Hey guys! Current grad student looking for some help here so any ideas would be much appreciated.

Okay some background. Right now I have a patient who is “locked in”. They can occasionally vocalize, but it’s inconsistent and we haven’t seen much of it in the sessions. They are a young adult. Usually they have PT and OT appointments before us, so they often come to our sessions tired. Sometimes they even fall asleep during our session.

As of now, we are just trying to establish basic concrete yes/no questions. We have tried everything we can with the resources available to us. We tried hand squeeze, thumbs up, yes/no buttons, low tech eye gaze, yes/no on AAC device. Answers are inconsistent or the patient is non responsive. We have tried motivators like food or a basic activity similar to their previous job.

Here’s the catch, sometimes they are non-compliant, but other times they are just not alert (aka asleep). Family tells us at home they vocalize occasionally and have even said a few sentences clear as day. So what can we do to get them motivated to communicate in the session (or to increase alertness)? We have tried having a heart to heart with them, acknowledging how frustrated they must be, especially since we are asking them those basic questions that may make them feel patronized. Still no response. They will occasionally perk up if we share “tea” with them lol. Any ideas would be greatly appreciated.

Hi folks—I posted on this sub a while ago about my experience as a contracted CF in the schools. At the time, I was back and forth between staying in the position for the rest of the year or leaving asap.

Well, I decided to leave. I put in my notice a while back and my last week is this week.

TLDR for why I’m leaving:

• my district provided me no computer, badge, database access, or district email for two weeks. Students started 2 days after I started.

• I had a stack of annual reviews due the month of august when I had no IEP access or knowledge of what I was even doing. I tried to schedule, then got a slap on the wrist from admin that I did it wrong.

• I have a supervisor but she is in another building and cannot provide me building-specific guidance, which is what I needed help with the most

• Lack of timely communication from administration, which they somehow figured out how to blame ME for

• Morning duty, afternoon duty, and lunch duty as a contractor

• Not feeling welcomed, safe to ask questions, etc. as a new grad

• Overall not good work environment/gossip

Thankfully, my last week is this week, but here is what I have been told to do before I leave:

• schedule and hold all annual IEP meetings until November

• Finish all open evaluations (4 of them)

• Complete all progress monitoring for 70+ kids

• Complete all Medicaid billing for 70+ kids

If I do not complete this, I’ve been told that the SLP world is small and word will get around that I left them hanging, which “won’t look good.” I’ve also been told by administration to tell nobody I’m leaving and to leave that up to them…which I personally think is a ruse for them to be able to paint their own story about me and why I left, but whatever.

I just started in this career and I already feel so hopeless. Schools are not all like this, right? I feel like I worked so hard in grad school just to be chewed up and spit out. Is this even worth it? I love this field, but I can’t go through another experience like this. My mental health has absolutely tanked and I’m struggling with my purpose right now.

I get to pick one of these for my therapy room. My private practice caseload is a little of everything so it's hard to decide based on that.

For me, I'm glad I chose not to go into teaching. Too much planning, and way too overstimulating!

I have an upcoming interview with the DOE for a CF position (extremely nervous). I was wondering if anyone has recently interviewed with them and if they remember any questions that were asked during the interview. Thank you!!

Hi! I am a current grad student, taking my voice disorders course. I have been really interested in it! I always thought I would work with children but sometimes I feel i could get burnt out really easily and i do not want to cut my self short of the medical/adult population. However, I have noticed throughout my courses, I hate swallowing :( i thought i would like it but i really dislike it lol. I haven't completed my adult rotation yet so maybe this could change with hands on experience. Anyway, i am sort of hoping to be able to hop on pslf (hopefully) but ofc that means nonprofit. Are there voice slps that work in hospitals or facilities that are non profit? Will i have to work with swallowing in order to work with voice and in non profit ? i know this could probably range from others experiences but I am interested in hearing more about this world of voice.

I have a handful of teletherapy clients working on AAC goals. With the younger children I use a lot of YouTube songs and we talk about what we see and hear. For the older students, they sometimes enjoy a bingo game I found on TPT, but we are all getting tired of that game!

Any new ideas for me?

Hi there, new to IEPs here. If minutes are written per month are we counting from first day of school (8/14) through one month (9/13)? Or are we assuming x minutes in a calendar month, such as September? If it is per calendar month, what about the first month of school, when we start mid month? Do we need to complete it the full amount despite a week of fall break or holiday?

school slps, do you ever feel guilt about taking personal days off? I’m taking some days off soon and I just feel so weird and guilty about missing work. I am trying to make sure I won’t be missing anything important but still can’t help but feel bad

I gave the CELF screener last week and now need to score.. but I am a little confused. How exactly do I score it? Am I missing something? I’ve totaled up their total score but I don’t understand how to get the criterion score (is this somewhere in the manual that I’ve overlooked?) to see if they are at or below the criterion score for their age.

please help- I’m supposed to have results by tomorrow morning!

Looking to connect with therapist in the Illinois area who do EI? I’m located in the north suburbs near Chicago but trying to connect to gather information about how to get into EI. Thanks!

