#021: Navigating the First Few Weeks of Therapy

Feeling overwhelmed with all of, the different options navigating the first few weeks of therapy. So, this is one of our meatier topics. We've got a lot to dive into here, and our plan is to kind of, talk through the four main things that we want to get done and this looks different in every district.

I know some SLPs start therapy on day one, and they just start their sessions, and they're doing all the things. Some districts have a little bit more lead time. The first week is, you have time to get things setup and then you start therapy.

So, this plan that we're talking through is just, kind of, once you start therapy what that would look like. So, in the first week or two of therapy we really want to focus on establishing rapport with our students, establishing routines and expectations, and then we also want to make sure that we have baseline data.

So, those are my top three priorities in the first week or two, and we'll talk about different strategies to make that happen. And then in week two or three is when I'll start actually with ... Starting with the actual therapy. And then we'll talk about what that looks like too.

So, the first thing that we want to do, is we want to establish rapport, and it might seem like, "Why would we take time to do that?" But we all know if we have a doctor who is not welcoming, and he's just, kind of, rough our interaction with him is much different than with a doctor who's friendly, and nice, and helpful. And we're probably going to get better results with this more friendly doctor.

And so, just taking some time, there's a lot of research behind it, there's some citations in the references at the end of these slides and so, it is worth taking some time to make that happen.

And some things that we might be able to do with our students are, just to check-in, talk abour our summers, what did we do? And it's also a great way to ... Because we're always looking at different components, this could be an opportunity to collect a language sample too, so we're collecting some data as we're establishing that rapport.

But let them tell us about their summers. I would model first and tell a story about my summer, and then everyone in the group could go around and tell a story about their summer. That could be an example, or we could just have a conversation about what we did over the summer and look at the interaction skills there.

So, we're always kind of, listening and taking in what the student is saying, but we also can use this as a way to start collecting that data and figure out where we're at.

Like, if we were working on K last year, and they're talking about how they went to camp with their beautiful K sound, then that's something that we'll note, and we always have our therapeutic brain on as we're doing these things.

Some other things that we might do if we're brand new to a school and getting to know these students for the first time, we might talk about what their interests are. What are their favorite things to do? And I often jot down notes so that I can be sure to incorporate some of their interests into therapy, because if they're engaged they'll also make that much more progress.

I also like talking about what their goals are. And we'll dive into this a lot more as we dive into the actual therapy components, but what do they want to be when they grow up? Do they have any goals for this year? Do they want to join the track team? Or do they want to accomplish ... Do they want to do some project or go on some vacation? What are their goals and how can we support them with that?

And then ... Yeah, just kind of, show your personality. Show your quirks and your interests. What are you interested in? Are you really funny? Do you like telling jokes? Are you a good storyteller? Are you a crafter? Do you make things? Bring in some of your interests into the therapy session too, because it helps the students get to know you and then it also helps make things a little bit more enjoyable for yourself as well as we're kind of, diving into all the things.

So, it works for our students, and it also works for us. And if we have a happy therapist, we have much more, awesome therapy sessions. So, that's important. Then we also want to take some time to establish routines. And we can do this in a number of ways.

And I'd like to talk about the why, behind routines as well, because it might make it feel like we're being robots, and it's super robotic, but there's actually a lot of research behind incorporating these routines into our therapy sessions, and it can be really helpful.

It makes it easy to incorporate evidence based practice into our sessions, because we can use these general principles that have been shown to improve student learning and outcomes, and we can use those to infuse our therapy sessions with those good practices.

And then it also makes it easier for our students. It gives them the cognitive resources to learn, because they're not struggling to figure out what's happening. They know what's happening, they know what to expect, and they can focus all of their resources on figuring out what to do, and how to make the most of the session, and how to really implement those new skills that we're teaching them, because that's what we want them to do. We don't want them to have to figure out what's happening in the session.

And then it also helps us. So, it frees up our own cognitive resources to be more flexible, and to do more problem solving, and to figure things out. And I think it's kind of, like a road trip map. If we know where we're going, if we are ... We're starting in Phoenix and we're going to New York. We're taking a road trip there, and we know that's where we're going. And if we know where we are, and where we're going, if there's a detour somewhere, if they're doing construction on one of the interstates or whatnot, it's easier to make that detour because we know where we are and where we're going. And we can more easily navigate that journey.

Whereas, if we're just like, "Where are we? What are we doing? Where are we?" And then it's just, much easier and just, less chaotic when we're trying to navigate the challenges that inevitably come up.

And it just helps increase student attention, engagement. Like I said, it gives them the resources that we need, and the research really does support taking precious minutes out of our sessions to do these different things. And we already talked about one of them, which involves the introduction, checking in with our students, kind of, establishing that rapport. And then we'll dive into the subsequent three steps as well.

