Episode 18: Building Bridges: Alyssa Acker on Speech Therapy Across Environments

In this episode of 'Hear Me Out,' hosts Niki Lampi and Tamara Pogin from the Masonic Children's Clinic for Communication Disorders discuss communication disorders with guest Alyssa Acker, a school speech language pathologist. Alyssa shares her personal journey into the field, inspired by her daughter's hearing issues. The discussion covers the Help Me Grow referral process in Minnesota, the importance of early childhood screenings, and how evaluations for communication issues are conducted in public schools. The team highlights the value of collaboration between professionals for the benefit of the child and their family. Tamara also shares tips for parents on managing activity transitions for children. The episode emphasizes the benefits of early intervention and support for children with communication disorders.

Transcript

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Hello and welcome to Hear Me Out, the official podcast of the Masonic Children's Clinic for Communication Disorders. This is the place where we dive into all things related to communication disorders and how we can best support the kids and families affected by them. We will be talking with speech language pathologists, clinic staff, families and donors to share stories, insights, and the impact of providing free speech, language and hearing services to children across our community. I'm Niki Lampi speech language pathologist and director of the clinic, And I'm Tamara Pogin, also a speech language pathologist with a focus on working with autistic children and their families. And we are your hosts. We're so glad you're here. hello. Today we have Alyssa Acker on our podcast. She's a school speech language pathologist who graciously works with us in collaboration at the clinic. Welcome, Alyssa. Thank you for inviting me. Hello, so glad you're here today. So Alyssa, when we interview professionals, we usually ask, how did you get started in speech language pathology or what drew you to the profession? So my initial bachelor's degree is in elementary education. I knew I wanted to work with kids. I had never heard of the field of speech language pathology. My younger daughter, she must have gone to her two year checkup and didn't pass her hearing screening. It was months of, you know, trying drops, trying different types of treatments. Did she have a lot of ear infections? She had one double ear infection. That's it. That's it. So it wasn't even on my radar. Right. And eventually she ended up getting tubes and they had to scrape some, you know, like muco fluid out of her eardrums. And she didn't pass a hearing test until she was four. So that's how a long time. Yes. That's how I learned about the field. And at by that point, I knew I didn't want to be a teacher. Um, it's, it just seemed like a lot of classroom management skills that I did not have. And it just kind of woke me up to another way to work with kids and to help them communicate. It's just different when your own child is going through it and you're having to interpret and deal with some tantrums and the frustrations of a little child who just can't get their point across. Sure. It really opens your eyes to the importance of communication. I don't think you can understand the importance of it until you lose it. So that's interesting. You have a, you have a very empathetic view then when you work with clients because you have some experience from the other side. Well, I try to, and I, I do share that with parents when we do initial evaluations as well. a lot of parents place a lot of blame on themselves for either, they think maybe they contributed to a communication disorder or. maybe they didn't notice it soon enough. Um, parents are really good at self blame, so I always share that my own child had communication difficulties and just try to get them to, um, maybe be a little more forgiving in the of themselves. That's great. That's so great that you have that insight and can share that with. I hope so. Now, did your daughter, was it your daughter? Yes. Had, did she have speech therapy then after you were working with ENT and Audiology? So they, the audiologist had put in a Help me Grow referral for her, but it was June. And nobody got back to us right away. And by the time the school year had started, she had made so many gains that it just, I didn't feel like it was necessary at that point. Her intelligibility went from like 40% to like 90% over the summer, so that, that access to hearing mm-hmm. That the appropriate, all the speech sounds that she was probably missing, she was like, oh, that's there. And just, just grabbed it. Yeah. That's really amazing. But I, I think that was lucky. That's not always the case. Mm-hmm. Yeah. And it was nice that, that you were monitoring that and then the schools were available, right? Yeah. Right. Um, so you mentioned a Help me Grow, referral. Now you working in the public schools, are you the one that kind of grabs those? Can you explain what Help me grow is Yes. And then how it, it gets to you. Sure. So, we have a Help Me Grow referral system in the state of Minnesota where anybody can make a referral for any developmental concerns they might have about any child. So if you notice your neighbor. Or you know, your nephew or whoever is struggling with any area of development, whether it's like gross motor or maybe social emotional issues, whatever it might be. Anyone can make a referral on their website or, um, by calling them. We