PRIVATE PRACTICE- TAKING A LEAP OF FAITH
By Kitty Griffin MSCD, CCC-SLP
Thinking about private practice? You could spend years writing a business plan or you take a leap of faith and get in there in the near future. Never once in my neatly laid out professional goals did the word private practice get written. My practice rose out of the ashes of a job loss. ( I should have called my practice the “Phoenix”!!!) Healthcare changed, and rehab jobs were eliminated or pared down to a point where it would be hard to support yourself, much less a family.
My kids were 5 years old when that job loss came and I was scared. I called my parents. I thought some sympathy might be in order. My mom (ever the fainting flower-NOT!) said “Are you any good?” I was taken off guard and didn’t answer. “Are you?” she pressed. “Then open your own office- just do that”. We went on other topics.
If nothing else, I am a woman of Faith. I called some local doctors, packed some toys in my old 65 Mustang and entered into home based treatment. Things went well and I learned about insurance, Medicaid and how to submit billing forms. I drove around MT with no phone- cell phones were not big yet! I then saw patients from a dedicated space in my home. I later rented space from our local hospital.
Nothing lasts forever, and the space in that area was needed for other functions. The hard choice was here: move to another space or buy something so I never had to move again. The day I came home and asked my low key husband Jeff :”Do you think we could use our house as collateral?” I held my breath. He said “You know what you are doing.” I never loved him more. We renovated a 2 bedroom house and State of the Heart Therapy moved into Taylor Drive. We have been in this location for 10 years now.
Everyone is different and I think every private practice is different, too. Just a few things to know:
- Try to grow slowly, many new businesses fail in the first 3-5 years due to the cost of doing business.
- You will work harder than anyone else you know, your life depends on it.
- Surround yourself with people to advise you, who are from different backgrounds in business. It could prevent costly mistakes. Jeff once said; “You are NOT doing that!!!” PS- he was right and I was crabby that he WAS right.
- Go for diversity in your caseload payors. A mix of contracts, clinic patients with insurance and with entitlement programs like Medicaid offer stability if the bottom falls out of one payor. Trust me, it is likely.
- ASHA has wonderful resources: asha.org and type in private practice!
- You will not be raking in the big bucks; the owner is paid last.
- This is the time to shine clinically. You will get referrals if you give more than is expected. It will cost you time and effort. And it will keep you in business.
- Take a leap of faith sometime soon. Maybe not in private practice, but somewhere: have Faith not fear.
You can reach Kitty on her mobile email email@example.com
Catherine “Kitty” Lebahn Griffin, M.C.S.D. CCC-SLP is a master’s level speech and language pathologist. Kitty has spent her career working with families in home based and clinic based treatment. She has worked across the nation including The Helen Beebe Center in PA and the Listen Center in CO. One of Kitty’s clinical specialties is working with families whose children have hearing loss. Kitty has worked for MSDB as a Family Advisor and is currently a DHH Outreach Consultant in SW MT. She is a certified Baby Signs® instructor.
Kitty is a former MT Speech Language and Hearing Association president and currently chairs the PR committee of that organization. (She likes to get the word out about services!) She also owns and operates her private practice, State of the Heart Therapy, Inc. in Dillon MT. Kitty’s most prestigious and rewarding assignment thus far is as mother to twins David and Elizabeth, who are studying at UM and making their Mom proud!
Conversational Skills: Teaching them can be Free!
Conversation Skills: Teaching Them Can Be Free!
Jennifer K. Schoffer Closson MS CCC-SLP
Teaching conversation skills is not something to be accomplished in two or three sessions. In fact, according to Spitzberg and Adams, the developers of The Conversational Skills Rating Scale, there are 25 skills that are required to be a conversationalist. In reality it could take two to three years to meet one’s conversational potential with intervention.
For a communicator that is daunted by conversation, The Conversational Skills Rating Scale will help identify areas of challenge. It is very subjective, however, SLPs are highly trained to make judgements about communication. It is also a little loose, but lends itself to follow-up observations and questions. For example, one of the items is “personal opinion expression (neither too passive nor aggressive).” If this item raised concern, the clinician may look deeper into flexibility, ability to respectfully disagree, personal space, tone, emotional regulation, etc.
Conversation skills are tough to teach. Every child with autism or related disorder is going to have a unique constellation of challenges with conversation. For this reason, I encourage SLPs to individualize their approach and implement evidence based practices (EBP).
