Build Your Caseload with New Referrals

How do you handle a dramatic change in your caseload?  Do you:


A.   panic, then have an emotional breakdown
B.   start looking for another job
C.   spend your extra time shopping at the mall
D.   consider a change of careers
E.   roll up your sleeves and do something about it

One of the agencies I contract with has slowly but surely stopped sending referrals over the last few months. At first, I was okay with it and took the, "Good. Now I can go on vacation during Spring Break" attitude. But, almost 2 months later, it's much more of a concern than it was back in March. My caseload has dwindled from about 20 visits each week to only 2 visits scheduled for this week. Yikes! 





I found myself asking, "Why isn't the phone ringing? I'm going to be unemployed next week if I don't get some new patients. What am I going to do?" I contemplated my options and then used the process of elimination to help me find the best answer. 





Option C- ELIMINATED.  I learned years ago that shopping is a bad idea. Even though there is more time for picking out new shoes to coordinate with your new outfit, you are spending money.  When there is less work,  that also means that there is less money. Now, I was in remedial math until 8th grade (seriously, I'm not kidding), but I have figured out that the money coming in needs to be more than the money going out. Using the old test taking strategy of eliminating the obviously wrong choice first, I moved on.

Option D- ELIMINATED. I've invested 21 years of my life working as an SLP, and changing course right now would be an even worse idea than going to the mall. Better keep going down the list.

Option A- ELIMINATED. The thought of getting all worked up and crying just seemed like it would not be worth the effort. Besides, people would certainly think twice about sending new referrals to the  teary-eyed therapist who was struggling to keep it together. Tears pouring out of my eyes are not going to result in new referrals, so, I'll keep going.

Option B- ELIMINATED...for now. I haven't had to look for a job in years and I really don't want to start now. The entire HR process you have to go through as a new hire for most companies is long.  It typically involves watching a bunch of boring videos about HIPPA requirements (again), demonstrating your ability to follow Universal Precautions (again), taking tests to prove you really do understand blood borne pathogens (again), updating the resume (again) and worst of all, peeing in a cup. Yuck! Who really wants to do all of that stuff...again? Right now, not me.

Option E- this is the only option that has not already been eliminated, so, I'm going to roll up my sleeves and do something about this pesky problem of mine.  Here goes!

After commiserating with my OT and PT friends, I made a few phone calls to talk to the bosses and the CEO. The common response was, "We're just not getting the referrals we used to." Hmmm- that can only mean one thing: someone is not doing their job! I'm not going to sit around waiting for someone else to do something about this situation, I'm going to get involved. 

I know exactly what to do...remind everyone how important Speech Therapy is!  After all, it is Better Hearing and Speech Month,and the timing could not be more appropriate. Now, how will I spread the news?

I remembered a handout I created before I did a presentation at the Corpus Christi Parkinson's Support Group not too long ago. I pulled up the document, made a few small adjustments for my new audience and printed it on some bright paper. 

I've been known to pop in to speak to agency staff during weekly case conference meetings, and that's my plan again.  Watch out nurses, here I come!

Making a Referral to a Speech-Language Pathologist

Common Diagnoses:  Referral to an SLP is usually justified with any of the following medical diagnoses:                                                                                                

• ·        Stroke, TIA
• ·        Parkinson’s Disease
• ·        Alzheimer’s and Related Dementias
• ·        Altered Mental Status
• ·        Dysphagia
• ·        Cancer of the Head or Neck
• ·        Head Injury
• ·        Amyotrophic Lateral Sclerosis
• ·        Pneumonia
• ·        Head Injury (Closed Head Injury, Traumatic Brain Injury)

Dysphagia:  70% of geriatric patients are experiencing difficulty swallowing

• ·        History of aspiration or aspiration pneumonia
• ·        Alternative feeding methods are being/ have been used
• ·        Weight loss: gradual or sudden, usually unexpected
• ·        Poor appetite
• ·        Altered diet:  changes to solids or liquids
• ·        Pneumonia- usually in the lower lobes
• ·        Dehydration
• ·        Malnutrition
• ·        Nutritional supplementation required (Ensure, Boost)
• ·        Difficulty swallowing medications
•          Coughing, choking

