Integrating Clinical Proficiency with Inter/Intra‐Accountability
April Brown‐Bell, MA, CCC‐SLP
Private Contractor
November 2008
Dallas, TX
‐‐Charles Kendall Adams
Introduction
y Regardless of your work setting, there are some clinical behaviors and actions that produce widespread outcomes during your workday. This presentation is designed to lead you through 10 professional behaviors that will guide you to increased clinical success and productivity each day. You will practice conflict‐
resolution techniques, learn to implement small therapy strategies that produce huge results, obtain at least 5 must have sources for professional support, and other practical strategies on how to survive your most challenging clinical endeavor. y This session will guide SLPs towards a model to develop the skills and habits of mind that harvest a platform of superior clinical management which cultivate superior clinical practice, regardless of an SLP’s work setting. SLPs have to find the balance between providing quality therapy and demonstrating workplace excellence through caseload management. These management skills include active problem solving, providing evidence and/or research based therapy, interacting with family/parents, and resolving workplace conflict. Introduction (continued)
y Through practice of the 10 steps presented, each session attendee will reflect upon his/her role in the workplace and create better therapy while developing those interpersonal skills needed to work on effective teams. This session will help the attendees learn how to respond to conflict, create more relevant, functional therapy, succeed during complex work tasks, manage time more efficiently, demonstrate self/program advocacy within a facility/school, develop a professional support circle, and produce quality therapy based upon quality evaluations. Each attendee will have the opportunity to practice each strategy, as related to his/her own workload. Session Outcomes
y Each attendee will leave with strategies for: 1) making therapy more functional and relevant, 2) analyzing a workplace conflict for positive resolution, 3) participating in strategic planning, 4) demonstrating self‐advocacy within a work setting, 5) creating and growing a professional network, 6) reporting clinical data more efficiently, 7) addressing issues arising from excessive caseloads, 8) linking an evaluation to research and/or evidence‐based therapy, 9) winning staff/family support from the onset of therapy, and 10) dedicating oneself to a continual quest for professional development related to clinical practice and management. Learning Objectives
y After participating in this session, learners will be able to:
y Discuss the relationship between evaluation data and evidence/research‐based therapy y Identify at least 4 strategies for developing a professional support circle
y Identify and mediate conflict when working with others
y Write 3 types of quality clinical data (session note, evaluation data, and observation) y Describe at least 3 ways to integrate the home/family into the therapy plan from the start of therapy
y Identify at least 3 strategies to combat work setting barriers for increased productivity
y Describe 5 ways to promote a Speech‐Language Pathology program in the workplace
Agenda
y Instructional level: Intermediate
y Target Audience: SLPs
y Time‐Ordered Agenda
y 10 minutes—Introduction, Overview, Exercise 1 (ID areas of need in the workplace)
y 100 minutes—10 Strategies Reviewed; Each strategy review & hands‐on application will last 10 minutes
y 10 minutes—Conclusion and Wrap‐Up Start with ID of Needs
y Guiding Question: What are your specific areas of need in the clinic (i.e. time management, staff communication, communicating difficult information, writing/communicating technical data, etc.)?
1. Need:
2. Need:
3. Need:
4. Need:
Please re‐write each item on the paper provided and give to your presenter for maximum session outcomes.
Strategy 1: Make Therapy More Functional and Relevant y We need functional and relevant therapy because we get therapy approvals from various insurances
y Use the patient’s/student’s personal items when possible
y (i.e. favorite blanket, book, song, trade journal, etc.)
y Use quality, user friendly materials. They do not have to cost much.
y (i.e., multicolored index cards, special printer paper, recorders, etc.)
y ID the association’s/state’s recommendations for research/evidence‐
supported therapy strategies
Make Therapy More Functional and Relevant
y Disorder_________________________________
y What is the profession’s best practice for treating this client (list specific, published strategies/techniques/publications)?
y What are the client’s hobbies? How could you integrate this into therapy?
y How are these hobbies limited by the client’s communication impairment?
y What are the patient’s preferences/unique qualities?
y How does the client like to be rewarded?
Strategy 2: Practice Workplace Conflict‐Resolution
y What are the things/behaviors that upset you at work?
y How do you respond when you are upset? y How does this impact others who work with you? y How do you handle conflict at work?
Practice Conflict Resolution (continued)
y What are your non‐negotiables at work? Have you communicated these with your team/CF in advance?
y Do you seek for understanding before responding (i.e. why did the individual do/say what they did)?
y Do you check for what is at risk before responding (i.e. a future promotion, a raise, your reputation, etc.)?