have a help me grow person through the school district, and if a referral comes in, she gets it to the right person. So, I work with children ages three to five. There's a separate like, crew of employees who are, birth to two. So if it's a three to 5-year-old who, if they're assigned or if their homeschool is the school that I am assigned to and there are communication concerns, then I would be part of the evaluation process. it depends on, you know, what the concerns are and whether there's other areas, Mm-hmm. So after the referral happens, whether it's by someone else or by the parents, the parents are contacted by this coordinator. Mm-hmm. And then the team is assembled, correct? Correct. And there's a whole, process we go through and, um, touch base with the parents. if they've gone through early childhood screening, we get that information so that we can see, what. What showed up on the screening, whether, you know, did they pass a hearing screening, do they have vision concerns? Is there a history of maybe like lead exposure or, any type of maybe a developmental disability that has been diagnosed medically but not yet? caught by the school district? There's just a lot of pieces that have to come into play. Mm-hmm. So you mentioned for your situation, you contacted the school around June, so of course had to wait then over the summer when they were not in session. And then typically for a child. If you were gonna contact the school, like September, October, how long would they have to wait before getting seen by the team? So typically once a referral is made, contact is pretty quick. Our Help Me Grow person is really on top of things and we'll connect with a family pretty quickly, typically within a few days is what I have seen. Oh wow. That's really fast. Yeah, she's really good. Obviously there's going to be times where it's busier. You know, we do early childhood screenings through the school district, and during those times there might be a lot more referrals, so she might just get backed up. Mm-hmm. Um, but typically that happens pretty quickly and we try to get in touch with the families pretty quickly. Usually within a week after. we get a referral because we really understand the need for early intervention and the sooner we can get in and figure out if there are areas of need, then the sooner that child can get some support and build some of those skills. Mm-hmm. And where do the evaluations take place? Do parents have to travel somewhere? Do you go to their house? So it, there are a lot of factors. F for birth to two, they often will go into the house. typically for the three to five year olds, we would have them come to the school or we can meet at like the library or somewhere that's. More convenient for the family. the benefit of coming to the school is that, at least for the children I serve, they're between the ages of three and five, and often they are preschool eligible or soon to be kindergarten eligible. And we're able to then kind of see how they do in a less familiar environment, maybe with some peers, how they do in more of like an academic setting. Mm-hmm. And that's not always visible in a, in a child's home. Mm-hmm. So that's something you talk to the parent about. ahead of time to, to determine where the evaluation will be. Right. I like that. I like that because I've heard from some parents that, we do outreach sessions for the clinic where we go out and see the child in the home or daycare, you know, and sometimes families just really don't feel comfortable with having someone come into their home and other families love that. Piece and they think it's so helpful, really depending on the family dynamics and the child. So I love that that is a, a choice that families have and that they discuss it with you, right? Absolutely. And the Duluth schools does have like an evaluation team for children who are not already in a daycare or in, a preschool program. So I mean. It's complicated on who specifically will do the evaluation. but it is nice for that the families have some options as well. Mm-hmm. And then once the evaluation process is completed and some. Needs have been identified. They would get either for a, a young child, I believe it's an IFSP, right? Correct. The individualized family service plan. Correct. And then, but you are serving under an IEP, an individualized education plan. Right. And so what I. Think is so great about your setting is that's different than the clinic, is that you have access to peers. And so that's one thing I wanted to talk about. Like as you are developing your, objectives, if it's, there's a, especially if there's social, emotional, um, needs identified or communication and needs identified, how do you work the whole knowledge that you have access to peers into your treatment? Well, one of the things I consider when I'm doing an evaluation is how well the child can get their point across to, um, their peers, and can they ask them to play when they're playing? Can they solve problems? Are they able to, do some communication repair? Are they even aware that their communication can be challenging to understand? Th that's the kind of thing that we can't really tell in a home because families are so great at, understanding their child. Understanding their speech patterns and even like predicting where a breakout might occur and preventing it from happening and even using context because they all share the same context because they've all been to the same restaurants, the same family vacations, the same things like that. So