So, with the introduction I like to take some time to check-in with the student. So, this goes along with establishing that rapport, and if I know that they love ... They do go-kart racing or something, and then I know that they had a race on Sunday and I'm picking them up on Monday for their session I can ask them how that go-kart race went.

And then in that conversation oftentimes other things come up. And I also like to do just, a general check-in with how they're feeling, and I'll give some different examples of visuals that we can use to do that check-in. And then I also review the goals, the students goals and I do that with the student, and that can be incredibly helpful for a number of reasons. And we'll dive into that in just a second too.

But first with that check-in. So, Nicole Allison has a free clip chart in her Teachers Pay Teachers store, and she uses it for behavior management, but I think it can also be helpful just to kind of, get it ... You can use it as an emotion check-in, if the student is ... If they're calm and ready to learn, they're green, or if they're kind of, sad or angry, maybe we can put them ... They can put themselves on yellow and red, and I would model this for the student first.

So, "My cat is sick, so I'm feeling a little bit worried and sad today, and I'm putting myself on yellow." But if they are like, "I won my go-kart race, I'm the champion," and they're super pumped up, they might put themselves on purple, because they're super pumped up and energetic.

And with either of those spans we could do some things to help them regulate and be in a place where they're ready to learn. Because, neither of those examples are going to be ready to learn. So, some examples that we could do are just doing a quick breathing exercise to ground ourselves.

We can dim the lights, we can have them sit in some kind of, alternative seating. Whatever will help kind of, bring them down or help them feel more comfortable. I've had ... I don't know, sometimes this is silly as a student, because I live in Arizona and it's hardly ever cold, but one of my students didn't have a coat, and he was freezing. And he wasn't going to pay attention to anything I was going to say, because he was just, so distracted by the fact that he was cold.

So, we, on the way from picking up, we just ran by the nurse and borrowed a coat and then he was ready to learn. So, sometimes it's just a quick little fix, or just a quick acknowledgement, a quick note, just something really simple and easy just to get them back on track.

And if they are very dysregulated we might have to take some other steps. Like, maybe they need to go back to class, and we need to see them another time, or maybe we need to change our plan for the session and do something that incorporates some more movement. We can be flexible and take that into consideration.

And you kind of, you learn this over time, and you learn to read the students, and you learn to know what is going to work and what won't work, but I think if you're still figuring that out this can be a good framework to start putting those puzzle pieces together, because sometimes it's just, not going to happen, and we need to find a way. And if it's a quick 30 second fix I will take that.

Another strategy that one of my special education teacher, friends uses is a temperature check. So, this is the visual that goes with it. And this matches up with what I was talking about with modifying Nicole's scale. But she has her students come in, and she sees larger groups, and so when they walk in they just put up fingers for how they're feeling.

So, if they are having the worst day ever they'll walk in with one finger up, or if it's the best day ever then they'll put a 10. And usually there's a verbal response that comes with their number. And then she uses those strategies too, and because she has larger groups she might get some students to start working while she checks in with the student who's having a one day, or the student who's having a 10 day and she just, kind of, triage's it as they come in that way. So, that's how that works.

And then for goal awareness, because I said I like to check-in with my students goals as one of the first things in the session. So, there's different ideas here. So, I've created some ... And you could actually get these for free, and I'll share it in the blog post too. I'll see if I can pull it up real quick for you in the chat too.

But I just have these little goal cards, and I have students write the goal in their own words, because I want to make sure that the student understands what their goal is. And sometimes we'll add ... It looks different for the different levels of students, but for some students we might add in a little bit about the why. Like, why that's important. I feel like all of, the middle school students that I've worked with want to become YouTubers, but that's convenient, because it works really well with a lot of our goals.

So, we'll just do a quick tie in, if they're working on story retell for example, that's important to be able to put together a good YouTube video. So, then we'll just make a quick tie in with that.

Another option ... So, I just print these out and just, cut little cards, and I store them in a pocket chart, and that's how I put that together. And I think this year I'll put them in the students actual folders, just in a little pocket. But both of those options could work.

And then they just grab that as they walk in the door, and then we review. And I usually just review one each time, like whichever one we're focusing on. And because they're paper clipped I can just shuffle them around. So, I can make sure that when we end the session the goal that we want to work on next is at the top.

But then we'll just check-in [inaudible 00:14:56] that goal and again, the student needs to know what they're working on for it to be effective, because otherwise they'll walk out of the speech room and say, like when someone asks them, "What do you do in speech?" Then they'll say, "Play games." But if we have this focus on the goals they'll know what they're working on. The research shows that it helps them make more progress and that awareness is so key, and so important.