Justification:

• ·        Promotes continuity of care
• ·        Provides cost effective treatment
• ·        Enables functional activities in a functional setting
• ·        Diminishes social isolation
• ·        Maintains quality of life
• ·        Allows for medical acuity and frailty at home
• 
  

You don't have to be a marketing expert to get your point across, just put on a big smile, pass these handouts around the room and let the enthusiasm you have for your job pour out of you. 

By the way, if anyone is interested in the complete, extended version of this document, contact me and I will be happy to share.

Over the years, I have found that information like this, given to the right people, can really make a difference in the amount of referrals you get. You are providing information and raising awareness, all at once- so efficient! 

Whether you're a speech language pathologist or not, the moral of the story still the same:  take responsibility, take charge and stop waiting for someone else to do the job. 

This week, consider situations that could be improved based on the actions YOU take. 

Post a comment to share your success story- I would love to hear from you!  In the meantime, don't forget to continue the celebration of Better Hearing and Speech Month.

  

Hope it's a great week....thanks for reading!

If it is to be, it is up to me.  William H. Johnsen

Ten Tips for Managing Tech Time

The average child age 8 and under in the United States uses more than three personal tech devices at home each day. With even the youngest kids now plugged in to tablets, smart phones and video games, it is important to remember to manage tech time so it doesn't overtake time for talking with children.

Talking to children in their first years of life sets them up for future academic success. The easiest and most effective way that children learn is simply by talking. Studies have proven that a link exists between the number and variety of words a child hears and later academic achievement. If that doesn't make you want to sit down and talk to a child, I don't know what would!

Every year, our national professional organization  recognizes May as Better Hearing & Speech Month.  Not only does it  allow SLPs to sparkle and shine, it designates an entire month to prioritize communication. The American Speech Language and Hearing Association (ASHA) recommends the following 10 tips for parents on how to manage kids’ technology use and  to keep communication at the forefront of child development.

     Create tech-free times. Find at least one or two opportunities during the day—at the dinner table, for example—for everyone to disconnect. Mealtime is a prime opportunity for conversation. Make a commitment and have everyone check their devices at the kitchen door.

      Resist over-reliance on technology to pacify boredom. Fifty-five percent of parents worry that they rely on technology too much to keep their child entertained, according to an ASHA poll. Roughly half of parents say that they are using technology as a means to keep kids age 0–3 entertained. Remember that the best opportunities for conversation and learning are often found in situations that may be viewed as boring, such as while running errands or on a long car trip—particularly for the youngest children. While it may be tempting, try to resist the urge to immediately turn to these devices as a source of entertainment.

Don't overestimate the value of educational apps. Children learn best simply through talking, conversing, and reading. Technology is not the best way to teach, though it can reinforce and allow practice of skills under development.

     Make tech use a group activity. While it is most often used on an individual basis, tech use can be turned into a group activity, such as while playing an online game. Talk about what you’re doing!

      Consider whether young kids really need their own devices. It is not uncommon for kids to have their own tablets or mp3 players. Many are designed and marketed specifically for kids. This may lead to more time spent alone with technology throughout the day. On the other hand, devices designed for kids often offer additional features that appeal to parents, such as limited, kid-appropriate content and extra security options, so this is a balance for parents to consider.

      Set daily time limits. Certain devices can be programmed by parents to shut off after a certain amount of time, but you can also make a child aware of the time limit and keep track yourself.

      Be consistent in enforcing the parameters you set for tech use. ASHA’s poll found a majority of parents report setting limitations on their children’s tech use. However, the reality of their children’s tech use often doesn’t line up with the set restrictions, by parents’ own accounts. Moreover, adherence often seems to break down at ages 7 or 8 despite the rules parents say they set. 