Practice Conflict Resolution (continued)
y For each scenario, your group will decide:
1.
2.
3.
4.
5.
What’s at risk?
What’s the SLP’s side?
What’s the other person’s/family’s side?
What common ground exists?
What’s the appropriate response?
Practice Conflict Resolution (continued)
y GROUP 1: You are excited because you are due for a professional review soon and you have been working hard to get a $10,000 performance bonus. The facility’s new therapy director has a reputation from her former company for not having good social skills. One morning she overheard your cell phone ringing in your lab jacket as you were walking down the hall. At the end of the day, you get an email from her warning you not to have on your cell phone or you will receive an official “pink slip” in your personnel file. She had no clue you were waiting for a call you could not miss from your physician. You are really upset that she did not acknowledge the thousands of dollars you have saved the facility with a new swallowing safety protocol. y Use the guiding questions to complete the activity.
Practice Conflict Resolution (continued)
y GROUP 2: For the third time this week, you have asked a family to stop feeding their grandfather popcorn and coke during visits. They tell you they refuse because they have been doing this for a long time. His recent swallow study revealed oral and pharyngeal dysphagia. As a result, he has orders for pureed foods and honey thickened liquids. You already know that if this does not stop immediately, the grandfather will continue to decline. You walk away in awe as you now know why the grandfather has made minimal progress that has been documented in the nursing notes. y Use the guiding questions to complete the activity.
Practice Conflict Resolution (continued)
y GROUP 3: It’s been a great day in therapy at the flagship elementary school in your county. During an after school staff meeting, the principal informs you that you will have to immediately evaluate the 8 third graders who failed the state test. When you object, he interrupts you and says, “Obviously, the speech teacher is who the special kids need to see.” y Use the guiding questions to complete the activity.
y GROUP 4: You are enjoying your career in the pediatric outpatient setting until the director says, “My CF/intern could do feeding therapy better than you in her sleep.” She recommends that you meet with her CF/intern prior to your next session to learn some new strategies. She further suggests that you give her a small gift to express your thanks to the intern. You know that the protocol you’ve followed was the latest published therapy strategy for which you spent a full‐day doing specialized training. y Use the guiding questions to complete the activity.
Strategy 3: Creating & Growing a Professional Network
y
y
y
y
What are your professional goals?
1.
2.
3.
Implement your goals above through networking by:
1.
2.
3.
Visiting/participating in ASHA’s discussion forums
Participating in your state association’s email lists
Identifying who to speak with about specific clinical issues
Strategy 3: Creating & Growing a Professional Network (Continued)
y www.speechandlanguage.com (Discussion Center)
y Specific job websites (www.pediastaff.com) Go to PEDIACHAT
y www.speechpathology.com (Connect with recruiters from all states)
y Exhibit hall at conventions/workshops (Collect business cards and keep in contact with recruiters for future referrals/opportunities)
y Specialized conferences (i.e. Schools, Rehab, Pediatric)
y Activity 1 Results:
y Activity 2 Results:
Strategy 4: Demonstrating Self‐Advocacy
y By promoting your clinical program/agenda, you create a continual source of support for your patients and your profession.
y Network with the “key players” in your workplace 1. Custodian (Can keep you posted about facilities)
2. Secretary (Can help get copies/clerical work faster)
3. Dietician/Food Service Staff (Collaboration for therapy/feeding)
4. Payroll (Can help track pay/vacation time, etc.)
5. Other professionals/staff (Can link you to other professionals)
Strategy 4: Demonstrating Self‐Advocacy (Continued)
y Who are your “key players” in your workplace?
y Who are the specific people needed to help you meet your workplace goals/objectives?
y What are your areas of need that will rely on your ability to become your own self‐advocate?
Strategy 5: Participate in Strategic Planning
y Now that you have completed your self‐advocacy goals, you will use specifically planned activities/actions to implement your goals—strategic planning.
y 1. Display ASHA/state association’s tri‐folds/brochures
y 2. Invite volunteers (parent/family/community)
y 3. Open‐house (monthly, quarterly, etc.)
y 4. SLP‐hosted meet & greet events
y 5. Write articles for other disciplines y 6. Display patient/student work in high traffic areas at your workplace
y Group Discussion
Strategy 6: Reporting Quality Clinical Data
y List 5 things that make the following clinical data quality.
y Goal/Objective:
The child will demonstrate use of appropriate voicing when singing rhymes using external cues during 90% of the opportunities presented by the therapist for 3 consecutive sessions.
y Activity: Write a similar goal for a client on your current caseload.
y Visit/Session Note: (Regardless of format, remember SOAP). y Make sure your note contains S (Subjective data); O (Objective data); A (Assessment data); P (your Plan for the next session/future)
Format 1: Pt. reported dull pain in right shoulder; 75% for short‐term memory; req’d. moderate level cuing; Con’t. POC
Format 2: Student seen in group; 60% for initial /s/; req’d. ST model; con’t. tx
y Activity: Create a session note for a client on your current caseload.