So, here's the link to that. And so, there's just a quick, little, easy template that you can use to implement that. And then Nicole Allison also has some really cool common core posters. So, I did use this for a little while, I just made all of her posters and then I had the students grab the one that they were going to work on for the day.

I just thought ... Like, it just gets a little bit tricky, because then they ... I have to know what they're working on and then I have to help them find it, and it just took a little bit more time. And it wasn't personalized for their specific goal and their why. And so, I thought ... That's why I switched to more simple goal cards, but that's a really great resource too.

Okay. So, now we get to dive into teaching. So, we've done the beginning part of our session. We've checked in with students, we've helped them regulate, if need be, and then we help them ... We make sure that they know what their goals are.

The next component is to actually teach the skill. And this is one that I often skipped when I was first starting out, because I had ... It's not a focus in a lot of the things that you can purchase. If you purchase a workbook it's all practice, it's not teaching. And so, that's something that ... And if we're working on an articulation we obviously want to teach the placement before we have them practice it, because otherwise it's a disaster.

And so, that was one of my most common mistakes was that I would just skip that, and I didn't have the materials that I needed to really make sure that I could teach them well. Because a lot of these concepts, they're not super easy to explain. Like, we need visuals and things for students to look at.

Like, if I'm trying to explain past tense verbs just using my words the students get ... They get all the googly eyes, because it's not the most simple thing in the world, and I also don't want my students to depend on me and be ... Yeah, dependent on my verbal prompts and cues to be able to complete a skill. I want them to be more independent.

And that's where visuals come in. So, having a solid set of visuals for that teaching is key, because it helps break down the process for us, it helps us be more effective teachers of that skill, and then it also sets a student up for success and enables them to comprehend what we're talking about and make that happen.

So, we talked about this already, but I use the case load at a glance to break that down for myself, because it can be overwhelming to think about getting together visuals for 50 plus students who all have two, or three, or more goals, and navigating that process.

So, that's where the case load at a glance comes in. Just to find where the overlap is and to start building that library, and really getting the goals that we have ... The most common goals first, and then going from there.

So, that's a note on teaching. And then the next step is to dive into practice. And so, the research really focuses on using authentic context for therapy, and this is all ... it's all in our [inaudible 00:19:20] guidelines and there's a lot of research supporting the use of authentic context, and I think that it makes sense.

So, we want to make sure that we're supporting the student's ability to access the curriculum, like, to interact with peers, to participate in the classroom, because that's what our role is as school based SLPs, and the research shows that the best way to do that is to use context that naturally lend themselves to that.

So, if we want a student to participate in a social studies discussion we can bring some of that into the therapy room. And this is often referred to as curriculum based therapy, or literacy based therapy, because literacy is a huge component of the curriculum. And so, that's something that we want to think about as we're putting together that therapy.

And this could be a whole ... Like, I did a whole eight hour presentation just on this alone. So, we won't dive into all the nitty gritty behind that, but I just wanted to put that out there. And I'll share a quick example of just, how this ... Because I didn't always use this type of therapy, it was something that I learned to do over time.

But I was working with a student, he was in ... Yeah, he was in second grade, and he was making amazing progress towards his goals. I was so excited, and I went to tell the teacher like, "Look, Johnny is meeting all of these goals," and when I went to talk to her I showed her the goals and how he was meeting them, and she said, "Well, he doesn't do that in class, and he doesn't do that in class, and he doesn't do that in class."

And one of the examples was following directions. He could follow three step directions in my classroom, or in my speech room, but he wasn't following any directions in the speech room, or in the classroom.

And it was just, really ... And I observed him and I looked at some work samples, and there were some really, really simple examples of things that he totally should have been able to do based on what I was seeing in the speech room, but he just wasn't in the classroom.

And so, I was able to ... That was the big eye opener for me, and I was able to do some really little adjustments, like sharing some visuals with the teacher. One of his goals was working on WH questions, and they had ... So, this was in second grade, but they had simple questions with multiple choice visual answers, and it was just, a quick little quiz they did and he didn't answer any of them. And they were just simple WH questions. Something that we had been working on for a really long time.

And so, the teacher ... I just shared the WH questions visual that I was using in the speech room and then the teacher used that, and then we suddenly saw his performance increasing. Because I think they just, they don't always see how, what they do, especially for using drill cards and things like that, they don't see how that skill connects to what they're supposed to be doing in the classroom for some reason. I don't know, it's really interesting how that works.

But because I helped build that bridge he was suddenly starting to apply the concepts that he learned in speech to the classroom. And so, that was just, a really simple example, but it's just amazing the impact that I can have.