      Always practice safe listening, especially when using ear buds or headphones. Misuse of this technology can lead to noise-induced hearing loss. Even minor hearing loss takes a significant toll academically, socially, vocationally, and in other ways, so prevent the preventable. Teach kids to keep the volume down (a good guide is half volume) and take listening breaks.

      Model the tech habits you want your kids to adopt. Practice what you preach when it comes to tech time and safe-listening habits.

 Learn the signs of communication disorders. This is important for all parents, regardless of their children’s technology use. Early treatment can prevent or reverse many communication disorders. Parents should not wait to see if a child “outgrows” a suspected speech or hearing problem. If you have any question about your child’s speech or hearing, seek an assessment from a speech-language pathologist or audiologist. Learn more at IdentifytheSigns.org

Please join me in celebrating Better Hearing and Speech Month and feel free to share this blog with someone you know. 

Thanks for reading...have a great week!

Communication is the best way to create strong relationships. 
Jada Pinkett Smith

April is National Autism Awareness Month!

How does autism impact your day to day life? 


For me, I experience autism twice a week for about 45 minutes. During that time I give it all I got and it's tiring to say the least. If you could watch this 4 year old girl and me, you would see up and down, back and forth, in and out, open and close, moving from activity to activity. It is controlled chaos. It may just look like we're playing, but this is serious business.   I'm in search of a smile, watching for gestures, listening  for a sound, trying to engage her any way possible, always keeping in mind, "Her parents are counting on me."  

When our time is up, I pack my toys, books, iPad and baby doll, and go home.  She, on the other hand, continues on in her silent, seemingly mysterious world. 

As a Speech Pathologist that has worked primarily with adults and geriatrics, that is the extent of my recent dealings with autism, and sometimes, that's more than enough. For teachers and parents, they manage children with autism on a daily and ongoing basis. It is not an easy task. My girlfriend, Catherine, knows this lifestyle all too well.  She relays to me the challenges of coordinating and scheduling  all of therapists and specialists that are necessary to provide the treatment  her son needs.

She says the front door of her home is always unlocked for all the people coming and going through the day. She also admits that she spends more time talking with therapists than she does her own friends.  (That's true, because I'm her friend and we havent' talked on the phone for since last November.) Sometimes,to me, it sounds like she is leading a three ring circus. So I say....MORE POWER TO YOU, Catherine!

Now flash forward to last week...

I was listening to the Today Show (no time to actually watch Matt, Natalie and Savannah),  I heard the latest statistic about the  prevalence of autism. It stopped me in my tracks. My son, Jay, saw my amazement. He asked me, "Is that bad, Mom?" I explained that the year he was born, 2002, the number (I think) was 1 in every 148 children. Now, its 1 in every 68!  My response to him was, "Yes, Jay, it is very, very bad." 

What has happened? 

Officials relate these dramatic increases in cases of ASD  to improving recognition. In other words, we, as professionals, are getting better at identifying autism. However, some believe the statistics related to autism are actually much higher, based on the fact that you can't accurately count the cases of ASD if the children involved are not receiving intervention. What all this means is that the government's autism estimate will probably continue to rise as communities continue to get better at recognizing the disorder. So, brace yourself, because within a few years, researchers predict that autism in the US is "on pace" to affect 1 of every  38 children. 

Want to know more?

Autism Spectrum Disorders (ASD) are a complex set of neurological disorders that severely impair social, communicative and cognitive functions. Even though researchers don't thoroughly understand  the science of autism, a basic understanding of these concepts is paramount to spreading awareness of ASD. So, every April, National Autism Awareness Month is recognized. It is the perfect time to inform and educate the public...and I want to do my part. Here are a few facts to take away after reading this blog:

• Approximately 1 in 68 children is diagnosed with ASD each year in the United States. It has been determined that boys are 4 times more likely to have an ASD than girls, and that narrows their statistics to 1 in 42. 

