Unearthing a Relic

 

While cleaning out my basement, I uncovered this treasure.  It's my Peabody Articulation Decks.  If you remember these, you are probably in your fifties or older.  

I own this kit for one reason and one reason only, I was required to buy it.  During one of my clinical classes, we were required to buy this kit which was pretty expensive for its time.  I think it was over $100. Alternatively, we could make our own.  

Making your own kit in the late eighties and early nineties was no easy feat. There were computers and printers but no internet that was accessible to the average person.  Digital images were in their infancy. Making 10 decks of articulation cards would involve looking through magazines and newspapers or whatever other printed materials you could find and searching frantically for pictures of objects that had the appropriate sounds in them.  That meant finding 10 pictures of items with /g/ at the beginning of the word, 10 with /g/ in the middle of the word, and 10 with /g/ at the end. Then you had to cut out the pictures and glue them onto index cards. Then simply repeat for each of the sounds in the English language.  Oh, and keep up with your reading, studying, clinic patients, and projects.  Like most people in the class, I bit the bullet and bought the kit.  And, when I say I, I really mean that I begged my mother for the money.  

Those of us who took the "easy" way out and bought the kit were harshly chastised by our graduate assistant who had made her own kit when she was an undergrad.  "I cut my butt off for months," she said not really selling us on why it was better to make your own kit.  

Once I started working, I did actually use the kit and I can assure you that it was a relic even back then.  One thing we did have in the 90s was CDs but the /r/ card deck had "record player" as one of the target words.  "Roller skate" was also a target word and depicted a skate from the 70s in the age of rollerblades.  All of the people pictured in the deck looked and dressed as if they were straight out of the 1950s.  To its credit, at least the people pictured on the cards weren't all white.  They did have some people of color represented.

In addition to the dated appearance, even back then, many of the target words were terrible.  Let's revisit "record player".  If you are working on /r/ you've got an initial /r/, a medial vowel controlled /r/, and a final /r/ all in the same word.  There's an /l/ blend thrown in for good measure. Definitely not a target that you would work on very often due to the many challenges it presents.  

Despite its negatives, I used this Peabody kit quite a bit. It was handy when the copy machine went down and I couldn't run off my targets for my next session.  It was there when therapy times got switched around and I had to see a student unexpectedly.  But, over time, it got used less and less as I learned more about how to coax speech sounds from children with the most challenging articulation problems.  

And so, today I bid farewell to the Peabody Articulation Decks.  I will never again see that neon green box beckoning me from the shelf in my office.  I will never again have to try and carefully seat the decks into the box so that the lid will close, not a task for the impatient. In fact, I will never again close the box because the latch tore off about 2 years ago.  Goodbye old friend.

Share the Load but Don't Lose Control

 Several years ago my friend "Jen", a relatively new teacher, told me a story about an experience in her previous school district. during her first year of teaching.  She was teaching in a classroom for students with Autism Spectrum Disorder.  There were 2 ASD classrooms right next door to each other so she and the teacher in the other classroom decided to share their teaching responsibilities.  Jen taught math and worked on the math goals with students from both classrooms and the other teacher did the same for reading.  It seemed like a great idea at the time.  

It seemed like a great idea until the other teacher left her position just before the holidays.  It was then that Jen realized that the teacher had left no records or data about the students progress on their reading goals. Right around that time, one of Jen's student's parents decided to bring in an advocate during their child's IEP.  As you can imagine, the advocate and the parents were unimpressed by Jen's lack of data regarding their child's reading skills and did not accept the excuse that the other teacher had been the one who was supposed to collect that data.  Jen was the teacher of record. Ultimately, it was her responsibility to ensure that she had access to that data.  She filed that experience away as a lesson learned and was much more cautious when it came to teaming with other teachers.

I was reminded of this story more recently when I came upon an even more troubling situation.  An SLP and teacher contacted me with concerns regarding the methods being used to assist a student with accessing his AAC system as well as completing writing tasks.  The student was new to her and had transitioned to the building with his one-to-one aide a few months prior.  Their concern was that all communication and writing assignments were being accomplished with "wrist support", meaning that the student placed his hand on top of the aides hand while using his communication app or writing using the keyboard on his AAC system. In other words, she was using Facilitated Communication, a communication technique that is not supported by research and has found to carry many risks of misuse.  The aide staunchly defended her use of this technique saying that he had used it with great success all through elementary school and no one had ever complained about it.  In fact, she argued that, without the use of this technique, he refused to write anything at all. The attempts of other staff members to use this technique of wrist support resulted in the student writing a string of letters, a far cry from the grammatically correct and perfectly spelled sentences he wrote with the aide.  Her excuse was that he didn't know the rest of the staff well enough and wasn't comfortable.