I could tell so many more stories of how just connecting what I was doing in the speech room to the classroom, how big of an impact that had for students. So, I know it's another thing to tackle, but if you're feeling good about this back to school stuff let me know and I'll share some resources there, because it's so huge.

Okay. And then another thing that we want to consider when we're providing practice is, that we want to facilitate success, we want to avoid that negative practice. If a student is constantly getting things wrong, then that motivation will start to tank, but then they're also not learning how to do it correctly.

So, it's kind of, a double edged sword there. And so, we get to use that prompting hierarchy that we're so incredibly good at, to provide students with the support that they need. And if we are pulling things from the classroom, if we are using text from the classroom those at a higher level than the worksheets that we might pull, or the decks of cards that we might be using.

So, we have to be especially mindful about the level of support that we're providing. So, we really have to step in and provide those different types of scaffolds and supports when we're using those more challenging materials in the therapy room, but we can do it. It works and it's totally doable.

So, one of the ways that we can do that, and just to make sure that we're being therapeutic when we're using these types of activity, is this framework by Ukrainetz, And it was in ... She describes it ... I'm sure there is other articles out there, but the best resource that I can share is her book Contextualized Language Intervention.

She does a really great job breaking down this framework and it's so helpful. And then it just ... I use it kind of, as a checklist to go through if I walk out of a session and I'm like, "Oh, that didn't go so well." I use this framework to figure out how I could improve, and to pinpoint what the issue was. And it works so well. It's amazing.

So, RISE, it stands for repeated opportunities. So, if we want to be therapeutic, we want to make sure that the student has repeated opportunities to practice the target skill.

So, if we are working on past tense verbs and we have them use one past tense verb one time, that's not enough repeated opportunities. They're not going to learn that one verb, and nonetheless all the other verbs that we need them to learn.

So, we want to have repeated opportunities. Then INTENSITY refers to what we decide when we set up their schedule or write their IEP in the first place. How often do we want to be seeing these students? And that's something that we, like I said, we decide as a team, usually on a yearly basis, but if they're really not making progress that's something we might want to revisit and look at.

And then the third section is systematic support. So, that's what we were just talking about. We want to make sure that we're providing those visuals, the verbal cues, those prompts and all of, the different scaffolds.

So, one example of a different type of scaffold could be reading something out loud for a student, or it could be working on a skill in a quiet room one on one, versus in the classroom.

And so, those are just, some different things that we can modify to set the student up for success and make the task more attainable. Then E stands for explicit skill focus, and that's what we ... We've got that covered with our goal cards.

So, when the student walks into a session they know which skill they're going to be targeting that session, and I typically focus on one skill and just focus on that. And maybe, if they're starting to master one we might incorporate more, or if we're doing an [inaudible 00:27:20] activity we'll do a little bit more.

But typically it's just, mainly focusing on one skill at a time, then we might jump between different skills or whatnot, but that's typically how that works. And the student just needs to know what they're working on at any given time to be able to check that box.

So, it's just, a really great framework. It's super helpful if you're diving into more of that contextualized practice, because it helps us ... It just makes sure that we're being stellar therapists. Rockstar therapists. And that's what we need to rock our school year, right?

So, then once we've gone through all of those different steps of the therapy process we want to recap the session. So, we can review performance, and we want to give them specific feedback. And it might be on actual task performance, or it might be on how hard they worked and giving that really specific feedback. Like, "I loved how you kept trying on the grammar game, even though it was really hard." And it's just, giving that specific feedback, instead of, "Good job," is really helpful.

And then for older students we can talk about how we might reflect on how the session went for us using our little framework, we can do that with older students too, and work on kind of, that self-awareness and that can be really key when it comes to generalization.

And then, we may do this on our own, or we may involve the students in the process, but the end of the session is a great time to make a plan for next time. Like, "Based on how things went what can we do next time, and what makes sense there?"

And we might also assign some homework and give them some extension activities to work on. And then just, any connections that we can make. If we worked on something that is related to what they're doing in the classroom we can have a mini ... We can just make a quick plug there. Like, "Hey, we worked on this vocabulary and this is what you're going to use later today in your reading class." Or, "Hey, we just worked on ..." For some of my students it was ... Like, my third grade teachers had a professional goal to ... I forget what the goal was called, but their group goal was to achieve a certain percent mastery on these really challenging word problems that they had to do, and that involved a lot of language.

And when they were talking about it, it was like, "Oh, that would make sense for all the students that I was working with in their classroom." Because it involved their different vocabulary, and syntax, and comprehension types of goals, because it involved understanding the math word problem and then explaining their reasoning, which is so good for language.