• Even though no one is sure what causes autism, we know that it is possible to detect signs of autism in infants as young as 6-18 months.

• Parents who notice signs of autism, or are concerned their children are not meeting developmental milestones, should contact their pediatrician and request a developmental screening. Don't take "no" for an answer and get bossy if you have to!

• Scientist agree that the earlier the child receives  intervention, the better the prognosis, and all children with autism can benefit from interventions that are available. The most effective treatments today are applied behavioral analysis (ABA), physical, occupational and speech therapy.

Whether you are reading this as a  therapist, teacher, parent, grand parent, aunt, uncle, friend or neighbor, please take time to familiarize yourself with age appropriate developmental milestones. As the Centers for Disease Control and Prevention (CDC) suggests:  Know the Signs. Act Early.

If you're still not sure a child is showing signs of ASD, there is a do it yourself screening tool available on the internet.  The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) assists you in determining the level of risk for ASD in children between 16 and 30 months of age.   With just 20 simple questions, the M-CHAT-R is actually a scientifically validated screening tool that is recommended by  The American Academy of Pediatrics (AAP). Neato! The link is above if you want to check it out.

Like always, if you don't use this information now, save it for later. If it doesn't apply to you, then share it with someone you know. With statistics like these, it seems inevitable that autism will affect your life, sooner or later. 

No matter what, join me in the celebration of National Autism Awareness Month. It represents an excellent opportunity to promote autism awareness and acceptance and enables us to  draw attention to the tens of thousands facing an autism diagnosis each year. 

Hope it's a great week for you. Thanks for reading!


To measure the success of our societies, we should examine how well those with different abilities, including persons with autism, are integrated as full and valued members. Ban Ki-moon- Secretary-General of the United Nations

Knowledge Is Power!

Last week, I wrote about the warning signs of Alzheimer's and shared a link which detailed the latest facts and figures about the disease. I'm a firm believer that knowledge is power.  As professionals, we must stay informed- our patients and their families are counting on us.

This week, I wanted to continue the dementia discussion by sharing information about dementia staging and the Global Deterioration Scale.

The Global Deterioration Scale (GDS), was developed by Dr. Barry Reisberg and was first made available in 1982. It provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease. It is broken down into 7 different stages.

Stages 1-3 are the pre-dementia stages and include:

1. No cognitive decline
2. Very mild cognitive decline- age related difficulties
3. Mild cognitive decline- Mild Cognitive Impairment (MCI)

Stages 4-7 are the dementia stages and are described as follows:

     4.  Moderate cognitive decline- mild dementia

     5.  Moderately severe decline- moderate dementia

     6.  Severe cognitive decline- moderately severe dementia

     7.  Very severe cognitive decline- severe dementia

Patients, caregivers and family members can get a rough idea of where an individual is at in the disease process by observing that individual's behavioral characteristics and comparing them to the GDS. Using this 7 point scale, I have helped family members better understand dementia and its progression. It has also been my experience that staging using the GDS enables families and caregivers to recognize cognitive deficits and set realistic goals for living situations and therapy. It can be a real eye-opener.

There are several  versions of the GDS available on the Internet.  The link to my favorite printable version is here.   I have kept it within reach  on my work desk for the last 8 years.

Our practice standards expect evidence-based approaches to the care we deliver. More and more, health insurance plans, including Medicare, are requesting standardization and outcomes to measure the value of the services we provide. Incorporating standardized test is an easy way to show evidence-based data to support our intervention. 

A highly recognized measure of function, the GDS is considered a standardized assessment tool. It enables the identification of dysfunction and deficits, it removes subjective factors, and provides results that can be generalized and repeated. 

If you're a healthcare provider reading this blog, print out a copy of the scale, and take it with you to work. Use it to complete assessments, plan therapy and provide education. I believe you will find it a very valuable tool. 

If you're a friend or family member reading, you may think this information is very technical and irrelevant to your daily life. I invite you to recall the statistics from last week:  1 in 3 seniors dies with a dementia diagnosis.  Dementia is likely to affect someone you know, and if you have a brain, you, too, are at risk.