they can pull something from that. Maybe someone who's an unfamiliar listener or a peer would not be able to grab. Absolutely. And often there are. Favorites. Like if a child has, I don't know, a TV show they love or, um, some action figures they always play with and they've named them. They have a family pet. The family is aware of what all of those names and special interests are, and often I have no idea. So even just the ability to know that context. You're right, it's so huge and we don't always have that at school. Mm-hmm. Mm-hmm. Yeah. So that's like the, the vice versa that we have going on sometimes. Whereas, usually some sort of family member brings clients to us and so we can be like. Oh, oh, that's he, that these are all your BLIPPY characters or these are all your PAW Patrol. That's what he's talking about. Got it. And so we can move from there and use their interests and because we have that parent interpreter with us. Right. And then you might not. And so that's what's so interesting about collaboration. 'cause maybe I send you an email and be like, so and so really loves the PAW Patrol and you're like on it or you know, or vice versa for different things that you. Activities that you do that we're like, oh, I wonder if they could do that at home. And that's been really amazing to collaborate with the SLPs here at the clinic because we see them in such a different setting. And I've been able to come over here and be part of some of their sessions and observe and see. Sometimes the behavior is completely different, sometimes. Um. Maybe at school, I think they're not able to do a certain thing and then I come here and in a different setting with their parent present, they are capable of a lot more that they just didn't let me see. And maybe it's because they were trying to follow school rules they didn't know, or you know, whatever. Uh, there's probably assumptions made on the child's part and on my part, but it's so helpful to come in and see how a different SLP provides intervention, the different queuing that you do. It's just really helpful. the other thing is sometimes there's things I've observed at school about a child and have been able to ask about, and the clinic SLP didn't realize maybe like a child was super shy. Because they're seeing them with their mom and their sister. Mm-hmm. And so they seem pretty precocious where I see someone turling into themselves and, maybe not playing with other kids and it's just something that everyone can work on then, you know. Yeah. It opens our eyes to different levels of support that we can provide the parents and the child. Absolutely. Yeah. 'cause we, we. We don't see everything in our, in each of our settings we see a different child basically. And it's so funny. It's like, so we wanna grab all those pieces and put it together and it's just become so much more helpful, I think, and more productive for the child and their progress. Absolutely. So we kind of got at it in this, in that conversation a little bit, but, uh, what is the most rewarding thing, uh, working in your current work setting as a pediatric speech pathologist in the schools? There's so much, it's, it's really hard to pinpoint one thing. Um, I worked with middle school for a long time and to come. And work with preschoolers has been really a big learning curve. Um, just, finding different motivational pieces. It's really different developmentally to work with preschoolers, but when there is say, like a sound that the child has not been able to do and I finally get that K sound out of them, it's like I can't hold it in. I get really excited. And then the child. Sometimes they're scared at first about what, what I'm yelling about, but it's so exciting and they're so proud of themselves and to just see them feel like. Oh, I can do this. Like, this is hard, but I can do it and she'll help me. It's just it, it's so meaningful. And when I have, say an annual IEP and I've been working with a child for a while, hearing the parents say like, oh, grandma doesn't have to ask us to interpret anymore. It. It's huge. That is, it's huge. A huge impact in their daily life. Absolutely. Right. You get to see that and experience that with them. Now, you mentioned IEPs. Can you talk a little bit about. What will happen following the evaluation if a child does need an IEP? Yes, so we typically will hold like an evaluation results meeting where anyone involved in the evaluation will share what they found with their testing and talk about what the impact on the child's, social skills and academic skills might be given what we saw. and then we ask the family if they're interested in pursuing special education services through the school. Not everybody is. Some of them just want to know what's going on and, you know, see what they can do from a family standpoint to support their children, which is great. But if they are interested in wanting to. Get some school-based services. Then we talk about what would be most meaningful for the family and where we see that we can help. We come up with some goal proposals. We talk to the family about what is most important to them and the generally the preschool teacher. We'll talk about what would be most helpful in the classroom, where they see the needs, and then we formulate a plan together. it, we talk about accommodations. What can we do at school to make the, the curriculum more accessible? Whether it's, needing some sensory breaks or needing visual cues or something like, a low tech communication board that the child can use when