenomena that must be discovered. Children by nature, learn through play and adults act as facilitators of knowledge.  We can guide and put things in the path a child to learn, but when all is said and done a child learns through a process of discovery.

Play Is fun – Discovery Is Fun – Learning Is Fun – Make Speech Fun

Children don’t play by the same rules as adults – they don’t yet think the way we do. I read an article suggesting that young children are faster to fix a computer problem than adults.  Not because these digital natives are naturally better at technology (although they might be), but because they keep trying different things until they have success.  They discover a solution while an adult will keep trying the same thing several times.

Children learn because they attend and are curious about something immediately in their path. They learn because something has caught their attention and sparked their inherent curiosity. As facilitators of learning, adults can place things in their path, but when all is said and done we can only hope it triggers an interest.

If a child is having fun it means that whatever is going on around them has the power to draw their attention and curiosity. And when in this state their mind is more open for learning.

Common First Words

There is no precise recipe for the exact first word a child will say. But generally first words;4

  • consist of early sounds such as /B/,  /M/, /P/, /D/, /K/, /Ah/
  • contain simple syllables e.g. “ba”, “poppy”
  • frequent a child’s routine e.g. “da”, “ma”
  • child shows interest in the word e.g “dog”
  • contain a social component e.g. “bye”

Examples of typical first words may include:

[one_fourth] Foods
apple
banana
juice
cookie
milk[/one_fourth]

[one_fourth] People
ma
da
poppy
nana[/one_fourth]

[one_fourth] Sounds
moo
ba
choo choo
woof
quack
beep[/one_fourth]

[one_fourth_last] Routine
bed
shoe
bath [/one_fourth_last]

[one_fourth] Play
ball
book[/one_fourth]

[one_fourth] Animals
dog
cat
duck
bee[/one_fourth]

[one_fourth] Social
hi
bye
please
more[/one_fourth]

[one_fourth_last] Things that move
car
boat
choo choo [/one_fourth_last]

It is not written in stone any one of the words listed here must appear a toddler’s early vocabulary, but these are some of the more common.

 

How many words should my two year old say?

The numbers vary but by age two a spoken vocabulary of at least 50 words is the average. Some children say upwards of 150 which is great, while others with a vocabulary of 25 words or less is considered a “late talker”.

Aside from the numbers, other things to consider include:

The clarity of  speech

Are your child’s words clear or lacking mis-articulations, omissions, or substitutions. How clear is his/her speech to peers, or non-family members.

Eye Contact

Does your child exhibit good eye contact when speaking? Is eye contact sporadic, or non-existent?

Comfort level when speaking

How comfortable is your child when speaking? Do they avoid speech tasks, or prefer other means of communication e.g.  will just go get an item  vs. asking for it. Do they look away and remain quiet when asked to name an object or respond to a simple question. Do they appear frustrated?

Processing skills

How well does your child respond to spoken directions. If you ask “please get me your shoes?”, “Do you want milk or juice?” Do they act appropriately.

The Trend

How speech and language gains trend over a period  weeks and months. Are their more sounds, words, phrases being produced? Do gains appear few and far between, or do things appear to be just staying the same.

If anything pointed out here raises  a concern, discussing the matter with your pediatrician, early intervention center, local speech therapist, or school district may prove to be a good idea.

Kids differ widely in the way they acquire speech and language. The good news is there are many avenues available which can help and often a little push may be all that’s needed. Two is the age when the foundation for speech and language is built. It’s a time about becoming the person your meant to be.

Sign Language Can Help Facilitate Speech

When the acquisition of speech appears problematic, I often turn to Amercian Sign Language for help.  opting to use sign language is best when:

  • a child shows a strong reluctance to speak
  • secondary issues  such as Down Syndrome, Cerebral Palsy, apraxia, dyspraxia are present
  • a child has the ability to imitate simple signs
  • communication partners are there to support the use of sign

It’s easier for a child to see and imitate motor movements associated with early sign than spoken words. By example the sign “more” is made by placing one’s hands together twice. It’s spoken counterpart supposes a child has 1. mastery over the  /m/, /oa/,and /r/ sound and can 2. can quickly coordinate production of all three sounds.

Sign simplifies the motor skills necessary to express a word. It facilitates self expression and  builds a vocabulary of words which will eventually be spoken. It allows a child to think in words.

Does a child’s use of sign slow or hinder their ability to ultimately speak?

My experience as a therapist has taught me that sign does help. There is a natural relationship between gesture and speech. Our mouth is not the only part of our body connected to the words in our mind. Watch your own hands or the hands of a friend during conversation. Notice the way hands, arms, and fingers move in all sorts of directions as spoken words occur.

The early use of sign takes the pressure off speech and buys time for it’s ultimate development. The good news is the vast majority of kids receiving therapy will eventually speak.  In the end sign only hastens the acquisition of the spoken word.   In the very unlikely event a child does not develop speech, the experience with sign serves as a foundation for language and bridge to other augmentative means for communication. Self-expression and the development of early language whether speech, sign or combinations of both will in the end only help a child’s ultimate acquisition of speech.

The Attribute of Patience

The dictionary defines patience as:

“the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.”

When concerned with matters in speech therapy, we should add to that definition, without getting frustrated, discouraged or disillusioned.

Sometimes in a therapy session there is a tendency to focus on a successful moment and assume all the moments destined to follow will be the same. The good news is that with commitment to therapy strategies, language is destined to change and progress is inevitable.

How do I know that?  It’s something all the people I’ve ever worked with have taught me. It’s the two year old with a developmental language delay who could say at best  say 3 words. The child with autism, who no matter what was presented, refused textured foods.  The inability of a four year old with apraxia to initiate even a simple thought.  All three cases had eventual success stories and collectively taught me the role patience plays in therapy.

Does patience automatically appear when told your child has a language or speech delay? No… simply knowing it’s importance can make the process easier. The attribute of patience is born of a confidence that comes from witnessing the accomplishments (small and large) a child makes over a course in therapy. Its a developing belief that at some point things will be be better.

 

 

Where Can I Find A Speech Therapist?

There are over 130,000 Speech Therapists in the US alone. They go by titles such as Speech-Language-Pathologist, Speech Therapist, Speech Pathologist. These therapists work in a variety of different settings and are generally not hard to find. Some work settings include:

  • Hospital in/out patient clinics
    (for any age group, any condition)
  • Rehabilitation settings (often post stroke, head
    trauma, or following a neurological event)
  • Long term care facilities such as nursing
    homes (dementia, stroke, head injury, debilitating disease)
  • Private practices (defined
    by the practice – articulation therapy for apraxia, lisp, stuttering etc.)
  • Schools (pre-school – K-12)
    therapy to help facilitate articulation, language. Help with speech or language disorders related
    to autism, Down Syndrome etc.
  • Early Intervention Service (children with
    developmental delays ages 0-3)
  • Home Health agencies (often service a wide variety of
    cases)

Places to find a Speech Therapist:

  • Check yellow pages for clinics, home health agencies, clinics, and private practices advertising in your area. (Look under terms: Hospital, Speech, Home Health)
  • Google the terms speech therapist, speech, articulation, language therapy for your area
  • State speech therapist association
  • American Speech and Hearing Association ASHA.org
  • Ask your pediatrician or family physician