Strategy 6: Reporting Quality Clinical Data (Continued)
y Evaluation Data:
The client was given the OWLS (Oral & Written Language Scales), a test which assesses the lexical and syntactic, pragmatic, and supralinguistic structures of language. The OWLS has a mean of 100 and a standard deviation of 15. Scores between 85 and 115 are considered to fall within the average range. The client obtained an Oral Composite score of 51 which falls 3 standard deviations below the average range when compared to his peers. This score placed him in the <0.1 percentile. These scores indicate that the client is functioning well below the average range when compared to the standardized sample.
y Write a small sample of evaluation results for your client population.
Strategy 6: Reporting Quality Clinical Data (Continued)
y Observation:
The client played with the toys with rigid textures only. His mother did not respond to his attempts to show her the blocks. He cried and screamed each time a toy displayed lights or played music. He calmed himself by rubbing the tag from his blanket on his face. He also rubbed the tag from the rubber duck on his cheek. His mother reported during intake that he often finds the tags on any object. She further reported that he becomes more fixated on the tags than on the actual object (i.e. teddy bear, shirt, etc.). y Write a small sample of evaluation results for your client population.
Strategy 7: Addressing Excessive Caseloads y Discuss your philosophy/service delivery model with your y
y
y
y
y
supervisor.
If different, compare and contrast service delivery models of yours versus that of your district/school.
List all of your issues associated with your caseload.
Prioritize each issue .
Note which issue will be the easiest to resolve.
For the more involved issues, list your “key people” and your strategic planning strategies needed for resolve.
Strategy 7: Addressing Excessive Caseloads (Continued) y Determine how much time a child actually needs and y
y
y
y
the best place to provide that time.
Not every child needs direct intervention each week for a set amount of time (remember‐individualized).
Teacher collaboration works and is the best option for service delivery in many instances (Curriculum Relevant)
This also gives you the time to work one‐on‐one with the students who really need it.
Use grouping to maximize your time and student outcomes through grouping.
Strategy 7: Address Excessive Caseloads (Continued) y Activity: Finding Similarities to Form Groups
1.
2.
3.
4.
5.
6.
7.
8.
You are the only SLP in the county and you have to service all of the schools. At the elementary school, you have ONE day to provide therapy and do the work. How do you group them to make sure they are all seen and get quality therapy (and your work done)?
2 students with a diagnosis of MR/CP
a student with Down’s
a stutterer who needs a fluency modification approach
a stutterer who need a fluency shaping approach (nearing generalization)
7 in kinder; 5 are for phonological disorders; 2 are non‐English speaking
3rd grader and 5th grader who are both working on /r/
a 6th grader working on language‐based tasks
You also have 2 evaluations and an IEP meeting to conduct
Strategy 8: Link Client Care to Research/Evidence‐Based Data
y We must have data (research and/or evidence‐based) to support or clinical decision‐making.
y Activity: Do the following scenarios demonstrate research/evidence‐
based therapy? Why? Why not?
SLP 1: The therapist was assigned a fluency case, so she went over to her storage to find her fluency class binder from her school days. When she found the binder, there was a fluency workbook next to it! She peeled the plastic from the workbook and thought, “This case ought to be interesting!” SLP 2: The therapist was just assigned a client for cluttering. She heard of cluttering before—even presented about it in school. She checked the ASHA position papers, most recent ASHA Leaders, and workshop manuals. She felt really good about accepting the case. She was especially grateful to have a step‐by‐
step protocol for working with this disorder type. Strategy 8: Linking Client Care to Research/Evidence‐Based Data
y SLP 3: This hospital‐based SLP enjoys her job. She noticed that when her elderly patient ate breakfast, she never demonstrated an adequate lip seal, so part of her breakfast spilled from her oral cavity because of poor lip/jaw control. She did not find any conclusive data on using oral motor exercises, but she does remember when they worked well with her last patient. She decided that she would collect some data that supports her use of having the patient using Non‐
Speech Oral Motor Exercises to increase muscle tone and strength when eating. Six weeks later, the patient no longer had the purple stain from her grape juice on her chin after drinking. The lip press and seal activities worked very well. The SLP was quite happy that she used her SOAP notes and materials to document a single‐subject design to create her own evidence‐based study to support the use of Non‐Speech Oral Motor Exercises in her clinical practice. She continued this for the next 6 months with other patients in her facility and found more supportive evidence that these exercises do work. Strategy 8: Linking Client Care to Research/Evidence‐Based Data
y SLP 4
The SLP at the district’s flagship middle school was very proud about her evaluation of an adolescent stutterer. She consulted several sources to make sure her evaluation covered all of the components of stuttering. The parents were pleased with her ability to integrate the data and make it relate in a report. After the second grading period, the IEP committee met to talk about the student’s lack of progress and lack of motivation towards participating in speech. The SLP is confused about what may have gone wrong. She was so pleased with her evaluation report. In therapy, she started to target those dysfluencies on the first day of therapy. She was known to be a disciplinarian and provided a highly structured therapy session for this student. She knew his key to fluent speech was to simply apply himself more, as he was not a child anymore.
