Permanent Referral Link to the OTB Boom Cards Store

Image courtesy of Pixabay.com

I now have a permanent referral link for the OTB Boom Cards Store. To access the store directly, please click here.

I am in the process of including the appropriate Common Core State Standards for each deck. If you need to reference this information, please scroll down to the bottom of the Details section and they will be listed there. Please be patient with me as I update the information for the existing decks. It will be included with all new decks.

Thank you for your continued interest in my work!

Happy Earth Day 2023

Image courtesy of nohaggerty on Pixabay.com

Take a moment today to give thanks to this amazing planet we call home and which has given us everything we need to survive.

Take a moment, too, to reflect how you can tread more lightly on her surface.

  • Can you avoid using plastic today?
  • Can you reuse or recycle something instead of buying new?
  • Can make that trip by walking or riding a bike instead of driving a car?
  • How can you use less water today?

If you ask yourself these questions every day (instead of just today), how much lighter do you think your footprints on the Earth’s surface will be in a year from now? In 5 years from now?

We all have a responsibility to care for the Earth which nourishes us. We all have a responsibility to leave her healthier than we found her.

How Not to be a “Karen” SLP – Part 8 Remember, You’re In Your Client’s Home!

Image courtesy of OpenClipart-Vectors on Pixabay.com

Today’s post is courtesy of an off-hand comment made by a parent late last week.

Honestly, I have to just shake my head sometimes at some people I’m supposed to call my colleagues.

At the request of the parent and the COTA (with whom I have an amazing working relationship), I recently was asked to take over case management of a 7-year-old child with CCN. The specifics aren’t really important in this case – just that this child is seen at home, has a trach and a feeding tube, is non-verbal, and does not currently have homebound school services (the lack of services not provided by the local school district is worthy of several posts on its own!). The family considers therapy to be the child’s educational services, although that is changing with some dogged determination from the COTA and now from me. The child himself is quirky and funny and has some remarkable knowledge of the world despite his lack of access to formal schooling and his medical issues which tend to keep him at home. The family is blended culturally. Mom is ethnically and culturally from another country and English is her second language. Dad is the rare native of the area where I live. The kids are being raised mainstream culture.

I’ve only been working with this family for a couple of months. I know more from the COTA than from mom about the relationship both had with the previous SLP. And, all I knew from the COTA is that mom and the SLP didn’t see eye to eye.

That’s not an issue in and of itself. It happens. We don’t get along with everyone we meet in life and the clients and families we support are no different. If that was where it stopped, then no harm, no foul. As it happens, I’m currently working to have an adult client reassigned or discharged myself mostly because of their unrealistic expectations for change and also because they are very open about some of their beliefs which are in complete opposition to mine.

But, mom let something slip late last week that concerns me greatly. Keep in mind this particular client is seen at home because of his medically fragile status. Mom reported the previous SLP told her (mom) that she (SLP) couldn’t work with parents in the therapy space.

So, wait? What? You can’t work with parents in the therapy space which happens to be a bedroom in their family home?

My first thought is, seriously??!! What an entitled comment! My second thought is then you probably shouldn’t be working in home health. Go find yourself a clinic- or school-based position where you’ll have your own defined therapy space. And then, you’ll probably complain that parents or caregivers are never involved.

Unfortunately, knowing the SLP, I believe what mom told me. There have been a few instances like this with this particular SLP. She has come across to me as very Karen-like in my interactions with her.

One of the huge advantages to home health is you get to work with your clients/patients in their family home. You know, where you can see what your client needs in their usual environment. Where you can provide suggestions and supports specifically tailored to the person’s environment.

Not to mention that the family has welcomed you into their home.

I would love to ask this clinician how she’d feel if someone said the same thing to her. What the SLP said was this: sorry, but you’re not allowed to watch me work with your loved one in your own home. I think my answer would be exactly what the family’s and the COTA’s answer was: time to find another clinician.

I also can’t help but think this SLP would never have said what she said if she weren’t white. I’m not sure that anyone else would feel entitled enough to make such a blanket statement to someone else in their own home.

I’m not saying there are good reasons for asking to work with a client one-on-one. There are. I’ve asked for the opportunity to work through issues in a one-on-one setting, including within the family’s home. I’ve asked either in the moment or during a conversation if it would be OK if I could have a little space and time to get through an issue (usually behavioral). But, I’ve never made a blanket statement that parents weren’t welcome in the therapy space. In fact, I go out of my way to tell parents, nurses, and other caregivers they’re welcome to join in our session any time they like. I want people to know what I do in therapy isn’t magic and, yes, they can do it, too.

As always, thank you for taking the time to read my post. I look forward to your questions and comments!

Cotreating with Other Allied Health Disciplines

Image by Antranias on Pixabay.com

Last weekend, I celebrated Easter Sunday by joining a friend from work on a mountain bike trail ride with her family.

I’m new to mountain biking and am definitely still learning. Her husband is semi-pro in the sport and their young son is definitely taking after him. She, like me, is relatively new to mountain biking and I think we both appreciated having someone else along at the same skill level. We both grew up riding road bikes which is very different from riding a biking over rocks, roots, and flora. In fact, I’m going to take the latest steed in my stable (a dedicated road bike I call Circe) out for about 20 miles after I finish this post.

She’s a certified occupational therapy assistant or COTA. I didn’t know she was a COTA at first. She thinks like me – outside of the box. We share several clients and cotreat when it’s best for the client. I know she’ll support what I’m trying to do with a client when I’m not there. I’ve learned a lot from her about helping kids use their hands differently and more efficiently. I’ve learned a lot about how to help kids (or not!) in activities of daily living when she’s not there. When we cotreat, it’s seamless for the client even though we haven’t planned anything in advance.