Have a great week...thanks for reading!

Knowledge is power. Information is liberating. Education is the premise of progress.                Kofi Annan

If You Have a Brain, Then You're at Risk!

Have you ever misplaced something...maybe your sunglasses, your wallet, or your car keys? Then maybe you can relate to the lady in this video:  Have you seen my keys? 

As the video mentions, the signs of Alzheimer's may be right in front of you. So, before anyone panics, take a look at the entire list:

10 warning signs of Alzheimer's

1. Memory loss that disrupts daily life
2. Challenges in planning or solving problems
3. Difficulty completing familiar tasks at home, at work or at leisure
4. Confusion with time or place
5. Trouble understanding visual images and spatial relationships
6. New problems with words when speaking or writing
7. Misplacing things and losing the ability to retrace steps
8. Decreased or poor judgement
9. Withdrawal from work or social activities
10. Changes in mood or personality

Now, consider this: everyone with a brain is at risk for developing Alzheimer's.

Yikes! 

Just  last month (March, 2015), the Alzheimer's Association published the latest statistics on Alzheimer's Disease. The information in this video will blow your mind! Please take the time to watch it.

2015 Alzheimer's Facts and Figures

As a Speech Language Pathologist, I work with geriatric patients every day. As a group of professionals, I believe we play an important role in working with an aging population. 

• SLPs  assist in differentiating between normal aging and disordered communication.

• SLPs  provide vital treatments for people who have cognitive communicative impairments. 

• SLPs have a role in preventing communication disorders by promoting a healthy lifestyle and educating patients and family members about how to prevent disorders that may lead to impairment. 

Whether you are a therapist, friend or the family member of a person with dementia, I believe knowledge is power. To get more information about Alzheimer's Disease and its related dementias, I recommend you go to alz.org. The information and resources there are priceless! 

Thanks for reading...have a fantastic week!


You will know the truth and the truth will set you free.  
John 8:32

Breaking Up is Hard to Do

Last week, my 85 year old patient, Mr. W, came back from the dentist singing the blues.  

Cavity?

No.

Extraction? 

No.

Well then, what?

Plaque...and the dentist told him he needs a new toothbrush. 

What's so bad about that?

Well, my patient has an affection for his toothbrush and here's why: he has a  Kiss toothbrush that plays "Rock and Roll All Night" as he brushes. 

Well, no wonder he's sad!

If you're like most people, toothbrushes come and go without event as there is no real attachment. Take me, for instance,  all I can tell you about my toothbrush is that is has a green stripe. Pretty soon, I'll be trading it in for a newer model- I'm thinking purple. Anyway, it'll be no big deal when I toss it for a new one, but not for this patient! His wife told me he nearly fell to pieces when his Bruno Mars toothbrush died. Everyone involved here recognizes, for Mr. W,  breaking up is hard to do.

So, flash forward to today- I was asked to break the news to Mr. W that is was going to be out with the old and in the with new. Me? Why me? 

I took a deep breath. Here goes nothing...

Mr. W frowned and narrowed his eyes when the topic of a new toothbrush came up.  After some explaining, a little sweet talking, lots of reassurance and a little bit of eyelash batting, his caregiver brought out the new toothbrush. Mr. W, I would like to introduce you to your new toothbrush:  the mighty plaque blaster...Sonicare!

(Quick, someone cue the applause)

His face said it all- he was not happy. There were no rock stars, there was no music, there was no happiness.

Reluctantly, Mr. W squeezed the toothpaste from the tube and began brushing. He moaned,  he groaned, he even rolled his eyes, but he was brushing. I knew I needed to keep this going for as long as possible, so I reached way back into my memory bank and started talking about the correlation between plaque on your teeth and plaque in you blood vessels. His eyes got wide and he brushed a little longer. 