they're not being understood or trialing a, an actual like high tech communication device. There's lots of things we can do at school, even like a visual schedule that can really help it's no surprise to you that when you're not regulated, your communication is one of the first things to just kind of go out the window, right? So regulation is like foundational. Mm-hmm. So. That's great that you can address all of those pieces. Well, and especially with preschoolers, they're, everything depends on each other. Mm-hmm. It's also interwoven that if you don't address all of it, you're going to get a month into the IEP and realize that it's not working. Right. Right. You can't silo all of those skills all. All, all those things make up who the child is, right? And we have to think about the whole child rather than just, oh, they can't do their k and g sounds. Mm-hmm. It's, that's, that's not a human. So what is some advice you'd give to parents who are maybe wondering if their child should seek services from Help me grow? depending on the age, one of the things that they can do is. Once the child is three years old, they can reach out to their school district to get an early childhood screening. And the early childhood screening looks at fine and gross motor. social emotional skills, academic or, well, I suppose pre-academic skills. Communication. They check hearing and vision. They check nutrition, weight, height. I mean, they're really looking at development as a whole. Mm-hmm. To see where the child and they just call the school district phone number for that? Mm-hmm. Yep. And they can look on the school district district's website and see, you know, there should be like a section for early childhood and there will be a screening area. Um, every school district does it a little bit differently, but Okay. The information. So it's easy. It's an easy process. Just reach out to the school district. Mm-hmm. Mm-hmm. Or even, you can Google, like Minnesota Department of Education, early childhood screening, and they have a finder where you can find your specific school district. So Alyssa, if a family is concerned about their child. Should they reach out to you right away? Should they wait? What would you typically recommend in those situations? I would recommend reaching out right away. we know that the earlier the intervention happens, the better the outcomes. So I would not recommend the wait and see approach. Mm-hmm. Like I said, anybody can make a referral at any time. Through Help Me Grow. The website is helpmegrowmn.org and anyone, you know, there's a portal for physicians to make referrals. There's a educators referral section, parents, caregivers, anybody can make that referral and it all goes to the same person. That's wonderful. Mm-hmm. And it's a pretty simple referral process. They're just asking basic contact information and a quick synopsis of what your concern is because the human on the other end receiving the referral will reach out and get more information. It, this is not like, what is your whole family history? This is. Give us a basic synopsis so we can get you to the right people. Mm-hmm. And I love that encouragement of reaching out right away. I think one of our other families that we had in here, actually, they were talking about how some providers were hesitant to. Give their child a, a diagnosis of autism or even bring it up. Sure. You know, and in, in their case, they're like, we wish they would've said it sooner. We wish they would've gone down that path sooner because they were able to get so much more intervention and information once they had that. Mm-hmm. Absolutely. I think it can be a little bit, um, I don't wanna say scary, but people worry about hurting feelings. Mm-hmm. Um, offending people. Mm-hmm. And that can be a tricky thing to work with, but the goal here is to help the child, so. Mm-hmm. I mean, we really do need to keep that in the forefront of what's best for the child. And putting our own feelings about it aside. Right. And as a parent, I think trust your gut and know if you have questions, you ask those questions and you reach out to people and you, you find those answers. Absolutely. I Cool. So, uh, Alyssa, we have definitely collaborated in the past, but one of my, favorite collaborations, that we did was with a preschool child, that was using an a a C device and was what we call a Gestalt language processor. Mm-hmm. So was using some verbal language, but in very scripted ways. And what I found so valuable was that this child was using scripts. that weren't literal, didn't have literal meanings, but had that, that idea of, of the a feeling or, uh, or, um, yeah, pretty much. They were like, they were like feelings. Like I remember like the, one of the ones that I thought was so amazing was, I enjoyed being with you, or Let's come together to be with, there was like. Don't anybody move. And, um, and so hearing from you about how he was using those kinds of scripts in your setting really helped me understand what those scripts actually meant. Did you find that too in our, when we were talking back and forth with that, with, different scripts that he, that this child was using? Absolutely. Absolutely. There were things that that child would use at school that, maybe we didn't realize meant like. I want someone to snuggle with me or I wanna go outside and swing. Mm-hmm. Because he wasn't saying that exactly. He was saying something different. Right, right. Or even, some of the scripts would help him to regulate and. You had started like a Google doc