I would like to know if any material is available on the same.

It's time once again to vent your blues away 😤

If you still need room to vent, why not join our discord!

https://discord.gg/7TH2tGxA2z

Hi all. What (if any) adaptive cups do y’all use in inpatient settings? Working at a small rural hospital that occasionally provides a more inpatient rehab approach to dysphagia. Im thinking the Provale cups may be good.

Thank you!

I feel stuck with some kids I work with in early intervention. Once I start seeing a kid for 3-4 months with limited progress, I feel stuck and the sessions are just repetitive. I tried all my bags of tricks and nothing seems to be helping. What do you EI therapists do when a child is making limited progress?

Also bonus points if case management isn’t common!

I have an annual subscription to Q interactive - If I use a paper protocol with q interactive, can I somehow avoid the administration fees or will I be charged no matter what? I’m not sure if this is a fee for it scoring and creating the report or just for using the product.

The PTO purchased Dinky Doodads. What word do you think this little toy soldier is supposed to represent? He was in the G & K bag. Thanks!!

I have a client (4;7 & male) who has a lot of speech sound errors and could use some advice. These are the errors noted:

• Collapses fricatives in all positions as well as 'fr' cluster to 'j' (ʤ) sound.
• Velar fronting k -> t & d -> g
• Gliding r -> w in medial and initial. Inconsistent gliding l -> y. But l & y -> j in initial.
• Inconsistent 'ch' and 'sh' sounds (sh is often deleted).
• Syllable errors: bana for banana, todeder for together (marking syllables?)
• Cluster reduction (usually first element reduced): sm -> m, sw & sn & sp -> b, st & sk -> d, spr -> br, skr & str -> dr.
• Cluster simplification: br -> bw, thr -> dw
• Stimulable for /k/, /s/, /z/, and /sh/ in isolation.

Please any ideas or assistance would be so helpful! This child is quite tricky to understand so the goal is to increase intelligibility but I don't know where to start. I would typically do multiple oppositions but the client is quite hyperactive and just not well-suited to the approach.

Hey everyone! I have a new class on my caseload this year. It is the Extensive Needs (previously profound) TK-5th grade class. These students have Multiple Disabilities including significant cognitive impairment. I am struggling to come up with good therapy ideas as I find that these students will not typically engage unless physically promoted to do so. I have set up a ton of BIGmacks and other AAC devices for them to have in the room as well as a switch with switch activated toys and a laptop. I haven’t been successful in really engaging these students.. I have been trying to find something to motivate them or capture their interest. I welcome any ideas, thoughts, advice or suggestions! Thank you!!! 🙏🏻

I am in a hospital setting and have a CF supervisor who is nice; however, is very picky. Like picky to the point I will be running a session and will get "feedback" that says things like I shouldn't saying "I'm sure this is overwhelming" to a patient but got feedback that I need to say "I'm sure this can be overwhelming" and just a lot more things like that. I hardly get actual clinical feedback just feedback on my semantics. I've gotten feedback on my notes that I shouldn't say "patient states" but say "patient reports". They feel that they are pretty superior to other SLPs and very much has an ego.

I have gotten feedback from my now coworkers and previous supervisors that I take feedback very well - in fact, I ASK for the feedback. I want to learn and grow as a clinician. But my CF supervisor picks at every little thing!! I think what makes this difficult too is that my supervisor constantly talks negatively about the other SLPs at my job, constantly comments on my face/ body language (ie says I look mad, I look frazzled, my body language makes me look mad) when I am literally not, and just overall micromanages everything and everyone.

The other day - I was getting feedback where they stopped and said "you say you want to learn but you just look mad" and I was like I am not mad!!! Like I am a bubbly person - but there are times that I am more serious or just flat (I don't know how to describe it lol). My supervisor has also told me that if I dont like their mentor style - to tell them. So I did. I said "I am not mad but I feel like the feedback I get does not help me clinically and you sometimes come off as, not condescending because thats harsh, but in that realm" they ended up snapping at me with all the other SLPs around and said "I dont think you take feedback as well as you think you do". The other SLPs came up to me and reassured me that they thought my supervisor was out of line and never thought I couldn't take feedback. My supervisor and I spoke at the end of the day where they informed me that they are not the only ones who feel this way. I asked who else feels this way about me because again, I feel like I take feedback very well. They responded with "I am not one to gossip"

We now have a scheduled meeting to talk about this and I am feeling very discouraged. I am two months into my CF. My supervisor wants me to bring in a list of strengths and weaknesses I feel like I have. Part of me wants to print out my previous calipso evaluations and letters of recommendations that comment on how well I take feedback and even encourage it - but I don't know if that'll add fuel to the fire.

What do I do? Am I being too sensitive? I want to keep this job, I just my CF supervisor to chill.

What is your process and/or favorite resources for incorporating visuals in therapy sessions AND to provide parents for use at home?

Anything that you find helpful (with links or suggestions preferably), including visual schedules for therapy sessions and home routines, choice boards, first-then, feelings, etc.