It’s a really good working relationship.

So, of course, we talked a little shop. It’s inevitable, I suppose. I learned that there really isn’t much financial incentive for COTAs to become OTs now, especially since everything is moving toward the Doctor of Occupational Therapy degree. She said it was only a couple of dollars per hour difference. Definitely not enough to offset the cost of going back to school for three or four more years. She gets to do the fun parts of the job without having to deal with the administrative parts of the job. I understand the appeal.

She mentioned that she’s frustrated by other OTs and COTAs practice strictly by the book and who don’t take practical needs into consideration. She mentioned that she’s frustrated by families who won’t follow through with suggestions and recommendations.

I completely understand and sympathize with her frustrations. I have the same ones.

I’ve been thinking a lot about this topic for a while now (as you can see by my posts). And, I’ve been thinking about our conversation on Easter Sunday.

Because to change things requires a change in thinking.

That’s a hard thing to do. You can provide continuing education on topics and research and intervention techniques. It’s a lot harder to “train” a shift in attitudes and connectedness.

But, I think I just had an epiphany which I’m going to type here before I lose it!

My colleague, Dr. Rihana Mason, and I recently (like last week) submitted a proposal to introduce new approaches in administrative-level DEI trainings as well as a way for individual practitioners to consider how they interact with families from CLD backgrounds. Hopefully, we’ll introduce the clinician and administrator approaches at this year’s ASHA Convention in November. We also wrote two book chapters on this exact subject and the book should be in print in time for the ASHA Convention.

It just occurred to me that maybe we’ve been too focused on simply trying to change the minds and attitudes of administrators and clinicians that we’ve forgotten to find out what our clients think about the therapy process, our roles and responsibilities, and – importantly – their roles and responsibilities.

I think I’m going to go on my ride now and have a think on this a bit more….

As always, thank you for reading and I look forward to any comments or suggestions you have!

I Stand with the Tennessee Three

Image courtesy of Clker-Free-Vector-Images on Pixabay.com

If you’ve spent time on this blog, you’ll know I’m an advocate and ally of all people from culturally and linguistically diverse backgrounds. I find myself writing this post because I’m dedicated to a more just, equitable, and beneficial world for everyone. I find myself writing this post because I’m both appalled and incredibly hopeful given what took place in the Tennessee Assembly yesterday.

The three stars in the state flag of Tennessee represent the three “states” of Tennessee – East Tennessee (Knoxville and points east), Middle Tennessee (Nashville area), and West Tennessee (Memphis area). It’s very long state geographically which covers two times zones. It takes 10 hours or so to drive from Knoxville to Memphis even on the interstate. The urban areas of Tennessee tend to be relatively progressive. The rural areas tend to be very conservative and in some areas, still very racist.

Tennessee is my home state. I was born in Knoxville as my dad was preparing to start a Ph.D. program in audiology at the University of Tennessee, Knoxville. My dad was born in Nashville and grew up outside of Memphis in Germantown. Before he was blinded in an accident installing one of the first TV stations in Memphis, my granddad used to be an audio engineer for the live broadcasts from the Grand Ol’ Opry. My mom was born in Murfreesboro and grew up in downtown Nashville, within walking distance of the Grand Ol’ Opry. My parents met when they were both students at UT.

One grandmother’s first cousin was Lester Flatt – the Flatt in the banjo duo Flatt & Scruggs. On the other side of the family, I’m related to Alvin York.

While I no longer live there, my Tennessee roots run deep.

Lester Flatt and Alvin York are part of the story the state of Tennessee wants you to know.

But, Tennessee has a dark and ugly history with race. There is no denying that. And, we need to talk about it.

Tennessee is the birthplace of the KKK. Tennessee seceded from the United States during the Civil War. Martin Luther King, Jr. was assassinated in Memphis. (My parents, newly married at the time, lived very close to the Lorraine Hotel on April 4, 1968.)

After I graduated from UT myself with my Master’s degree in Speech Pathology, I went to work at the now defunct Greene Valley Developmental Center in Greeneville, Tennessee. Greeneville is named after Nathaniel Greene who was one of George Washington’s most trusted officers during the Revolutionary War. However, when I lived in Greene County in the late 1990s, it was a “sundown” area. I saw the signs posted at the county lines myself.

I learned yesterday that the state of Tennessee used census data from 1901 until they were forced to stop by the federal government in the 1960s. They used the old data so they would not have to reproportion districts to include more Black citizens in districts. It only stopped when the Voting Rights Act was enacted in the 1960s.

If my mom’s mother were alive today, she would live in the district represented by Justin Jones. My grandmother was a daughter of the Depression and a lifelong Democrat. She was a Democrat because the Democrats brought electricity and clean water and relief from the Depression when she was a girl. My grandmother was a deeply religious woman and believed in helping your neighbor by giving the shirt off your back if they needed it and it was all you had to give.

I can’t help but wonder what she would have thought about the events in the Tennessee State House yesterday.

If I were still living in Knoxville, I would live in Gloria Johnson’s district.

Last week, Justin Jones, Justin Pearson, and Gloria Johnson (who survived a school shooting as a teacher) were three Democratic representatives in the Tennessee Assembly. They were duly elected by their constituents in November, 2022. On Thursday, March 30, 2023, they joined their constituents in protesting the most recent school mass shooting which happened in Nashville just days before. They asked for time to speak about gun violence on the Assembly floor and were denied by the Republican speaker, Cameron Sexton. In fact, their mics were cut off on the floor. So, the Tennessee Three got a bullhorn and protested with their constituents who were present.