of the gestalts you were hearing and what you were interpreting them to mean. That has been incredibly helpful. we added to that as things showed up at school, but even having, between homeschool and the clinic, we could. More comprehensively figure out what the child was trying to communicate and try to kind of mitigate some of those gestalts to get them to be more, efficient for talking with anybody who didn't have his history. And what I also, I think that we did with it is when we looked at what the communication function of that gestalt was, we we'd be like, Hey, hey, let's model more language. That means can we go out and play? Right. And so we tried like a variety of different ways to say it and then maybe he caught one or two of them, right? And we're like, okay, so now you have this way to say it, but also this way to say it. Yes. And that was really helpful. Um, and I think too, yeah, we can't leave out the parents' contribution because they were so amazing about the sources. Yes. Of the, because a lot of times scripts come from, media. Or from something that a parent has said or a teacher has said, and something that we are not around for before they grab it. And so to be like, oh, that comes from this episode of la la la and you're like, oh. And then we could like watch it ourselves or find it. Yes. And so because this child had an AC device, that was another thing that we were doing, was maybe recording some certain things or mm-hmm. Or changing the. Aac C so that we would inform each other, like you'd be like, I added blah, blah, blah to it, and I'm like, thank you. Or I did the same thing for you so that we would know where it was. Right. So that when we came in the session, it didn't just show up and you're like, ah, changed. It looks so different. And so that was helpful. The other thing we noticed is that some of those gestalts were built around routines and there are different routines at school than there are at home, than there are at the clinic. So, so you used needed different ones? Yes. Or we heard ones. That might happen at home and school, but would never come up at the clinic. So being able to collaborate on that is just, it's priceless. Mm-hmm. Yeah, that was a really, that was a really fun collaboration. I thought it was, I couldn't have done it without you because, and, and without mom. And then I think we, it was just a very symbiotic kind of thing to, to help that child in investigate their gestalt so that they can communicate better. Absolutely. And it's just been really fun to watch that child's language blossom. And I don't think it would've happened without you. Oh, thanks. Yeah. Yay ladies. Yeah. Teamwork. I thought of one more thing. Oh, oh, yep. I, so a lot of families are not aware that the county has services available for children who have some type of a medical diagnosis. Um, you can. Check with your physician or check with the county to see if your child might be eligible for some, um, disability related services, including getting a disability case manager through the county who can help you access services and materials. Um, obviously I don't work for the county, so I don't have specific details, but I know that families have been able to, get help with like transportation to medical appointments, helping with things like, respite care for children who have more significant support needs, and that that is something we work really hard with our school families on because not everybody realizes that that is. A service that's available to them. Mm-hmm. That's a great resource. Thank you. Yeah. And bringing that up also is, like we talked about how we collaborate, here at the clinic, but you definitely have other opportunities to collaborate with other professionals, like through the medical model. parents I know have in. Have asked that I be invited to IEP meetings. But also they've talked about maybe some other professionals, like maybe they have an a, b, a therapist mm-hmm. Or they have, uh, some other tutoring agencies that can then also be invited to an IEP meeting just to be able to, again, give that more holistic view of the child. So I have other, is it beyond the IEP meeting? Kind of, but the, that's one of the ways that. You can collaborate with the professionals Yes. Yeah. In a different setting. Yeah. It's really helpful to just get a, like you said, a holistic view of the child and what their overall needs are and how we can support that, and how we can support the family. Because having a child who, has higher support needs than would be expected is, it's hard. It's hard, and it can be isolating. Mm-hmm. I That's great. Thank you. Thank you. So our last question we kinda ask everyone too is like. What is your go-to, either therapy, activity, or toy that you like using and bringing into your sessions? A toy. There's so many good ones. Mm-hmm. Or an activity or, mm-hmm. Or something. Mm-hmm. Um, honestly, one of the things I really love to incorporate is some type of art. A lot of my kids. Have some difficulty with fine motor or some sensory stuff. So bringing in some different textures, different materials is kind of fun and they get to explore a little bit and branch out a little bit in a way that's safe. I never force. Um, but like say we have watercolors, I've had some kids who get really. excited about watching the water drip off or seeing how they combine and it just kind of branches out into more ideas about things they might enjoy, how we can build their vocabulary around it, using adjectives, using different verb tenses