Over the next few minutes, he heard the condensed version of a study researchers completed in 2003. (You can find the entire article on the Internet.) In case you're pressed for time, and don't have time to read the entire thing,  here's the gist of it:

• hardening of the arteries is caused by plaque built up on inside of  blood vessels
• gum disease is caused by plaque built up on the teeth
• when gum disease is advanced, teeth are lost
• the more teeth lost,  the more likely you are to have  carotid artery plaque
• conclusion:  plaque on your teeth is related to plaque in your blood vessels

Well, in the end, Mr. W was sold! He realized that thorough elimination of plaque on the teeth could limit the amount of plaque in the arteries which could reduce his risk for having a stroke. He understood that the old toothbrush was just not as effective at removing plaque as the new one. So, pretty soon, it was bye-bye Kiss, hello Sonicare. Once again, the speech therapist saves the day!

This week, as you are busy performing oral mechanism exams and promoting the importance of good oral hygiene, keep your eyes peeled for plaque. Who do you know that needs a new toothbrush? 

 Thanks for reading...I hope it's a great week for you!

"A smile is a curve that sets everything straight."  Phyllis Diller

No Straws?

Maybe you've seen a sign like this somewhere along the way? No matter where you saw it, I can almost guarantee that a speech therapist made it. How would I know that? Because I know that speech therapists hate straws!

But not me!  I love straws and, apparently, I'm not alone.  According to Eco-Cycle International, 500 MILLION straws are used every day in the United States! Wow, that's a lot of straws!

So, as an SLP, I'm going to ask you to consider giving straws a second chance.

Of course, I know straws aren't right for every single person in every single circumstance. (Good clinical judgement must always be used when recommending the use of straw.) However, there are many good reasons for using straws and week after week I encourage my patients to do so! Let's take a look...

Dentists and orthodontists regularly recommend straw drinking to:

• reduce enamel erosion
• provide stain protection
• reduce cavities
• reduce exposure to temperatures for sensitive teeth

Some people like straws because:

• they're convenient
• they're clean
• they're fun

Sipping from a straw is said to increase the overall amount of liquids you consume. Healthcare professionals routinely promote the benefits of drinking more liquids each day. That's because adequate hydration can:

• improve kidney function
• maintain normal bowel function
• boost immunity
• prevent dehydration
• improve skin
• aid digestion
• regulate body temperature
• lubricate joints
• eliminate wastes and toxins

Straw drinking helps to increase tongue and lip control and coordinated breathing, all of which support our ability to speak with good articulation. Additionally, researchers tell us that as we suck, many of our cranial nerves are stimulated. That's a good thing. To take it even further, scientist have proven that straw drinking enhances inter-hemispheric brain integration. Wow- straws do that?


I'm making a case for straws today because just last week, I sat across from a patient sipping water from a tall glass. He tilted his head back to drink and a tidal wave of liquid entered his mouth.  Guess what?  He began coughing! If only he had a straw, he could have avoided neck hyperextension, he could have better controlled the amount of water he was getting and his lungs would not have been at risk for aspiration or penetration. Because of his good cognition and oral motor function, I say give this man a straw!


Now, having said all of that, there is such thing as a bad straw. Maybe you know the ones I'm talking about? Bad straws are typically extra wide and usually hang out at places like convenience stores and fast food restaurants...stay away from them!

Bad -vs- Good

Good straws, on the other hand, are all over the place...believe me, I'm looking for them everywhere I go. He are a few straws I found this weekend at Target:

A Manon Jar style- how trendy! Bonus points for the no-spill top and wide grip handle.

A straw with stripes, what's not to love? Easy to grip and no-spill too!

             

             

These cups are my awesome because the straws are held steady by the cup itself. These may be too juvenile for some, so take that into consideration. 

My daughter loves silly straws...another good option.

This week, take notice of the straws you see and try to categorize them as good or bad- it's a pretty fun game. More than anything though, think of the people you know and ask...

Hope it's a great week for you. Cheers!

Through the lips and over the gums, look out stomach, here it comes!