The Tennessee Highway Patrol (responsible for security at the state capitol) stated the protests were peaceful. Not one person was arrested.

But the Republicans, in an abuse of their supermajority in the body, passed motions to expel the two young, Black men who represented parts of Memphis and Nashville and the white woman who represents parts of Knoxville. The votes were held yesterday. By votes of 75-25, Justin Jones and Justin Pearson were expelled. By a vote of 65-30, Gloria Johnson was able to hold onto her seat by a single vote. When asked why she thought she’d survived the expulsion vote, Rep. Johnson honestly replied she thought it was because the color of her skin. This morning, she has acknowledged she was treated very differently from both Justin Jones and Justin Pearson.

The world got a glimpse of the systemic racism still very much present in the southeastern United States in the way the old, white, male Republican Assembly members talked to Justin Pearson and Justin Jones. The racist, fascist white men stopped just short of saying, “boy.” You could hear it in the way they talked to their Democratic colleagues. The two 27-year old Black men responded with courage and grace their Republican colleagues can only dream about. In their quest for supremacy, the white men who are temporarily in control overreached. The world is no longer 1863 or 1953 or even 1963. It’s 2023.

We do not have to put up with what we witnessed yesterday. In this country, founded on a protest, we the people have the right to peacefully assembly and petition our government for redress of grievances. These rights are guaranteed to us in the First Amendment to the US Constitution.

I am so proud of my fellow Tennesseans who showed up to peacefully assemble for their right to go to school without being shot. I am so proud of my fellow Tennesseans who protested – loudly – throughout the day yesterday at the treatment of the Tennessee Three. It gives me hope that, while yesterday may have been a setback, that ultimately the world will be a more just, equitable, and beneficial place for everyone.

I want to say thank you to Justin Jones, Justin Pearson, and Rep. Gloria Johnson for their bravery and their grace. Thank you for standing up for what you believe in. Thank you for standing up for your constituents. Thank you for standing up to end gun violence.

I stand with the Tennessee Three.

Happy Opening Day 2023

Image courtesy of cindydangerjones on Pixabay.com

For all those who celebrate (or knows someone who celebrates), today is Opening Day 2023 in Major League Baseball.

I’m an A’s fan. I appreciate the outside the box thinking of Moneyball, even if it can take a while to take shape. Baseball is a marathon, not a sprint and Opening Day is the beginning of the marathon. Every team starts with the same record. Today, every team has the same chance to go to the World Series in October. Hope springs eternal, today especially.

Did I mention I’m an A’s fan? All too soon, I’ll have to face the reality of a very young team of players who will likely be big stars somewhere else in a few years. But, today, I’m going to enjoy watching how well the A’s players match up against Ohtani and try to see just what A’s management sees in our young left-hander, Muller.

Happy Opening Day 2023 everyone!

How Not to Be a “Karen” Nurse

Image courtesy of Prawny on Pixabay.com

Sometimes, I wonder if people would interact differently with me if they knew I had: 1) a long-standing interest in making therapy more just, equitable, and beneficial for everyone; and 2) an active blog where I document incidents like the one last week.

I recently took over the case management of a 4 year old client with complex needs. She’s growing up in a primarily Spanish speaking household with the exception of all of us healthcare providers who are native English speakers. I took over this child’s case because the management of her care was a little too complex for the new grad who took over for someone else. And, because of the nurse.

This nurse is a “Karen” by every definition. And, like many “Karens”, it was the video she insisted would prove her right that was her undoing. She is very, very lucky she is assigned to this particular family and that the mom recognizes she is very skilled at the nursing tasks. Because, I think she should have been fired for what she did.

I knew from the new grad clinician that this nurse could be very challenging and would actively seek to sabotage therapy sessions. I knew that things had gotten to the point where the new grad clinician asked that the nurse not be present in the room for therapy sessions. I knew all of this before I saw the client for the first time in early February this year.

I should point out here that the client is a preschool-age child with a trachestomy, has a g-tube for nutrition and hydration (refuses to eat by mouth), is non-verbal and non-ambulatory, and lacks any symbolic communication system. On top of all of her medical issues, she is undergoing evaluation for autism.

During the first session, the nurse spoke to me at least. Her attitude was quite frankly pretty terrible, telling me that she did not know why the mother bothered to bring us in. She was very challenging and patronizing, stating, “Go ahead. Try putting anything in her mouth. I want to see it. This is entertaining.” She sat back and crossed her arms over her chest. The client was resistive to having anything near her mouth – a not uncommon issue with kids who have had feeding tubes placed when they were infants. I asked about the possibility of trying to work with oral care rather than feeding to work past some of the client’s oral aversions. I got the same reaction from the nurse. Her attitude was basically, “whatever you try with the client will be entertaining for me.”

A pretty poor attitude toward your patient, if you ask me.

A different nurse was present during my next session with the client. The client was visibly tired and did not want the nurse to leave her side. So, the nurse sat on the floor with us as I tried to engage the client. I talked with this nurse about her observations of the patient and asked for her suggestions as far as getting past the client’s oral aversions. This nurse was very insightful and helpful. After about 20 minutes, the client fell asleep and could not be roused. It happens sometimes with clients with complex needs.