The National Professional Development Center on Autism Spectrum Disorders (NPDCASD) http://autismpdc.fpg.unc.edu/evidence-based-practicesis my favorite resource for EBP. They have joined forces with The Ohio Center for Autism and Low Incidence (OCALI)http://www.autisminternetmodules.org/ and this is my favorite training resource for when it is needed now. These two resources are user friendly and reveal what really works.
Some of my go-to EBPs are great for teaching conversation skills:
Social Narratives: Social narratives describe the expected behavior clearly. They tell the learner what the setting looks like and how to respond. The nice thing about Social Narratives is that they can be shared with teachers, parents, and other support personnel for generalization of skill. This allows the stakeholders to have common language, common expectations, and a tool to pre-teach a skill to support social success. The NPDCASD and OCALI (the two sites above) will support you in learning how to develop social narratives. My favorite person to consult is Carol Gray.http://carolgraysocialstories.com/social-stories/
Video Models: Video models provide expected behaviors for the learner to emulate. These videos can be purchased or be made quickly on a smart phone by using the learner, an actor, or the point of view of the learner. One of my favorite tools for purchase is Fitting In and Having Fun. Here is a video they produced about Taking Turns Speaking. https://www.youtube.com/watch?v=3RjRZ9jMfs0The reason why I like these videos is that they share the perspective of the participants. They show the old way and the new way and provide social narrative at the end. But, for those of us that have a budget of $0, go ahead and make your own. Here is one about Making Plans. If you are curious about the point of view video “Petting the Dog” is an example.https://www.youtube.com/watch?v=ieM8GHE6RLk
Scripting: Scripting is quite useful for skills related to employment or independent living. A script can be faded as the communicator becomes more competent. Here is a script that would be affixed to a pouch for ordering food (fill in the blanks with dry erase marker):
Hi, I would like ____________________________ please.
Here is my money. Inside you will find ____________ dollars.
Please put my change and receipt in the pouch. Thank-you.
Teaching conversation skills is hard. Sometimes we don’t know where to start or how to teach a skill. Using The Conversation Skills Rating Scale can provide a guide or a starting point. Implementing evidence based practices ensures that you are using researched methods of intervention. Generalization can be supported by sharing social narratives, video models, scripts, and other materials with stakeholders. Working as a team, individualizing instruction, and using EBP will likely help your client develop his or her conversation skills.
MSHA Monday-Summertime Teletherapy Update
Diane Simpson and Rachel Stansberry offered another webinar on “Getting Started in Montana Telepractice” on June 27, 2017. Diane and Rachel have been offering these two-hour webinars several times each year to help MSHA members add telepractice to their service delivery models. Telepractice offers us a chance to reach areas in our state that are not receiving speech therapy and audiology service and Diane and Rachel are committed to getting services to these areas.
Each webinar contains four parts. First, they discuss the Montana telepractice Law and the Rules and Regulations governing telepractice in Montana. Next, they cover the expectations of privacy for HIPAA and FERPA compliance. The third part deals with the equipment, platforms and physical needs to provide telepractice and they conclude with web-based resources, both for therapy sessions and for getting additional training. Diane and Rachel will continue to offer these webinars as long as there is interest. They will are also planning to present a poster on telepractice during MSHA’s fall convention in Missoula
MSHA will host another webinar on Telepractice on September 19. This one will be taught by Tracy Sippl. Tracy is a telepractioner who offers a variety of services to telepractioners. She has a course through ASHA and she does individual consultations. Rachel recently consulted with Tracy to get more ideas for online therapy materials to share. “Tracy was a great help and shared techniques to help me better utilize my teleconferencing platform and she gave me a list of online activities I could use in therapy,” Rachel reported, “and all for a reasonable price”. You can check out her site and blog here. Watch the MSHA Facebook page for more information on the September 19, 2017, webinar.
Her latest Blog was on e-helpers.
ASHA also sent this information on Sig 18 that I thought was worth sharing.
“Advocacy State-by-State pages have had a new edition – Telepractice/Telesupervision! This has been a big initiative to track the laws and regulations specific to telepractice to assist members in their endeavors to provide appropriate services within the confines of the law. Go to the Advocacy Tab, Click on State-by-State then select the state you would like to research. Telepractice is listed as one of the subsections. http://www.asha.org/advocacy/state/ Contact Cheris Frailey with questions at firstname.lastname@example.org. ”
Are you looking for ways to incorporate more authentic materials into your current telepractice? ASHA has a recorded webinar and has a lot of good ideas for making your own materials as well great tips for managing technology and using web based resources.