descriptors. It's just. I don't know, art, I mean, my mom taught, elementary art and then head start, so I think I just kind of grew up mm-hmm. With art happening all around me and it's so easy. I mean, you don't have to go and buy a kit from Target. You can take really basic things, even like, you know, dead leaves and sticks and glue and come up with a collage. It's just, I don't know. It's kind of fun. I love that. I love using the everyday basic items around you. Mm-hmm. That's great. Mm-hmm. We did a, one a couple years ago where I just had the kids like tear up tissue paper and use a Q-tip to rub glue on a glass jar and they made them into mosaics and then we put little battery powered, um, candles in them. Mm-hmm. And the kids were so proud of them. Aw. And they're so simple. And you're using recycling. Mm-hmm. It's kind of cool. Very cool. That sounds fun. Well, thank you Alyssa for coming today and sharing your experiences and how to help parents find, services for the child through a public school district. Well, thank you for inviting me. Hello and welcome to Tips from Tamara. I'm excited to use this platform as an opportunity to share my experience from over 20 years as a speech language pathologist to focus on one concept, a resource at a time, now let's hear some tips from Tamara. So this week's tips from Tamara is all about transitions. So parents often ask for resources to help their child stop an activity without melting down. Um, but what they're really asking for is how to help them transition to something new. Uh, so what we. So there's lots of ways to do this. And it of course, a lot of it depends upon your child, their interests, how much they understand. So I have three ideas that might help generally with a lot of these. So the first one is a. An object, so having an actual tangible thing that they can put in their hand. It could also be a picture if that works for your child, but an actual object that gives them a cue about what they're gonna do next. For example, even maybe they're, maybe they're in the living room playing, but you give them their toothbrush to signal it's time to get up and brush their teeth to start getting ready for bed, and then you walk with them to the bathroom. Um, some other things that might help is they might be really enjoying playing with trains in the living room, and they're not ready to give it all up yet. So you can say that it's okay to take one train with you to the bathroom while you get, start your, start your journey to getting ready for bed. So it's kind of like that little. It's their, it is their transition object. It's their, their little lovey that they're like, well, I remember how much fun I was having with it, and so I'm just not ready to give it up yet. And so that helps them with their emotional regulation as they have to do something else. Um, some other things that you can do a. Again, depending on their level of understanding, is to give like a picture schedule of this is what we're doing next. Uh, you know, the picture of the bathroom, a picture of the toothbrush, a picture of the toilet, a picture of their PJs, and be like, okay, it's time for this, you know, going on now. And then they get to like maybe put it in the all done envelope once they do it. So then maybe there's some motivation there. Um, some other things that, uh, Teri Bushy and. Some other things that Tera Bushy and Susan Larson Kidd taught me. They were, um, some mentors here that worked at the clinic. They talked about having some sort of an almost done. Visual and then a stop. And so almost done doesn't have a clear picture. So it is something that needs to be taught, needs to be practiced. And so what they used is just a little yellow dot that said, almost done on it. And Dr. Kidd would use the example of like maybe to watching a television show. We as parents know when the television show is about to be done, you know, it's 25 minutes, it's 30 minutes, you know, whatever. We know that it's. Dialing up so we can put a, on the TV screen on the corner, we can put almost done. And then when it's showing the credits, we're like, and stop. And then that kind of cues them to have to turn it off. And that doesn't mean it will eliminate all of the distress about that, but it gives it a bunch more clear message and then you can practice it with other things. You know, you can be playing again using the trains on the, in the living room example. And you can put, oh, we're almost done, and then we're gonna be doing this next step. And then you put the stop out so that, or, or even a cleanup picture. And so that can be helpful as well. And so those can, those three things can really help with transitions. Especially when you have to go from something they really love doing to something that maybe isn't their first choice, you know? So we call that going from a preferred to a less preferred activity. So a lot of these are for those, those things. So those are tips and tricks for transitions. That wraps up this episode of Hear Me Out. Thanks so much for listening. Be sure to subscribe, share the podcast with others, and join us next time as we continue learning from the professionals, parents and donors who make this work possible and celebrate the amazing kids we serve. To learn more about the Masonic Children's Clinic or to support our mission of providing free speech, language and hearing services, visit our website and consider making a donation. Every gift helps us give children the voice they deserve. Visit us at masonic children's clinic.org.