At my next visit, the regular “Karen” nurse was back on shift. I was talking with the client’s mom about how the last two sessions had gone and was talking with her about what she wanted for her daughter. The Karen nurse came out of the client’s bedroom and launched into a tirade about, “I heard you and [the other nurse] let her sleep. She’s not allowed to sleep.” When I tried to explain that wasn’t the situation at all, the nurse continued to interrupt me, stating she was the other nurse’s “supervisor” and she would tell her the client wasn’t allowed to sleep during the day. Keep in mind, this is a 4 year old with complex medical and communication needs the nurse was discussing. At the end of that session, the client’s mom walked me out to my car and said she didn’t like the way the nurse had talked to me. She said she would address the situation with the nurse.

The very next session, the Karen nurse did not open the door until 5 minutes after the session start time. She refused to look at or to speak to me. The tension simply roiled off her. I made sure to speak to her pleasantly and then to basically ignore her for the duration of my session. Per my discussion with the client’s mother, I had the client sit at a child sized table and chair in her room for feeding therapy. In addition to severe oral aversions, the client had developed an aversion to the high chair the previous clinician used for feeding therapy. The client’s mom was fully supportive of my taking a different approach to feeding therapy as well as my taking a different approach to helping her daughter develop a symbolic communication system.

This situation continued for the last few weeks, with the nurse only opening the door on time if the client’s mom was home, refusing to speak to me when I spoke to her, and sitting in my sessions while brooding and scowling from her chair in the corner. The family installed an in-room video camera during this time. I was able to establish solid rapport with the client who began to make eye contact and reach toward me when I entered the room. She was beginning to access a light tech SGD AAC device to request more of preferred activities. She was beginning to tell me “I’m all done” or “stop” with the device rather than physically protest when she’d had enough of feeding therapy, requests which I immediately honored. The client’s mom showed me clips of my sessions with the client and told me how happy she was to see her daughter smile and participate in therapy sessions without crying.

Fast forward to last Tuesday. The client’s mom wasn’t home. I ‘cop knocked’ on the door when I arrived at the set appointment time. I waited five minutes and ‘cop knocked’ again. I waited a couple more minutes, then texted the client’s mom. She immediately called me back, then texted the nurse who said she’d been in the bathroom. The nurse finally granted me access to the home and the client 13 minutes after the start of my scheduled appointment time. I said, “Hi, how are you?” to her as I always did, knowing I would be met with a frosty silence and intentional avoidance of eye contact. As I took my shoes off and got ready to walk down the hall, the nurse said in a very nasty tone of voice, “You need to use the high chair if you’re going to do feeding. If you’re not going to use it, then you’re not doing any feeding today. Mom said so.”

This was clearly a lie, so I asked, “Why? What happened? She really hates the high chair and we’re making progress with her seated at the table in her room?” I got back, “Do you want to call mom? She eats in the high chair or she doesn’t eat. End of discussion.” I replied, “Let’s call her mom. I want to hear what she thinks.” Of course, the nurse didn’t call the client’s mom. By this point, we’d reached the client’s bedroom. The nurse again made comments about not seeing the need for speech-language therapy. At this point, I told the nurse that I’d been nothing but nice to her despite her childish behavior toward me. I asked her to leave the session and sit outside the room as she had done with the previous two therapists. As can be seen on camera, the nurse physically lunged toward me while screaming, “End of discussion!” and putting her headphones in her ears.

The client’s mom returned home a few minutes later and came into the room where the nurse sat absolutely seething while I was trying to at least get some therapy time in with the client. I asked the client’s mom if I could speak with her after the session about the concerns the nurse had raised and that I did not feel that the current situation was appropriate for her daughter. After the session, I asked the mom if it would be possible for the nurse to wait outside the client’s bedroom with the door open as she had done with the previous two clinicians. I confirmed with her that she was on board with the way I was approaching feeding therapy to help her daughter get past some of the aversions she had developed with the high chair. I confirmed with her that she was happy with the way therapy was going in general. It was a good discussion and I appreciate that the client’s mom was willing to listen and to come up with other solutions.

I saw the client again last Thursday. Her mom was present in the home, but the nurse was not. I’ll be perfectly honest and admit I felt a ton of relief when I saw the nurse’s car was not in front of the home when I arrived. It was a good session with the client.

Afterward, her mom came in the room and asked me when I had arrived at the home two days before. I stated I thought it was exactly on time. She showed me the video feed from the in room camera where the nurse clearly heard me knock both times and then sat back down. There was also footage showing the nurse getting the text from the client’s mom and responding back that she was in the bathroom. The entire 13 minutes is documented on the in-room camera footage. I told her I didn’t think it was the first time the nurse had been intentionally slow to answer the door, just that this was the most egregious. The entire interaction between the nurse and me, including her physical lunge toward me and putting in her headphones is documented. The client’s mom told me the nurse showed her the text the nurse said she sent to my “company.” (I’m an independent contractor, so I don’t work for a company like the nurse does.) She asked if I’d heard from the woman who owns the company about the situation. I told her I hadn’t. The client’s mom then said she knew the nurse was the reason the new grad clinician had asked to have someone else assigned to her daughter’s case. She then asked me if I would leave, too. I told her what I’d told her before – her daughter was my priority and we could figure out another arrangement with the nurse. I told her the owner of the company was fully aware of the issues with the nurse and that I had been warned ahead of time. The client’s mom explained all of the difficulty she’d had in getting a competent nurse to take care of her daughter during the week. I agreed that this nurse had great nursing skills, that it was just that her attitude was causing problems. The client’s mom told me she had asked for another nurse to present on Tuesdays and Thursdays when her daughter’s PT, OT, and ST therapy sessions are scheduled.

