I am a pediatric speech-language pathologist. I’ve been an SLP for a day or two now. If I’m honest, it will be 25 years in August. I started my career in Upper East Tennessee, the heart of Appalachia and where my family originates.
I’ve worked all around the United States – from coast to coast. And, I’ve worked in a variety of settings. I’ve seen a lot over the years.
My mother was the one who opened my eyes to the privileged upbringing my parents were able to provide to my brother and me while we were growing up. She made sure we had experiences with people who were less fortunate than we were. She was the one who insisted that we were merely more fortunate than people who had less stuff, less security than us. My mother was the one who made sure that my brother and I understand that people who are low-income are people first.
Especially in the United States, people who are low-income are less secure. Especially right now. People are struggling. A year or two ago, a family of 5 living in a house that really should be condemned could have afforded to move. Not now. Rents for a 1 bedroom apartment are now more than double what this family is paying for rent. Luxuries like regular carpet cleaning or new furniture are long since gone. Yet, the kids are home more because there is no disposable income for summer camps or sports leagues or even a Y membership. Gas is over $5/gallon where I live right now. There’s no money to drive out of town a bit where it’s cooler. Oh yeah, it’s also summer. Where I am, summer cooling bills easily total $300-$400 a month for a family of 5.
I prefer to work with low-income families. So often, these families have their concerns dismissed because they’re low income. So often, they’re low income partly because they have children with developmental disorders. So often, the family is headed by a single mom whose husband/partner left when the child(ren) was(were) diagnosed. The families are so grateful for the help. They rarely miss appointments, even when phone numbers and other contact information change constantly. They never no show because they forgot about another child’s soccer game.
For the last year or so, I have agreed to supervise students from a new speech-language pathology graduate program in my area. Last summer’s students were a group of very diverse women who came from different backgrounds. Many of the women came from the communities I serve. Even when that wasn’t the case and one student in particular was out of her element, she stuck with it for the opportunity to learn.
The student I had in the spring this year was absolutely amazing as a clinician and a trooper as far as rolling with the changes inherent in contracting/home visiting.
This summer’s student was a different story. She made it 4 days before choosing to quit the assignment. Now, this student was not a 20-something young woman. She’s my age. Let me preface the rest of what I’m about to write with I think she had another agenda for this summer. She was assigned to me as one of the (hopefully last) school-based cohort. What I mean by that is she started working with her bachelor’s degree as a “speech-language therapist” with the local school district about 7 years ago. When students return to school for their Master’s degree, their attitude toward their clinical experiences usually fall into one of two categories. First, they recognize they really weren’t prepared to be in the position they were placed in and they are very open to learning. Or, they can fall in the second, where they are just getting their supervised hours and you don’t have anything to teach them. This student definitely fell into the second category despite her statements otherwise. That became readily apparent when we started seeing clients in their homes.
As students, we are required to earn 400 clock hours of supervised therapy time in addition to completing classes. 375 of those hours must be direct intervention with clients and at least 325 of them must be earned as a graduate student. It generally takes 2 years (5-6 semesters) of full-time graduate work to get the hours when there is not a pandemic. More hours and more varied experiences make you more attractive to employers when you graduate.
But, now that I’m thinking about it, the issues began before this student accompanied me to see clients. She only needed about 50 clock hours and she absolutely needed clock hours with adults. The first time this student and I spoke on the phone, she mentioned she to work for the local school district during their summer programs. She wanted to know if she could work with me 2 days a week so she could work the other 3. I explained that my schedule is not set up that way. I explained that because I see clients in their homes, my schedule is arranged to minimize driving, especially right now. That means the adult clients on my caseload are interspersed with pediatric clients, again to minimize driving as much as possible. (Families have been extremely understanding about that and amazingly flexible, by the way.) I told her honestly that different families were in different circumstances and that everyone was doing the best they could. No matter the neighborhood or income-level, different families live differently. I suggested that she wear easily washable clothes because we’d be on and off the floors and some houses were cleaner than others and to wear shoes that were easy to take off because some families prefer no shoes indoors. She made it a point to tell me about her experience with being both a parent advocate prior to working with the school district and her experiences filling in for the homebound school program (i.e., that she had experience doing home visits). Ok, great, so you know how different things can be from family to family.
Now, I wonder about her experiences.
The first day – the Tuesday after Memorial Day – was without issue. But, we were seeing kids in a more affluent area of town closer to where I live. The issues started on the second day. One of my adult clients has an interesting past that has immediate bearing on her current communication issues. She also lives in a shared housing situation. Everyone living in the house is an adult. There are no children present. The condition of the house can vary from visit to visit depending on factors I know about and some I suspect I don’t. But, there is always a place to sit and work, the lights and A/C are on, and there is running water. Last week, the living room where we were was in a state of disarray. I could see that some reorganization was going on because I’d been to the house before. Furniture had been moved and there were boxes and piles around the room. The client was a bit disorganized herself, an effect of her medical conditions. However, with some work on my part, we were able to work on addressing her goals. When we left this home, the student immediately started in with should we call someone? Did I think this client was safe on her own? Should I let someone know about the condition of the home? Yes, this client was safe; she was not on her own (at least 1 other roommate was present) and no, there was no need to call any authorities because of a messy living room (we had not gone into any other areas of the home). She then wanted to know if we should call someone to get a home health aid to assist the client. I told her that 1) the client’s stated goal was to be as independent as possible for a long as possible; 2) the client herself had already requested in-home help and was on a waiting list; and 3) asked the student who she would call for help for a 40-something year old client with a terminal illness on Medicaid. There are no resources beyond what the client herself had found already. I told the student I did not believe the client was a danger to herself or others and that there was no need to call APS or the police about the situation. Fast forward to the last client of the day that day. The 5 year old is seen at his grandmother’s house. The grandparents are doing some pretty major renovations to their home including new kitchen cabinets and countertops and new flooring throughout the home. So, yes, the house is ‘an obstacle course’ as the grandmother calls it. We saw the client in a room where the flooring was already finished. Yes, it was dusty. But, this was also the last client of the day. When we left the home, that was first time the student asked about bringing plastic to sit on in the homes. I laughed it off that time because we’d just left a house under renovation.