I never thought I would do math activities in speech, but I did. And so, we were able to ... Sometimes we worked on the actual word problem, and sometimes we worked on the component skills, but we always connected it back to, "Okay, so we did this type of thing, and this is going to help you in this way."

And so, we just, kind of, helped to bridge that gap. And maybe, even make a plan for how they could use their strategies. If I taught them a specific strategy, if I taught them a strategy for using context clues like, "Next time you see ... The next word that you see, that you don't know in your whatever textbook, then do this." And we would make a plan and sometimes they don't do it, but at least we're planting that seed.

And then I just mentioned this briefly, and we'll talk about homework more in the parent section, but additional practice can be really important for carry over and continued practice. And I will be the first to admit this is something that I struggled to put together, so I'm excited to share some different ideas and strategies in the parent communication section, but we have lots of different options.

We can send home worksheets, we can send home folders, we can use communication apps, or we can send home monthly handouts. Whatever it may be. We can get creative, but as long as we have ... Or we can reach out to parents and have phone calls every so often, but I think that extension piece is really important, and if we can get parents on board then that is always a win.

So, that's the overview of what we want to do with our therapy routine, and hopefully that gives you some different ideas. Hopefully you're doing a lot of these already, and so it's a confidence boost of like, "Yep, check. I'm doing that. Check, check, check." And then maybe there's one or two things that you might want to implement in your own therapy routines. Some new ideas or some tweaks and adjustments that we can add to just, keep stepping things up.

And just one note here is that, this isn't always a parallel, or just a nice, little cycle. Some sessions, we might have to spend a lot more time in that check-in phase. And sometimes we'll spend almost a whole session teaching. Sometimes we'll just get to dive, quickly run through those in a matter of seconds, and spend our whole session with practice and just a quick wrap up.

And so, it just, really varies. And sometimes we might start with a check-in, we might start teaching and do practice, and then have to go back to check-in. And, so, we're constantly adjusting and it's not like, "Okay, first three minutes are check-in, then we do our teaching for three minutes, and then we practice, and then we wrap up." It's not always going to be the same, and that's okay.

And it shouldn't be exactly the same each time, because our work dynamic, our students are dynamic, our sessions are dynamic, and their brains are learning and adjusting. And so, it's not supposed to just be a perfect little cycle. And so, I think that's helpful to consider and know in case you think it is supposed to be that way.

And then it also might not apply perfectly to all types of students. So, some students might need a slightly different routine, and they might need different components in the session to help them be successful.

And so, we can use the data and use that RISE framework, and all of those different components, use our problem solving skills to figure out if something's not working, and if we need to make a change.

And that's why we're spatially rich pathologists, and not speech robots, because we get to make those decisions and really analyze what we're seeing in our sessions to make the best decisions, and adjustments for our students.

Okay. So, now we got through the routine and we're diving into some baseline data. So, this is something that ... So, I went into quite a bit of detail on the routine, and we just want to kind of ... We want to just, establish some of, the expectations around that. And our initial sessions might not include ... Well, our very first session with a student might include a check-in and it might include some of that.

Maybe it will include some teaching, and instead of teaching a specific skill we'll be teaching about the routine, and then we'll practice different components of the routine.

So, you could look at it that way, or you could just, like with older students you can explain, "Okay, so, when you come in you grab your goal cards and then we kind of, get ready for what we're going to practice today. And we just do some teaching, and then we actually practice it, and then we're going to wrap up."

And you can talk about it in student friendly terms, kind of, how I just went through it. Or you can just teach it in action and not have as many words around it. So, there's just, different ways to set that up at the beginning of the school year.

I saw one SLP who had ... She made four pieces of colored paper for the four steps of the routine. And she just ... I think she used a paper clip or something to move through the different sections for her students, so they knew what to expect. And then I imagine as they came in being like, "Okay, so, we're going to do our check-in and then we're going to ... We're doing some new things today, so we're going to spend more time teaching and we'll just do a little bit of practice." And maybe she used it that way.

So, there's just, some different ideas depending on what you're group need. But before we dive into all of, the therapy, we want to have an idea of where we're starting. And I think it's important to first build that ... Establish that rapport, build those routines, but then we also want to know where we're starting, like I just said.

And so, you can do this in a number of ways. It really depends on what your schedule is, and how quickly you're starting therapy. For some of my schools I would have to wait for all of, the other schedules to be put in place, and sometimes it took a really long time and I didn't have my official therapy schedule until a week or two into the school year. I think one time it even took longer than that. I'm not sure though.