I’m grateful that the client’s mother is so understanding. I’m grateful that I have a good working relationship with her and that she is pleased with how therapy is going. It makes me happy to see the progress her daughter is making with both communication and with feeding.

It makes me sad to know there are people in this world like the nurse who are in positions with just enough power that they can abuse it. It makes me wonder what is going on in this nurse’s life to make her this way. It makes me wonder if she realizes the only people she hurt in this situation were: 1) the client by forfeiting her therapy time; and 2) herself by losing 16 hours of work per week. She used her positionality as she perceived it to interfere in a position where she ultimately was the loser.

I offer the following meditation for the nurse: May you be well; May you be happy; May you find peace. May you find it in yourself to be more humble and accepting of the help others offer to the clients in your care.

As always, thanks for reading. I look forward to your comments!

Repost – Stimulable or Non-Stimulable First? That Is the Question…

A therapist guides a young girl through speech therapy exercises using a playful and modern approach.

I originally published this post in April, 2021. It’s now March, 2023, but this particular post has gotten considerable traffic lately. So, I decided to repost it at the top of the blog.

As always, thanks for reading and please get in touch if you have any questions!

Conventional wisdom in the treatment of SSD holds that speech-language pathologists should treat speech sound error patterns for which kids are stimulable first. Being stimulable for a sound means that the child is able to imitate correct production in some context. That might be in isolation or at the syllable or word level.

It’s this idea of stimulability that has lead to the misinterpretation of Sander’s (1972) When Are Speech Sounds Learned chart. Conventional wisdom holds that children should be ‘ready’ for treatment on particular sounds because they are able to imitate them.

But, conventional wisdom is not evidence-based practice (EBP). The 3 tenets of EBP state that we should strive to incorporate the current external scientific evidence with our own clinical expertise and the client’s/family’s perspectives. We also have an ethical responsibility to be lifelong learners as part of the service to our clients.

What does the external scientific evidence say? For about 15 years now, the evidence has been clear. Treating stimulable sounds initially will result in quick and easy treatment success for the child and the SLP. Why? Because those sounds are already on their way ‘in’ to the child’s system. But, treating stimulable sounds first or only sounds that are stimulable substantially extends time in treatment. Why? Because the SLP is piggybacking onto the developmental changes which are already happening in the child’s system.

The research evidence overwhelmingly demonstrates SLPs should spend time treating non-stimulable sounds to create the greatest amount of change in the shortest amount of time for the client.

So, what role should stimulability play in treatment decisions in SSD? Should you determine stimulability in an eval or progress monitoring of a child with SSD? Yes, but you should be interested in the sounds that are non-stimulable from a treatment perspective. Should you monitor stimulability every time you probe for system-wide phonological change? Absolutely. Change in stimulability is change in underlying phonological knowledge on the child’s part and informs treatment target selection on your part.

One of my favorite resources for determining stimulability during the initial eval and during progress monitoring probes is the Secord Contextual Articulation Tests or S-CAT. I especially like it because it assesses stimulability across all contextual levels and does so in real words. As a proponent of using nonsense words in therapy, I want to know that I am getting demonstrable carryover to the child’s everyday life.

I’ll take up the theoretical and research evidence for using nonsense words in phonological intervention in the next post.

Thank you for reading. Please feel free to contact me with any questions you may have and/or to discuss setting up a treatment plan for a client. If you’d like an example of this type of intervention, please click here.

How Not to Be a “Ken” SLP

Image courtesy of RosZie on Pixabay.com

If you weren’t already aware, a “Ken” is the male version of a “Karen”- with the added benefits that come from being male in mainstream culture.

Some Personal Background

This post will be a little different because it’s personal. It’s about an individual I loved deeply and for whom I still have love in my heart.

Unfortunately, because of this individual’s own emotional trauma, abuse, and substance use issues, he has become a “Ken.” That is, he has become an entitled white male who cares little for the people around him. He doesn’t appear to care who he hurts as long as he has access to what he wants in the moment. It’s impulsive. It’s cruel. It’s short-sighted. And, it’s cost him a lot.

But, it’s also cost me a lot. I want to say plainly, I take responsibility for my part in what went wrong. But, I will no longer take responsibility for his part in it.

I last saw him in person 2 1/2 years ago. Despite my requests for space when he walked out, he has continued to contact me via email approximately every 6-8 weeks. Sometimes, I hear from him more frequently. Sometimes, it’s not quite as often.

Some of his emails have sounded like the person he used to be. Some have been contrite and seemingly truly apologetic – like the last one I responded to just last week. But, many have been confrontational, combative, mean, and downright abusive. It’s clear he doesn’t completely understand why I had to step away. It’s also clear he misses me as much as I miss the old him. However, I don’t miss the person he has become and the person I become when I’m around him. His more combative emails can dredge up that person I don’t want to be. Because I never know what type of email he’s sent, I always get anxious when I see his name in my inbox.

I will admit that earlier today I wrote an awful, mean, snarky email draft where I was able to get out every bitchy, hurtful thing I’m fully capable of saying when I’m emotionally involved in a situation. It made me feel better for a minute. But, I just couldn’t find it in me to hit the send button. Because I don’t want to be the one person who really can hurt him as deeply as he’s hurt me. I could easily be that person. He knows it as well. I didn’t send it because I hope he’ll find his way back to himself. Because, if I’m honest, I still have enough love for him that if he’s serious, I want to leave the door open to be the friend he’ll need. But, until that time, I refuse to give him the power to hurt me again.