If you’d like to be listed as a telepractioner on this website, be informed of the next webinar, or receive periodic emails about telepractice resources, contact Rachel at email@example.com or Diane at firstname.lastname@example.org
MSHA Monday: Speech Therapy and Sensory
Hello MSHA Members!
I am slightly shocked over the cooler weather we’ve been experiencing as summer approaches. This is my last week of ESY, and I wanted to reflect on some career changing ideas in regards to speech and the importance of understanding and incorporating sensory needs. If you have worked with a student or adult that needs information presented in a more kinesthetic or tactile fashion, you may be able to relate to some of the ideas and activities I’ve used this year!
This year my fellow OTs showed a video about the “Sensory Funnel” (https://www.aspergerexperts.com). CAREER CHANGING. I was hooked immediately from listening to these guys explain how targeting executive function and social skills are the last skills to target (SLPs will say ‘WHAT?’). They introduce a hierarchy to work on social and executive function skills with bringing our focus to the foundation deficits before targeting the more metacognitive skills. I full-heartedly see the benefit of targeting learner’s sensory, emotional, and awareness skills before getting to social and executive function skills. Take a moment and listen to their explanation and please comment on your own ideas!
With taking this information into consideration, I made my New Year’s Resolution for my work to be “More Fun”. How many of you sometimes get into that rut and do the same games/activities? Taking the Sensory Funnel, previous pool-based speech therapy training, and participating in the SLP Summit’s training, I started by searching in my basement for plastic containers, rice, beans, pasta, and straws. I made my first sensory box! I am going to reflect on the best ideas when using sensory boxes and check out http://www.thedabblingspeechie.com/sensory-bins-speech-therapy/ and https://slpnataliesnyders.blogspot.com/2017/01/how-to-make-sensory-bins-for-speech.html. I am sure there are many other posts about sensory boxes in speech, so make sure to do a Google search!
- VISUALS. Have a visual for pre-teaching the fundamental use of the sensory box! I have each of my learners use hand sanitizer and review the rules of the sensory box before using it. Every student, even the ones who will buck directions, will follow and use hand sanitizer!
- MATERIALS. Use what you have! You can use those articulation cards or make fun ones from different TPT store creators! I found a great box of objects on Amazon that were organized by speech sounds in the initial, medial, and final position. Etsy had miniature objects for I Spy and these have been a great hit this summer for ESY. How many of you are vying for tangible objects after using the iPad so often?!
- PLAY. My favorite use for the sensory box! I find creating play based activities in the box provides significantly more opportunity for language! I used my rice and glass gems to create land and water and then sorted water versus land based animals. Then we increased the complexity by making decisions of wild versus zoo animals and made a zoo in the rice. I had the opportunity to use spelling goals, math goals, and speech goals within this one activity! PLUS my student, who usually gives the aide a difficult time to work on adult directed activities, followed EVERY direction. It was the most positive session with teaching opportunities and conversation!
Go for it, try it, and tell us what you think about using sensory boxes! I use these with pre-schoolers up to high schooler depending on their needs. Go for a hike this summer and collect! This does not need to be a pricey addition to your daily practice, but is a possible one!
MSHA Monday: June Update from the MSHA Board
I hope that you are all having a great start to your summer! The weather has finally turned warmer here in Missoula and the days have been lovely lately! Even with the great weather, the Board has been hard at work. Here’s a brief update:
The Board met on Saturday for 3/4 day session. We reviewed our strategic plan and our awesome organization has already met many of the action items outlined last summer! We will be outlining new goals and targets in the near future. If you have something you’d like to accomplish as an organization, please send me your ideas!
We spent a good deal time talking with our lobbyist, Abigail St. Lawrence, about happenings in the legislature. As you may have heard MSHA was successful in getting a bill passed regarding limited licensure (HB 347). Basically, this bill revises the current language of “temporary license”. To that end, there will be a rule change from the licensure board. If you have input or wish to participate, there will be a public hearing on the issue and suggested rule changes on June 20th at 9:00AM in Helena (Small Conference Room, 301 South Park Avenue, 4th floor, Helena). You may also send suggestions and information to any MSHA Board member prior to that date as we will have representation at the hearing.
The issue regarding reduction of licensure fees has not been forgotten. According to the licensure board, the issue is still being discussed as it relates to State budget. A final determination has not yet been made.