But I didn't have my set group schedule, so I decided just to start pulling students individually and gathering their baseline data that way. So, I'd just run through my probes and just, update that, so then when they started coming together in groups it was just, really easy, I knew exactly where everyone was, and I didn't have to deal with trying to take data while managing other students.

And I think that's ... If you have the option to do that, that's really amazing and you could just have your probe week, and it's a good opportunity to check-in with students individually. If some of them are more shy, or just, maybe they're more likely to open up if they're not surrounded by their peers.

So, that's one option, if that works for you. I really liked using that in the past, but another option could be to ... Because if you're doing this in a group you might just have some different activities going on that are related to establishing that rapport or even diving into some skill practice right away.

So, you could set up stations, if you're going to do a book unit maybe you can have one station where the students are doing probes with you, and then another station has where they're doing ... They're listening to the book on audio and that can be a station where they're going through that.

And then another station can be where they're doing a pre-story knowledge activation and you can just have them move around, or you can have a back to school themed activity. So, there's different ways that you can set this up if you're not able to see students individually, but I think that's ... It's just, a really good use of time to get that figured out right from the start.

And then in terms of organizing this, on the goal cards that I showed you guys I just started writing the number ... A number that corresponds to that goal, and I just have a massive binder that has all of, the different assessments in it that I want to use.

So, then when I pull up a student's goal card I can see what number that is, and then I just flip to that tab, because they have super cool, mega number tabs and I just flip to the tab, give them the assessment that corresponds to their actual goal, and that measures it in the way that it needs to be measured. I just collect that data and enter it into my online system, and I don't keep all the paper sheets, I just have the template that I run through, and that's how I organize that.

But you can ... If you want to have data sheets, probe sheets for each student you can put that together too. There's all the options in the world to make this work. So, those are my tips for gathering baseline data, but I would strongly suggest that you revisit the students IEP goals and make sure that the probe matches up with how the goal is written, otherwise Parker's report time will not be very fun.

And I think it's a really good habit to make sure that you have probes or assessments for the goal when you put it into the IEP going forward, and that's just an action step that I add to my checklist to make sure that I'm getting that set up so that I am totally set up for success and ready to go.

And that prepares us for therapy. And we have got a really good start already. The students know their goals, we have a routine around our session, we have a way to collect data, we know where we're starting and hopefully, if we did like that case load at a glance, we have the visuals that we need to teach the skill and then we just need to find something ... Once we have those pieces together we just need glue for the session. We need something to piece it all together to work on all of those different skills.

And this is more of a logistics type of course. We won't be diving into too much detail on how to do all of, the contextualized intervention and all of that. Like I said, that would be a whole other day seminar, but hopefully we'll be able to walk away with some quick, actionable tips to make this happen in the meantime.

So, we talked about this quite a bit already in terms of the SLPs curriculum. We don't have a textbook or anything, but we have a built in set of strategies and you are your best therapy tool, or your best therapy resource. All of, the strategies and the knowledge that you have in your brain are what help your students make progress.

Sure, it's nice to have a great activity, but you have ... Your brain is what is driving that change with the students. So, that is incredibly important. How we structure our sessions, and what we're doing in the session really matters.

But it can be helpful to have some additional supports, and visual supports are huge and there's some really nice research behind that. We've talked about it a little bit, but some of, the ... It can help us structure our therapy, it increases student independence, because we don't have to talk as much. We can refer to the visual, instead of going into a whole spiel explaining how something is or how it works ... Sorry about that.

And then it's also easy to fade the use of the visuals. So, when we start introducing a skill we can hold it right in front of the student, we can point to it, we can talk through it, we can reference it all the time, and then as they start to understand the skill we can maybe, just point to it without using any words, or we can just put it on the student's desk and not point to it.

And so, it's really easy to gradually fade the use of that and just, kind of, as the student makes progress we can back off, and it's just, really easy to do that with a visual, because we have more [inaudible 00:44:30] there.

And then we can also ... Like I shared in the story, it's easy to share that with teachers to help with generalization, if we have a visual that's really working for a student we might print a mini version and put it on their desk, or we might put it in their binder, like, in their math binder and so, when they open up to do that crazy math word problem they'll have whatever strategy I taught them to make that ... To help them be more successful with that.

So, that can be a really great strategy. And then, it can be time consuming to create this, but that's why we have that case load at a glance, and we just tackle it one by one. We can conquer anything, just one little step at a time.

And so, just taking the time to build that up is a really, really great use of time. And we can find these materials in a number of places. So, sometimes the best visuals are a Crayola marker and a white piece of paper, and we just knock it out in the session.

And sometimes that's all we need, and sometimes those are the best visuals, because they're made specifically for the student. We can pull ... Sometimes teachers will have really great visuals, and it's nice to be able to pull from what they're using in the classroom to help bridge that gap.