Despite his outward presentation, I know he’s very vulnerable and insecure. I know this because he’s shared those thoughts with me. I know this because, as I’ve told him on numerous occasions, it’s what he doesn’t say that always tips me off to what’s really going on. I think he treats others the way he does because he’s scared they’ll see that he’s hurting. I think it’s his personal pain that drives his need to alternatively hurt others and then numb himself to what he’s feeling. Unfortunately, the closer you are to him, the more likely he is to hurt you. I think his insecurities are part of the reason why he fell down the QAnon rabbit hole. I have my suspicions as far as other reasons why he followed this path, but I’ll keep those to myself.

I feel very sorry for him. I feel sorry that he has become a Ken who seems to revel in putting others down, gaining from their misfortune. It makes me sad to think about how much the once sensitive and compassionate, if impulsive, person I used to know has changed. Everyone has a dark side, me included. But, this side of him has taken over. His friends have all disappeared from his life, including me. He has no relationship with his family, because one can only tolerate being so deeply hurt so many times.

I do sincerely wish that he is happy, that he is well, and that he finds the peace I know he wants.

On Being A Ken SLP

Ken is a practicing SLP, working primarily with adults with acquired disorders. Therapy services with adults with acquired disorders tend to be shorter term than those for children. Whereas I might work with some pediatric clients for several years, adult-focused services tend to remain in place for only weeks or months.

I think his choice to work with adults with acquired disorders is due to a couple of factors that feed into his larger issues. First, and importantly for him to stay employed, the expectation is that therapy services will be of shorter duration. That means his caseload turns over much more frequently than someone who works with pediatric clients. Secondly and relatedly, he can be quite charming when he chooses to be. He is able to maintain that facade for a while when he first meets someone. Because his caseload turns over relatively frequently, his clients rarely have the opportunity to see behind the image he wants them to see. His choice to work in home health also means he does not often cross paths with co-workers.

However, I have watched the devolution of his therapy skills. Where he once took the time to individualized and tailor therapy services to each client, he now prescribes “one size fits all” strategies. He blurts out things that are thoughtless at best and hurtful at worst to clients and caregivers. He no longer considers how what he says will be received by the listener. He cuts corners where he can and structures his schedule and his caseload to be as easy as possible – for him. He spends minimal time with clients during each session and dismisses them quickly. The therapy he provides is about him, not his clients. He uses his positionality as a middle-aged, mainstream culture male to simply skate by professionally.

I really don’t think most women would be able to get away with what he does. He is most definitely a Ken SLP; even Karen SLPs would be held to higher standards.

Using Your Positionality Statement to Form Closer Connections to Your Clients

I recently have begun developing a positionality or reflexivity statement. These types of statements were originally developed to help social science researchers acknowledge their own positionality when conducting studies. I am attempting to use my positionality statement as a way to capture how the supports I provide to families is different from others SLPs. What I have discovered is that my positionality statement is part of my own healing journey. Through the process of developing my positionality statement, I have come to realize that many of the experiences I had while involved with Ken have given me much deeper connections to the clients on my caseload.

Developing a positionality statement requires that you take the time to do some self-reflection. Some of us are personally and professionally in a place for such an undertaking. Other practitioners may never realize the benefits of looking inside themselves to become a more resilient, stronger, and more empathetic clinician.

The questions in the positionality statement I am developing are:

1.How do I identify?

2.How do I understand the therapy process & my knowledge?

3.What are my beliefs about the therapy process?

4.What is my history/personal interaction with therapy?

5.What is my understanding of systems of oppression & their influence on the clients I support?

6.What is my connection to my clients? Do I share any commonalities, identities, or experiences with my clients?

7.What is important for my clients to know about me?

Here are my answers:

How do I identify? I identify as a mixed race, multidialectal, nomadic, transitioning to middle- age woman who is a child language researcher and speech-language pathologist. I have always been the “new kid.” I attended 11 public school systems in 9 states during my K-12 education. While you may not be able to imagine how I grew up, I don’t see moving that often as a disadvantage. For one thing, it was all I knew as a kid. It was just normal. (If it sounds odd to you, remember that staying in one place for years sounds odd to me.) I’ve had the opportunity to live in every corner of the United States and I mean every corner! This is how I became multi-dialectal.

How do I understand the therapy process & my knowledge of it? I’ve posted about the differences between “training” and “therapy” before. But to that, I would add the following: I understand the therapy process to be one that involves the whole family (or all caregivers), not just my client. When the client’s communication skills change, the dynamic between the client and all people in their life changes. As a lifelong learner and someone who has lived in all corners of the US, my knowledge reflects my study of typical & disordered language acquisition, my knowledge of how different dialects affect typical & disordered language acquisition, & how disparities in evaluation & assessment affect children who have CCN or who come from low-income &/or CLD environments.

What are my beliefs about the therapy process? I believe my role is to be a coach & information source. Taking the client’s concerns into account, my role is to help direct the plan of therapy & to provide responsive, EBP-based or research-suggested, individualized recommendations & elicitation strategies. I also believe that part of my role is to support the family unit as much as they want me to. When the client with communication disorders gains or loses skills, it changes the dynamics of the family. Because I work with pediatric clients, I believe that part of my role is to explain the process behind IFSPs or IEPs and the differences between home-, center-, and school-based SLP services.