On Thursday, we saw the same 2 clients as Tuesday and a 3rd child the student had not yet met, a non-verbal almost 5 year old boy. A couple of months ago, this family thought they were going to lose their house. They were preparing to move, including putting things in storage. Then, they were able to stay in the home. Their son has life threatening cardiac issues they have been dealing with since his birth. He also was diagnosed with autism only a few months ago. He is functionally non-verbal and despite having had early intervention for his medical issues, no one ever mentioned the possibility of a pervasive developmental disorder to them until they contacted a home health provider for OT & speech services (that could be its own series of posts!) One the day of the visit, the family was clearly unpacking. It was a chaotic situation, admittedly. The dad usually stays with the provider to observe the session to learn. He doesn’t interfere, just watches and provides an extra pair of hands when it’s needed. Mom seems to be struggling with her son’s autism diagnosis along with the other stressors the family has in their lives right now. So, she doesn’t always stay in the same space with us while therapy is going on. She has been staying in her bedroom with the door open so she can listen. The student had a note pad and took copious notes during the session. She also began talking to dad about the client in the 3rd person with the client sitting right there. She began telling dad it would better for “him” (the client) if there were fewer things in “his” environment. As soon as we were back in the car, I began the discussion about 1) talking about the client in the 3rd person with the client sitting right there; and 2) talking to the family about things like their environment as a student and as a guest in their home. The student asked if I thought it would be appropriate to call CPS given the living conditions. I firmly stated, no I didn’t. The client is clean, well fed, well cared for, and clearly loved. I also told the student that the family was experiencing housing insecurity and it was not our place to judge how they organized their space. I told the student I was much more concerned about the client going to a general education kindergarten in the fall and that it was our place to educate the family on the special education process.
The next day was Friday. To work for the school district that morning, the student declined to participate in a teletherapy session with the pediatric client with long haul COVID. She joined me to see the family with the home under construction and the family whose son had just been diagnosed with autism. As we were coming back to my home (where her car was parked), she again brought up different families’ living conditions and bringing plastic to sit on because she was concerned about cleanliness. My response to the living conditions comments and questions were it wasn’t our place to judge how others live their lives as long as the lights and A/C are on, there is running water, and the family has food to eat. We have a responsibility to provide resources for those things if families ask. But, it absolutely is not our place to call CPS just because we wouldn’t or don’t have to live the way some families do. To the question about bringing plastic to sit on, I told her that if she could think of a way to bring plastic to sit on that would not interfere with my existing relationships with the families and/or create a barrier in her developing relationships with them, then we could discuss it further. When she left, we left on good terms and the last thing we discussed was the schedule for Monday.
Thank goodness the family of 5 who live in a house that should be condemned and an adult client who lives in Section 8 housing with the torn and stained carpet cancelled last week. I can only imagine what would have happened if she’d seen their homes. I want to state unequivocally that I have the utmost respect for both families. They are doing the best they can with the resources they have. Both families make sure to put down clean sheets on the furniture for visits because they know already.
This Monday, I got an email from the clinic director of the student’s program. The student had requested an immediate assignment to a different placement because she was not comfortable with the living conditions of some of the families. (When you were in grad school, how many of you had that option?)
My immediate reaction was a sense of relief and a weight lifting from my shoulders. Overall, that is still my reaction. It would have been a long 9-week summer semester. But, then I started thinking about it. First, I think her priority was working for the school district and my schedule didn’t accommodate that.
Secondly, from her questions and comments, I think her Karen-ism was showing. Her comments and questions definitely reflected her privilege and, quite frankly, her sense of entitlement. It concerns me greatly that she was so greatly offended by the conditions of families who are just trying to get by in today’s America. It concerns me greatly that she may be working with some of these families in the school district and not be able to understand the stressors that some of these families are under. It concerns me greatly that her immediate reaction to seeing the reality is to call APS or CPS rather than trying to more fully understand the entire situation. What I don’t think she realizes is many of the families I work with have had Karens like her call CPS or APS before. The families have been through the investigations and trauma caused by well-meaning, entitled women who don’t realize what it’s like to live with a person with substantial needs that aren’t covered by insurance or be housing insecure in this market or be food insecure or have the lights cut off for non-payment or not have a car or… It concerns me greatly that the student, like many Karens, thinks there are resources available to help the families I serve in today’s America and that these families’ issues can be solved with a phone call.
There is a sizeable part of me that thinks the student should have been forced to tough it out this summer. Maybe she would have lost some of her Karen-ism along with some of her assumptions. Oh well, at least the families and I don’t have to worry about CPS or APS complaints being filed now.
Part of me really wonders if the student mentioned my current ants in the kitchen problem to the clinic director. I kind of hope so, because then I would be in the same category as my clients. And, quite honestly, that’s where I want to be – just as human as them.
Outside The Box 