Sometimes that doesn't do the trick though, and sometimes they need something a little bit more specific, or the teachers don't always have the best visuals to explain how certain skills work.

So, we can also go to Teachers Pay Teachers. There's lots of options on there. And then I have the SLP Now Membership, which includes lots of different visuals as well. So, that's another option to find some of those visuals.

And here are just a couple examples to give you some ideas. So, these are some of my favorites. The Expanding Expression Tool, which I'm sure most of you, if not all of you have heard of. It's a really great multi-sensory tool. I think students just connect with it right away, and it's a nice way to build on some describing skills, and that's a nice example of a different type of visual. It includes the sensory element as well.

Nicole Allison does a really great job with her intervention binders. She does a great job of breaking skills down for our students, and she has some really nice examples there. I have created a bunch of different sets of visuals as well. I have these, just, little strips that I used to hang on my therapy wall, and they just include super, super, super quick, simple explanations of different skills.

Since then I've moved to bigger visuals that go into a little bit more detail, and that helps scaffold different parts of the skill. And I just store them in a file tote in this roller bag. I think it's meant for ... It's from Michaels and it's meant for sewing machines actually, but it fits my visuals perfectly. So, I just put this file tote inside and then I label all of, the different skills that we're working on, and then you can see that I also have my assessment binder in there.

But I like this system because I can just wheel it close to my therapy table, and then if I go into the classroom or if I go to a different school it's just easy to transport my most used therapy materials, and it just works really well.

If students get familiar with a system and they're able to just pull their visual for whichever skill we're working on, and that works really well. And I just print and store them in sheet protectors, because I feel like ... Well, that's the fastest way to get started, because we don't all have a ton of time on our side.

And it works well, because we can easily make copies and we can use dry erase markers to right on the sheet protectors, and it's just, really easy and simple. So, that's my motto, "If it can be easy and simple we can go with that." So, those are some examples.

Here are some more. So, this is how I used to organize my skill packs too. I would put the little manipulative cards in a little pencil pouch, and then I would put the visuals, and assessment, and practice pages in a plastic portfolio folder and that, I would just have a folder for each skill and then I would pull that. So, that's an option if you like focusing ... If you like everything for one skill to be in the same place.

And then the tote here, it's like a deconstructed version of that. And I thought that just worked a little bit better with my workflow, but I wanted to share the other example in case that's helpful.

And then this, I used to have this cart and I would store the different folders up top, and I just used a binder clip and just cut out a little piece of sticky labels to label the different skill packs. So, if you're looking for ideas to organize those, that's one idea.

And I kept this close to my therapy table, because it just had the stuff that I used most often. You can see it has some books in there, and some different worksheets and activities. I have my iPad right there, because I like to pull up some different activities on the tablet too. So, that's one option.

This is just showing on the left, we have an example of the different visuals hanging on the wall, and then another option could be to use one of these carts with all the drawers in it to organize the different visuals as well.

So, just throwing some ideas out there in case one of them gets you particularly excited. And so, we've got a really great system going. We've got our routine, our data, a plan for our visuals and now we just need something to piece it all together.

And so, I've just got a couple examples for you, and then we'll dive into the next module. So, the first thing is, this is an example of how I worked on narrative skills, or story retell using a book called The Gingerbread Man Lose in the School.

And I really like this one around the holidays. A lot of times they'll do some ... Usually in the younger grades they'll do some fairytales, but this book is appropriate too for the older students, like if they're doing anything related to gingerbread, stuff in the classroom I take any chance I get to pull this one, because it's like a cartoon.

So, the older students are receptive to it, and it's just, it's a nice ... It's an easier read, but it still has really great vocabulary and different targets. And great for compare and contrast, and comparing and contrasting to the original story and all of that good stuff.

So, that aside, when we were working on story retell, this is just a snippet of a small activity that I did. I typically have a month long unit where I dive into a book, into a lot of detail and we work on all of their different goals in the context of the book.

And the story retell activity is one of the things that we do later in the unit, because it's a great way to integrate a lot of different skills.

So, there's so much research on there. I did a presentation on vocabulary a couple months ago, and there was so much research on using story retell as meaningful opportunities to practice vocabulary targets.

We're creating sentences in our story retell, so it's a great opportunity for embedded grammar practice. It's a great opportunity for perspective taking. I just talked to a social language expert and she uses narratives and story retell in her social language group, specifically because it's such a great activity for that.

So, there's so many great activities that we can ... Or great skills that we can target in the context of a book like this, and story retell just incorporates so many of the goals in one, nice activity. So, this is an example of how I did that with The Gingerbread Man Lose in the School and I just used some of my different story cards to help scaffold their retell of the story.