What is my history/personal interaction with therapy? As an undergrad, I spent a semester either losing my voice or suffering from bilateral ear infections (a chronic life issue) secondary to allergies. I sought advice from the voice professor who suggested I try voice therapy. As she pointed out, therapy was free for students & it would be good for me to experience the patient side of things. She was right. I find that I spend more time explaining the “why” I’m doing what I’m doing or recommending because that’s what I wanted to know – why do you want me to do this? What’s the point?

What is my understanding of systems of oppression & their influence on the clients I support? I prefer to work with clients and families who have been marginalized based on income and/or CLD issues. Many clients and families have CCN and the cost of those needs contributes to the family’s SES status. Many families are headed by single moms of color. Many clients and families face housing, food, and utility insecurity. Many adults have a high school education or less. Many clients are used to having their concerns dismissed or unheard and many have experienced simply being told what to do.

I’ll relate just one episode from my own life that has given me a better understanding of systems of oppression and their influence on the lives of others.

During the height of the pandemic, I found myself caught in the same system of oppression that traps many people with partners like Ken. I became a statistic in Spring 2020. In April, 2020, things became physical. A neighbor two floors down heard the fight and called both the police and the landlord. Ken fled before the police or the landlord arrived on scene. The police put absolutely no effort into trying to find him because I did not know where he might have gone. The officer on scene told me I wouldn’t be able to get a restraining order because of the pandemic and it wouldn’t be enforceable in that apartment because Ken was on the lease. I was told Ken would be allowed to return to the apartment. I was told my best option was to move out, despite the fact that it was a minimum of $3000 to provide at least first month’s rent and a deposit. Many places required first, last, and security as a deposit with no option to pay over time. I also would have to forfeit the $1500 I had put down on the apartment where we lived or remain legally liable for any damages Ken caused after I left. At that point, I would have had to struggle to scrape up $100 because of the financial situation Ken had put us in. I was the only one working at the time and all of the bills were in my name. Going to a hotel wasn’t an option because they weren’t open. Going to a shelter wasn’t an option because taking the cats with me wasn’t a possibility. Even though he had never hurt the two special needs cats I still have, he had a history of hurting animals in the past.

If you’ve never been in a situation like this, please believe me when I say you can’t just walk away. You have to make sure you have a plan. You have to make sure you think through all contingencies, especially if children or animals are involved. You have to make sure you have money stashed away. You have to make sure you leave no traces when you go. It just wasn’t possible during the lockdowns.

So, I stayed. I stayed as far away as physically possible in the space as much as I could. I basically lived in one room. I started only leaving the space to go to the bathroom or eat after he went to bed.

In May 2020, he decided he wanted to leave the area and he decided I was going to go with him. I agreed to go because due to the laws of where he wanted to go, it would be much, much easier to get away from him. But, in leaving, I had to give up a faculty position – something I’d always wanted. I had to give it up to leave the area and to be able to find a way to disappear. It’s not easy to get away when your name and image are posted on a university’s website and you’re expected to present and publish with that affiliation. It turns out that he chose to walk away several months after we moved across the country – without telling me what he was doing and leaving me to clean up the aftermath.

The truth of the matter is he used his positionality as a white male to hide the truth of what was happening. I’m sure that the fact that he was a white male and so was the cop who responded to the call figured into the lack of effort to find him that April night. Because these things don’t happen in middle-class households, right? The tenancy laws of the state where we lived also protected him over me. The rental practices where first, last, and security deposit are required to rent homes also force people who need to leave a situation to stay.

What is my connection to my clients? Do I share any commonalities, identities, or experiences with my clients? My mother made sure my brother and I understood people are people, no matter their circumstances. And circumstances can change and change quickly. This is a lesson I have experienced firsthand at several points during my life. Because of choices Ken and I both made, I know what it’s like to stress over not being able to pay rent on time or even know where you’re going to sleep that night even though you have a job you have to go to the next morning. I know what it’s like to skip a utility bill and hope it doesn’t get cut off. I know what it’s like to not be able to buy things on credit or to have to pay the outrageous fees and penalties you’re charged because you’ve had to make financial choices in the past. Because I was always the “new kid,” I’ve experienced what the social pressure to assimilate feels like. In some places (like where we were living in 2020), the “locals” make it clear to you just how you need to change. They, however, have no need to learn to be more accepting of you! I know how it feels when you look or talk differently than those around you.

My experiences have made me more grateful. I’m grateful for the families I support. They welcome me into their homes and their lives. I’m grateful for the little things – like being offered a bottle of water or a helping of a meal so I don’t have to cook after a late appointment. I’m grateful for the opportunity to share in their accomplishments. (I watch all of the videos families share with me!) The families’ willingness to share what they have keeps me grounded. I hope they know I identify with them simply because we are all human. I hope they know I am better able to connect with them because my life experiences, even if I haven’t shared exactly what I’ve experienced with them.

What is important for my clients to know about me? First and foremost, I hope my clients know the therapy process is not about me. I hope they know the therapy process is about them and what they need. I have changed the way I think about the therapy I provide. I don’t provide “services” – I don’t deign to “serve” my clients. I support them where they are and seek to provide supports, suggestions, and recommendations to help them get where they want to go. I want my clients to know I see myself as a partner with them, not as the expert lecturing from “on high.” I want my clients to know I don’t have all the answers. I’ll make mistakes. Things won’t go as planned. But, my skill set is helping all of us figure out how to move forward toward the family’s goals.

A Note of Gratitude

Thank you for taking the time to read this post. As I mentioned at the outset, this was a stage in my journey of healing from the chapter of my life that included Ken.