Strategy 9: Winning Staff/Family from the Onset of Therapy
10 Family Integration Success Strategies
Offer volunteer opportunities that advocate for you.
2. Make appointments with family for updates/questions.
3. Give the family cards to write down questions they may have for you.
4. Analyze your caseload by family dynamics complexity.
5. Ask for family/parent preferences for updates/contact.
6. Send periodic greeting cards when appropriate.
7. Facilitate support group meetings.
8. Offer parents/family time to think over information you have given them.
9. Make family/parent education a priority (articles/reviews).
10. Provide positive feedback about performance, especially if negative information has to be provided later.
y Activity: List your caseload by family/parent complexity and needs
1.
Strategy 10: Dedicating Yourself to Continued Growth
y In order to continually improve yourself, you have to always have the habit of mind to honestly evaluate yourself and seek out those skills and competencies you need to become a better SLP.
y Activity 1: Discussion
Discuss with a partner the following, “How do I go from ‘am I doing anything to make my clinical performance better’ to ‘what do I need to do to improve my performance?’” (There is ALWAYS room for improvement)
y Activity 2: Goal Setting
Set 3 Clinical/Professional goals you will implement for yourself, as well as the timeline for which each goal will be completed/updated
Strategy 10: Dedicating Yourself to Continued Growth
Remember:
1.
ID the core problem, not the symptoms (i.e. time management versus blaming a specific activity).
2. Visit various websites and blogs related to the profession.
3. Create a binder of resources from various workshops. Place 1‐3 sheets of key points in a special section, by topic/presenter for easy reference. 4. Learn how your position is budgeted/administrative process for paying you(i.e. payor sources, company specifics).
5. In the midst of referrals, trainings, and caseload management, you are changing the face of human communication daily.
About Your Presenter
y April Brown‐Bell is a Dallas, TX‐based SLP. She is currently a private contractor with over a decade of clinical experience managing challenging workloads in schools, pediatric, adult, geriatric, and home care settings. She has coached many SLPs through professional mentoring to achieve their professional goals in the workplace.
y April Brown‐Bell, MA, CCC‐SLP
Helping You Meet Your Career Objectives with a Comprehensive Approach
9090 Skillman Street, Ste. 182A‐PMB218
Dallas, TX 75243
(214) 607‐0324
[email protected]
Session Evaluation
1.
What basic message did you hear today that you could use on your next day at work?
2.
How will you use what you heard to increase your clinical efficiency?
3.
Do you know of others who would benefit from a complimentary copy of the material
presented today? How may I provide the handouts to them?
4. What part of the presentation did you like best? Least?
5.
What should I add for the next presentation?
6. On a scale of 1‐10, please rate my: Appearance____ Material____ Delivery Style______
Clarity of Presentation______
(Optional)Name:
Topic’s Relevance to SLPs_____ Rate of Speech______
Address:
Email:
Email Sign‐Up
y ⌧ Yes! Sign me up for your quarterly newsletter that
offers valuable tips to help increase my clinical efficiency.
y My email address is_______________________________
y Name__________________________________________
y I understand that, at any time, I may email to unsubscribe
from this list.
112008ASHAIL
Data Collection
y Please complete the following questions so that I may establish the effectiveness of this program for data collection/reporting purposes. Please leave this completed form in the designated location.
1.
Will the strategies presented today help you to become more efficient in your work setting? Y or N
2.
Which strategy was the most beneficial to you?______________________________________________
3.
Which strategy was the least beneficial to you?______________________________________________
4.
Would you recommend other SLPs to attend this training in the future? Y or N
5.
What areas of need/strategies would you like to see added to this presentation?____________
______________________________________________________________________________________