I've been seeing a 33 month old for 8 months and I feel like the underlying issues are not being addressed. I am an assistant and my supervisor is remote. She is directing treatment but I feel like there is a bit of a disconnect due to issues with the team dynamics in general.

This child has many strengths, social, understands many words and concepts, gets his needs met with gestures and sounds. There has been some slow progress in his speech after working to find the variety of strategies to which he responds best.

However, there are many things that are concerning. His eyes are droopy (pulled down on the sides) and his mouth is always open, sometimes drool will fall out. His mom said he had trouble latching as a baby but that was later dismissed by the doctor.

When he wants to tell us something, he vocalizes long strings of uhh uhhhh uh uhhh uhhhh, poor prosody (though he does have some changes to intonation at times). His mother has a list of 40 words he has said, but he uses around 5 consistently (mama, baba, tata, nana, wow-wow). He is stimulable for several consonant sounds, but as for vowels, mostly /a/. He is just starting to tolerate when I encourage him to look at my mouth for different vowel sounds. He frequently makes a glottal sound and his speech sounds almost slurred.

Behavior has been a bit of a challenge for me. While it has improved with working on connection and play, I feel like we can't get much "speech" work done.

Please bear with me as I complain and maybe throw myself a bit of a pity party 😣

I feel that I have provided good treatment to a certain point but I'm not comfortable with this situation.

His mother is a good mom, she's loving, tries to implement any strategies we recommend. However, I feel she is defensive and overestimates his skills. He isn't getting other therapies and I believe it was partially due to parent report and lack of concerns. It bothers me that I'm the only provider with "eyes on him." (Aside from supervision)

Any concern that has come up always has an excuse. Oh, he's drooling because he's teething. His speech doesn't sound slurred to me. He doesn't follow those (routine) directions because you came at his nap time. Oh he didn't want to imitate because speech hasn't been consistent (he'd been sick) Oh, his ped said there's no need for an ENT visit. Oh, he only has the bottle for nap. Or she gets really upset when I mention skills that are usually targeted by other therapies.

My supervisor wants him to receive a medical diagnostic. He was reevaluated for physical therapy, occupational therapy and developmental therapy though the service coordinator said everything is the parents' choice if they want to accept it or not.

I understand, I'm just upset that every week, I am giving it my all with this child and to be honest I feel disrespected that they want results but aren't willing to consider recommendations. It bothers me that I have to walk on egg shells when I tell the mom about a concern I have, but if I don't, parents are like "no one ever told me that was an issue!"

A long time ago (4 years ago) I was told by a PT that kids needed to sit criss cross or something was wrong with their posture. If they sit in a W shape, they can hurt their posture? I kinda blindly believed it. I looked online and it said it was bad practice to make kids sit criss cross and abusive so I got scared.

I never corrected a kid’s sitting position before, but I felt bad realizing that it can be invasive to make a kid change sitting positions and I told someone that I thought something was off with their posture and they got mad at me. I only did it once. I did recommend PT to the family and he did qualify

I now know that I should not make kids change positions, but is it wrong of me to fix their sitting position if it looks painful or mention something to the family if they have bad posture?

I do not know a lot about PT. Someone told me offhandedly and I probably shouldn’t have said anything.

Any ideas how to handle this situation better?

As the title suggests, can a speech pathologist solely own a private practice offering all of speech, occupational therapy, and physical therapy services in California? What are the underlying requirements?

Thank you in advance!

Hi, I work at a SNF and they are wanting to transition to NDD diet guidelines from IDDSI. I’m having a hard time even finding the NDD guidelines and getting conflicting levels. I’m much more versed in IDDSI so kinda lost. Thanks!!

Hello, This might not be the place but I figured yall would have more info than the average person. So, i want to get my SLP and go the traditional route to get certified and credentialed and pediatrics is my preferred field, but i wondering if anyone does non traditional SLP work, specifically in designing educational toys and materials?

I haven’t been in a SNF since they changed the payment models and have recently agreed to start helping at one. My question is, do we need to do a treatment on the same day as an assessment if we pick someone up or can we just do the assessment?

I work with special needs children in an elementary school assisting them with their daily school work. I've mostly been mainstreamed with one student since he was 1st grade . This student needs a sitter at all times being a fall risk since school started this year he's been really off, as in disturbing the class learning whining loudly, while teacher is speaking, banging on desk ,kicking desk,kicks other students at desk or on caepet.teacher wil say take him for a walk he'll refuse to leave class without physically being removed. Another child who has a private nurse with her h8red by her family, her nurse has told staff members at school I've been agressI've with student I work with, that I've grabbed him by arm and drug him.ive never been agressI've with this child, it's actually the opposite I firmly remove his hands when he's grabbing me squeezing my arm or trying to h8t me I will firmly remove his hand and place it on his desk or body,I will scoot my chair away from him and he will slide down in his chair to try and reach me with his foot.principal request a meeting with me on Friday 9/27 but only vp showed for meeting .He tells me about report but says staff members Well if it was s5aff members it was because this nurse told them is what I was told. She's done this in the past . My question is do I pursue this further with principal or let it go I don't appreciate having my name dragged in a way as thos it looks bad.