There will be a new CE opportunity upcoming. Rachel Stansberry and Diane Simpson are offering a webinar on tele practice on June 27th 5:30-7:30 PM. Contact Rachel for registration information (you can also find it on the MSHA website and Facebook page!).
The Board discussed other ways for our members to receive CE credits, including activity with our special interest groups and teleconferencing of meetings, etc. As soon as this is finalized I will update you!
The schedule for the MSHA Fall Convention is very nearly completed and the finalized schedule will be posted on the website, Facebook, and sent out via email and the Communicator by the end of the month. This convention will have a very different look and there will be many more opportunities for various topics and interactions! The convention committee is really excited about brining this new format to you and hope you enjoy it.
We still have one opening for a representative in Region 5 (Missoula, Ravalli, Lincoln, Flathead, Sanders, Lake and Mineral Counties). If you and/or a buddy are interested please let me know!
Whew! I think that is all I have for now. Again, I hope that you are all doing well and that you are preparing for an awesome summer! If you need anything from the Board, please feel free to reach out to us!!
MSHA Monday: We’ll be posting a blog each Monday…stay tuned.
This summer, MSHA plans to post a blog every Monday. Our goal is to share and compile information that will be useful to your practice. If you’d like to guest blog on any therapy topic, let us know. Our schedule for June is June 5-Books for Therapy, June 12 Board Update, June 19-Sensory Boxes and June 26 Implementing AAC.
“If you know me, you know I love stories. I read stories, I listen to podcasts that tell stories and I use stories in therapy to work on every aspect of language. Each year I add to my list of stories that are good for developing specific skills. While I have favorites for working on pronouns and past tense verbs, I thought I’d offer a list of books that I use most frequently for narrative and expository development. I’m a big fan of the Story Grammar Marker. I use it to help me to focus on specific stages of narrative development. The icons really help build memory for the key story components and kids love to hold the actual story braid. If you aren’t familiar with this tool, check out this site. https://mindwingconcepts.com/ I’m a random abstract person, so these are in no particular order
- Waiting is Not Easy by Mo Willems. Well, really anything by Mo Willems is great because the story elements of character and setting are so obvious that it is then easy to teach the temporal sequence and/or perspective taking. Elephant and Piggie have so many great adventures and their emotions are easy to read. I try to use at least one a month. If you haven’t discovered these books, do it. Right now.
- High Wire Henry by Mary Calhoun. Henry is another go to character for me and I use at least one of his stories each school year. He typically has one problem in each book and this offers a great opportunity to teach the critical thinking triangle for the kick off, emotional response and plan that then leads him through the temporal sequence to a solution. There is also opportunity for a two person perspective between Henry and The Man of the family. Enjoy.
- Titch by Pat Hutchins. The original Titch is great for character and setting. Once again, the pictures support the elements of the story. The subsequent stories, Titch and Daisy, You’ll Soon Grow into them Titch and Tidy Titch, offer a complete episode that is simple enough for my kindergartens to retell.
- For those students who are into non fiction, these books by Gail Gibbons are perfect. They can be read and discussed in a twenty minute session and they offer great practice for expository structures. This one is good for a List as well as Problem/Solution. There are also books about Hurricanes, Sea Turtles, The Moon, Frogs, From Seed to Plant and the Reason for Seasons.
- Finally, for the past three years, I’ve been using more classic comic books. Calvin and Hobbes are great for teaching emotional vocabulary, critical thinking triangle and problem/solution. After seeing the movie, Life Animated, I am even more committed to using a child’s interests to teach what he/she needs to learn. I have one student with ASD who has taught me how to make this happen with this book in particular.
Our first Summer Blog is from Rachel Stansberry. Rachel works as an SLP in rural schools in Central Montana. She is a past MSHA board member and a current member of the licensure board. If you have books you love, write them up. We’ll post your list along with this one. Email it to MSHA’s web manager, Emily at email@example.com
Summertime and the living is easy!
For many MSHA members, schools out for summer! Whether you’re playing or working, we hope you’ll stay connected with MSHA on facebook, pinterest and on this website. Our plan is to post something relevant each Monday. If you’d like to guest Blog to share what you’re doing, let us know.
Here’s a link for summer calendars:
Here’s a list of some upcoming CEU opportunities in our state. Check with MSHA to see what is MSHA/ASHA sponsored:
PECS Level 1 Training, June 12-13 in Billlings
Hanen Presentation; Building Communication, Supporting Parents of Preschoolers with ASD or Social Communication Difficulties June 22 Billings. Registration info 406-281-5885
Hanen More than Words June 23-25 Billings-get info through MAEP
Congratulations 2017 Graduates!