Similar to the situation Jen found herself in, this aide requested a transfer and moved to another building.  So now a student who previously "wrote" long beautiful sentences and stories is now writing strings of letters.  He is frustrated with the staff who aren't able to make his former communication technique work because, and I am speculating here, they refuse to write the words for him.  So here we are with an 11-year-old, with limited and completely unintelligible speech, with no form of communication.  We have his parents who were under the impression that he was doing well academically who will now realize that his skills were not at the level they thought they were.  We are tasked with completely starting over from scratch.

Much like Jen put her trust in her teaching partner, The staff in this student's elementary school put their trust in a teacher's aide and then never checked in or questioned what she was doing.  The teacher never spent any time working one to one with this student to verify his skills, she simply trusted the report from the aide and the work that was turned in.  The SLP was never able to get the student to do any kind of work for her so she simply dropped him from direct service and put him on consult.  Then, she never checked in or realized that the aide was using a communication method that went against the code of ethics that she agreed to when she renewed her ASHA membership at the beginning of the year. 

Most of all I blame myself.  As a new consultant, I visited this student twice per the request of the classroom.  I was there specifically to assist in getting a mount for the student's wheelchair so that he could use his communication system from the chair.  I took pictures of the device and chair and place the order.  I even went back with our tech specialist to observe while he attached the mount. During that time I never checked in on the communication of the student.  I accepted the aide's report that everything was fine without asking her to elaborate on what "fine" actually meant.  Like all of the other professionals involved in the scenario, I not only accepted that things were fine but I was relieved that, given my busy schedule, I didn't need to do anything further for this student.  

The moral of this story is that, when you are responsible for a student's learning, you need to ensure that the student is in fact learning.  It's fine to team teach with others.  It's fine to have a teacher's aide assist the student in the classroom.  but, a the end of the day, the responsibility for the student's learning is yours and yours alone.  Make sure that you know your student's present level of functioning in all areas, even those you don't teach.  Make sure that you are in control of what techniques and accommodations are being used with your student and make sure that they are research-based.  It is tempting, given the many demands of a special educator, to offload responsibility when you can but resist the urge to completely check out.  Resist the urge to accept that things are "fine" without actually checking to see if they are.

So as I face a terrified teacher, a frustrated SLP, and heartbroken parents, I swear to myself that never again will I accept "doing fine" as an answer.  I will ensure that the students under my care, however indirect, are receiving quality communication services based on solid research and I hope you do the same.  Your students and their families are depending on you.

The Dreaded Dead Man's Goal

There I was,  sitting in a very long IEP for Lily a student with multiple impairments including but not limited to quadriplegia, vision impairment, seizure disorder, as well as numerous other medical conditions. When we came to the goals and objectives section,  the teacher read off her carefully crafted goal, " By the designated date, Lily will respond questions using alternate means (pictures, symbols, etc) given maximum verbal, visual, and physical prompts 30% of the time as measured by documented observation."  As I listened to the reading of this goal, something that I had been wrestling with for a while finally clicked into place.  I realized that this goal, which had seemed so reasonable and typical in the past now seemed like complete bullsh-t. 

So, what's wrong with this goal?  Lily has a complex body.  She has difficulty with movement and she doesn't speak so isn't this goal perfectly reasonable?  The answer is no, it's not.  When I listened to the teacher reading this goal, I was transported back to a training on IEP goal writing that I had attended sometime before.  I remember being warned to avoid writing "dead man's goals"  meaning goals that a dead man could still achieve.  At the time I thought it was ridiculous, who would actually write a goal like this?  Who would be that stupid?  And now, sitting here, I realized that not only was the teacher sitting next to me that stupid, but I had been as well.

What I realized as I heard this goal read aloud was that, when you add physical prompting as an acceptable prompt to use in achievement of a goal, you have just written a dead man's goal.  You see, Lily doesn't actually have to be conscious or even breathing and she could still achieve this goal.  The teacher could ask Lily a question, place the symbol system in front of her and then take her hand (or other body part) and physically prompt her to select a symbol to answer the question.  Lily doesn't have to do a thing and even if she, God forbid, expired during the lesson, we can all rest easy that she could continue to meet her IEP goals posthumously.  