I hope you’ll take the opportunity to ask yourself the questions in the positionality statement. I hope that the answers will give you the opportunity to form closer connections to yourself and your clients.

How Not To Be a “Karen” SLP – Part 7 Food

Image courtesy of bookdragon on Pixabay.com

Remember, if you’re a practicing SLP, chances are you’re a relatively young, white, middle class woman. After all, we are a field composed of 96% women and 92% white/mainstream culture.

Let’s assume you’ve stopped asking questions about MAE use during your speech-language evaluations. Let’s assume you’ve stopped touching your clients’ hair. Let’s assume we agree you’re providing therapy and not training. Let’s assume you’ve taken a critical look at the materials in your “stash” and have made a conscious effort to use materials that are more inclusive and reflective of the clients you support.

Now, let’s talk about the foods you discuss when you work with clients with feeding or dysphagia issues. Yep, here again, there can be some situations in which you need to use some cultural humility and cultural responsiveness when it comes to feeding and dysphagia issues.

There’s a trend in early intervention to ask about a young child’s ability or willingness to eat “family foods.” Yet (in my experience anyway) I was the only one to ever ask what was meant by “family foods.” Because – news flash here- that phrase means different things to different people.

And, if you don’t ask specific questions about “family foods”, you are being a “Karen” SLP. Because you’re making assumptions about what a family eats. Alternatively, if you only make suggestions or recommendations based on a typical, meat-based mainstream culture diet, you also are being a “Karen” SLP.

The number one way to not be a “Karen” SLP: Remember, therapy isn’t about you!

Let’s take rice as an example. In mainstream culture, rice dishes are generally short-grained and relatively highly processed. They also tend to be served as a side dish which may or may not be eaten with foods of other textures. Often, the rice dish includes a sauce that helps the person eating it form a bolus (e.g., risotto).

In many other cultures, rice dishes form a staple carbohydrate eating as part of the main course (e.g., sushi; Indian curries). Some variations, like sushi rice, are prepared in a way that the natural ‘stickiness’ in the rice helps the person form a solid bolus. Other rices, like jasmine or basmati rice, are longer grained and are not naturally ‘sticky.’ The person is expected to have the ability to use their tongue, jaw, and lips to form a bolus along with the other, chunky foods and spices that are included in the curry/stew portion of the entrée.

If you have dysphagia or have behaviors/issues that put you at-risk for aspiration (e.g., using a munching chewing pattern; missing teeth; “shoveling” food into the mouth), rice can pose a substantial danger. That’s especially the case if your family uses rice as a primary carbohydrate in meals and snacks. It can be hard to form a bolus with rice on its own. It can be hard to keep track of all of those little grains in your mouth, especially if you have a tendency to pocket food in your cheeks or under your tongue. It can be a challenge to deal with the mixed textures of dishes like curries if you have any of these issues.

So, what does the non-Karen SLP do? She asks questions. She asks what a typical breakfast, lunch, and dinner and snacks look like for the family. She asks the family to provide foods they’ve already prepared so she can see how the family typically prepares foods.

The non-Karen SLP takes the time to find out if the family follows any dietary protocols, like keeping Kosher or being vegetarian. The non-Karen SLP asks about snacks in addition to meals. The non-Karen SLP asks what the family eats and when and how they eat the foods before making recommendations and suggestions for diet textures and compensatory strategies.

The non-Karen SLP asks the client and/or family about foods that appear to be challenging for the individual to eat. The non-Karen SLP asks to see how these foods are prepared. The non-Karen SLP asks about how safe foods are provided to the person with feeding or swallowing issues. This includes the use of adaptive equipment. The non-Karen SLP talks to the OT or COTA about these issues. Adaptive equipment can include a variety of things from non-slip mats under dishes to adapted utensils and cups. The non-Karen SLP talks to the PT and OT about different positioning options for people who are unable to sit on their own and how long each individual client can remain in a seated position. The non-Karen SLP asks where the person usually eats (e.g., in a hospital bed in a bedroom, at a table in the kitchen, in a busy cafeteria, etc.) and how they are able to eat safely (e.g., with full assistance from others, with monitoring/verbal prompting, etc.) The non-Karen SLP asks the family about the importance of having the family member with feeding or swallowing issues participate in family meals, including celebrations. The non-Karen SLP ensures that all caregivers understand why adaptations in the way foods are prepared, compensatory, and positioning techniques are being recommended, even caregivers who may not speak English. The non-Karen SLP takes the time to explain how the swallow mechanism works and where the person has difficulty. The non-Karen SLP working with clients with long-term feeding and swallowing issues recognizes this is an on-going process that likely will require revisiting from time to time, even if the person is medically stable. (This is especially the case in situations like long-term care facilities or the schools where staff turnover happens on a relatively frequent basis!)

When making recommendations or suggestions, the non-Karen SLP remembers to use language like, “What if we tried pureeing the rice to make it safer to swallow? That way, you could still mix it in the curry sauce.” Or, “what if we mixed a little water or milk into the rice to make it more like a pudding? That would make it easier for you to swallow.” Or even, “I know you really like mango, but it’s hard for you to swallow. What if we put a piece in cheesecloth so you can get the flavor while we work on chewing?” The non-Karen SLP makes sure to talk about the foods she knows the family eats because she asked.

Are you an SLP who works with clients with dysphagia from culturally diverse backgrounds? What issues have you run into? How have you addressed those barriers?

As always, thank you for reading. I look forward to your comments or suggestions!

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