Congratulations U of M 2017 Graduates! Best of luck!
BSHM: Why Should I Be A MSHA Member?
May is a busy time of year for SLPs and AUDs with Better Speech and Hearing Month! This year not only do we want to support you with BSHM, if you join MSHA in May 2017 you will receive a $25 discount on your membership fee and on conference registration. Members who are apart of MSHA already are in a drawing to be held in May. This in turn will save you money on all in-service and conference registrations. Please go to Join MSHA Today!
Congratulations! Jennifer Pierce is the winner of the 2018 free MSHA Membership!
Read Better Speech and Hearing Month Letter from MSHA Board and join in May 2017!
In addition, you’ll have access to people and information:
*MSHA is on the cutting edge of current events.
*MSHA serves as a clearing house for distribution of information.
*MSHA enjoys affiliations with other organizations.
*MSHA members promote optimum services for the communicatively impaired.
*MSHA promotes cooperation among persons dealing with communication disorders as exemplified
in educational, clinical, rehabilitative and industrial settings in the state.
*MSHA stimulates the exchange and dissemination of information pertaining to Speech-Language
Pathology and Audiology.
*MSHA encourages a better understanding of, and a deeper interest in, persons with speech,
language and/or hearing disorders by professionals in related disciplines and by the general public.
*MSHA advocates for the rights of persons with communication disorders.
*MSHA members can provide input about local needs to university programs.
*MSHA has a proactive lobbyist who helps members understand legislation and advocates for the
profession and our clients. We held a MSHA meet and greet event with U of M students and legislators
in 2017. MSHA has increasing name recognition in Montana.
*MSHA Legislative committee followed over 20 bills this session and provided input and testimony!
*MSHA collaborated with the MT Licensure Board to introduce a legislative bill during the 2017
Legislative session. The bill was sponsored by Rep. Jones, passed and signed by Gov. Bullock and
creates a CFY license in statute.
*MSHA representatives attend all MT Licensure board meetings and provide comment and feedback
during each meeting. Changes to MT Licensure Board exam, CEUs required, and requesting fee
reductions are amongst MSHA–critical issues addressed.
YOU WILL HAVE OPPORTUNITIES FOR PROFESSIONAL DEVELOPMENT:
*MSHA members receive reduced registration fees for MSHA sponsored events and ASHA CEUs..
*MSHA coordinates the annual Fall Conference, local inservices, web based conferences and MSHA
sponsored CEUs throughout the year.
*MSHA stimulates the exchange and dissemination of information pertaining to Speech-Language
Pathology and Audiology.
*MSHA encourages a better understanding of, and a deeper interest in, persons with speech, language and/or
hearing disorders by professionals in related disciplines and by the general public.
*MSHA promotes the highest professional standards and ethical practices.
*MSHA Regional networking activities will be announced in your region soon!
THE PERKS ARE GREAT!
*MSHA membership provides an opportunity to give back/contribute to the profession.
*We have a super newsletter, The Communicator!
*We are on facebook with monthly themes and daily updates.
*We also have a great web site, www. mshaonline.org.
*MSHA Board positions offer great opportunities to develop your leadership skills.
*MSHA conferences have a great silent auction to raise scholarship monies.
*MSHA raises money for the Community Outreach Program which can help your client (as a MSHA Member)!
*MSHA conference attendees have a chance to win super door prizes.
Autism Awareness Month is Here!
MSHA is dedicated to supporting professionals and families with Autism Awareness Month.
We have collected some up and coming things happening during April to commemorate Autism Awareness Month! Check it out below!
FUNctional Autism Activities Week
April 3-6 @8pm EST Webinar Series: http://speech-time-fun.thinkific.com/courses/functional-autism-activities-week
April 10th and 12th: Words for Life https://www.prentrom.com/education/classes?type=master_the_technology&method=online&page=1
Proloquo2Go 50% off!
LAMP Words for Life 50% off!
Sesame Street’s New Muppet: Julia
Check out these resources:
Autism Navigator http://www.autismnavigator.com/
Autism Society http://www.autism-society.org/
Autism Speaks https://www.autismspeaks.org/
Dyan from And Next Comes L http://www.andnextcomesl.com/
The Autism Helper http://www.autismhelper.com