There is a LOT wrong with this entire scenario.  Think about it. This is a goal to, presumably, further Lily's communication and use of symbols but it is padded with so much prompting that she doesn't actually have to DO anything.  This goal can be achieved if someone moves her hand for her and, they only have to do it 30% of the time.  I mean, if it's OK to move her body for her, why is the measurement so low?  Is the teacher so busy that there is only time to physically prompt 30% of the time?  Are we measuring Lily's performance or the teacher's?  

And don't get me started on figuring out what 30% of the time means because I have no clue.  When it comes to communication, percentages are problematic.  By 30% of the time, we really mean 30% of the times WE wanted her to respond.  It measures her compliance with our request that she select from the choices that WE put in front of her.  And, last time I checked, communication was NOT a compliance task that could be measured in percentages.  Communication is an exchange of information between partners and when you are a person with a complex body, sometimes the only power you have is to NOT respond.

So, why do these goals get written in the first place? Why do administrators and compliance consultants allow these goals to continue to be written? These types of goals hint at a dirty little secret...we don't believe in ourselves as teachers.  Students like Lily are challenging.  With her limited movement, it's hard to find things that she actually CAN do.  And then she's absent for months with her medical issues so its difficult to write a goal that she can actually achieve.  And truthfully, students like her scare us.  As teachers, we develop a set carefully honed tools that work for most students.  The Lily's of the world remind us that we don't know everything.  They challenge us to reevaluate our methods and dig deep to look for strategies for those students who are the outliers in a group of outliers.  Some of us choose to rise to that challenge while others are consumed by the fear that we might fail.  So instead of rolling up our sleeves and trying something, anything to teach the student, we simply blame the student for our own failings.  We say things like, "well, she's too low to..."  or "she's to medically fragile to be expected to.." 

When we take this approach, we rarely get any pushback from our administrators.  They are afraid too.  They are just glad it's not them on the hook for teaching this student.  We, more times than not, don't even get pushback from the parents.  They have bigger fish to fry as it can be a full time job just keeping the Lily's of the world breathing let alone ensuring that they are properly educated.  And they've had years of professionals telling them what their children can't do.  Many of them have had to lock away the pain of those statements just so that they can continue with the business of loving and caring for their child.  

So what do we do instead?  Well, every child is different but I can tell you what I did.  First, I looked at Lily with a fresh set of eyes.  Instead of looking and all of the things she couldn't do, I focused on the things that she could do.  While she had limited independent movement of her limbs, she could control the movement of her head.  I also learned from her family that she had definite likes and dislikes.  She loved hearing the voices of her family members and familiar caregivers.  She loved swing and rock.  She disliked cold sensations.  Using these few motivating activities, we were able to start building her ability to use a single switch placed near her head.  She was quickly able to learn to activate the switch to hear her sister recite poems and stories that we recorded on a simple communication device.  She was able to use her switch to request a push on the school's wheelchair swing when it stopped swinging.  From there, she was able to begin to use her simple communication device to call for attention during down time in the classroom.  The reward of getting someone to come over and pay attention to her or simply call out to her increased this behavior. She was eventually able to start to use partner assisted scanning to access more vocabulary.  

Instead of writing goals that Lily was already able to achieve or writing goals with low expectations, We were able to collect data and write meaningful goals that would move her forward.  Before her next IEP we measured how many times she used her device to make a comment during a classroom activity.  It was about 2 times on average.  We wrote a goal that given the use of a symbol based communication book and partner assisted scanning, she would independently make a comment 6 times during a classroom activity.  In order to achieve this goal, we modeled commenting using her system so that she would understand what to do.  We tried to incorporate sensory experiences and activities that were motivating for her into our lessons.  Did she meet her goal? No, she didn't.  She only averaged 5 comments per session by the end of the year but, despite not achieving her goal, she improved.  She was starting to use symbolic communication. She went from working on a goal where she didn't have to do anything to one where she did.  And, did anything bad happen as a result of us having slightly missed the mark on goal achievement? No!  Nothing bad happened.  We just reviewed our data, adjusted our goals for the following year and moved forward.

Not only did we feel good about Lily's progress, we stopped having that weird sinking feeling in the pit of our stomachs knowing that we had just written a bullsh-t goal.  There was another difference as well, Lily's mom started to listen to our progress report with interest rather than checking out like she normally did.  We were now writing goals that made sense, that she knew that Lily was likely to achieve.  She could see a slow and steady path ahead.  There was hope.