I also have sets of visuals that students could use to match the appropriate story grammar element, but with this group of students they were a little bit more advanced and they didn't need the visual support, we could just fill in the graphic organizer.

And as you can see we did a very, very simple version, because the goal is for them to retell the narrative, and I just wrote down enough for them to be able to retell this story.

So, it's not like, writing out the whole sentences necessarily, unless that's a support that the student working on syntax for example, need it. It's just, a really great way to combine all of these different skills.

And then this is an example of what that looks like for Little Red Riding Hood. And this is just the example of the interactive activity. So, all of these are little, interactive pieces and I used sticky tack to attach them to the organizer, and then we can move them off, we can stick them to the board, we can stick them in pages of the book. Lots of different options there.

And then I also have the vocabulary cards and the WH question cards. I just store those, it's kind of, hard to see, but this is a little pocket from the Target dollar spot that I use to store those little cards.

So, that's just an example of how I put that together. And again, like I was talking about with The Gingerbread Man Lose in the School, we go through an entire five step unit where we start with pre-story knowledge activation, because a lot of our students are missing some of that background knowledge that they really need to comprehend the unit.

And of course, this is customized and adjusted for each student, in each group depending where they are. So, we know, as clinicians we can use that clinical decision making to figure out what makes the most sense for our students, but we start with some pre-story knowledge activation, then we read the story, we do comprehension activities.

Which a lot of times does include the story grammar activity sheet, because it includes a lot of comprehension. They have to know who is in this story? When did this story happen? Where did it happen? What was the problem?

And so, that involves a lot of initial comprehension and then once they're comprehending it, then we can move onto really specific skill practice and diving into all of those components. And then we work on integrating, practicing those skills, and then integrating them in the subsequent steps of the unit.

And so, that's a super, super quick overview, but if you're interested in learning more, like I said, happy to share different resources there.

And then this is an example of what we could do with a narrative organizer without printing it out, if you're just trying to do some digital therapy to get yourself started.

So, I pulled this into an app called Notability and I will share these names in just a second. But Notability is an app that you can use to ... You can take a picture and draw all over it, you can import a PDF and draw all over it, you can add pictures to PDFs, like I'm doing here.

So, with this one the students needed more support, and so we took a picture of the character in the book and used it to fill in the organizer. And then afterwards we can print it out or do whatever we need to do to support the students there. But it's just, a really great way to add additional visual supports, if they need those.

And then just a couple more ideas, and then we'll move onto the next sections. So, now just one other idea for following directions. If we're sticking with The Gingerbread Man unit and we're just needing some different extension activities to work on following directions, in general I would target directions in the context of therapy.

And so, if they have a goal to follow directions I would identify what's causing them to struggle with those directions. Like, if they're missing some of, the vocabulary that they need to understand the direction, I would target that, or if it's more of a attention or kind of, executive function strategies we can dive into those and target those in the context of the session.

So, I would give them additional directions and give them visuals to work on those strategies, but sometimes we just need a little to really hone in those specific strategies, we want to dive into some more of the specifics and give them lots of repetitions in one go, so they can really understand and use this strategy.

So, one example of doing that is, I have different visual instructions for different crafts, and I don't know if there's anything else quite like that, where they have the different pictures of the crafts, but you can find YouTube videos and take screenshots of different steps and any kind of procedure.

But then I just cut out the different steps of the cards and then I'll verbally give the directions as I show it and pair it with the following directions organizer. So, if one of the things we're working on is syntax, then I definitely want to use something like this, because I want to get them more meaningful exposures to the different directions.

So, the directions with, after in the middle, actually have a reversal and that's so confusing. So, if I say, "Dance after you laugh," the student has to laugh first and then dance, and it's just out of order and it's like [inaudible 01:00:19]. I am sure you guys know with out of order directions.

So, with this type of activity we can do something that's related to what we're working on, all the other students can still use the different vocabulary that we've been working on, but the student working on following directions has the opportunity to practice using this more complex syntax and we can manipulate the pictures and move them around. And I can give him directions as he makes his craft, or if there's another student working on it, maybe she can give the directions to the other students and then she has the opportunity to give the directions to multiple students in the group.

So, those are just a couple ways to work on that. I am trying to share as many ideas as possible, but then still staying on track with the time. So, let me know if you're wanting any other specific ideas, but I just thought I'd throw that out there.

And this works with older students too. So, I was reading an article about forensic science with a group of middle schoolers, and you might be thinking, "Oh, those are Fisher-Price animals. Why did you do that?" But that was all that I had in the therapy room at the time that would work to navigate this different vocabulary.

And it actually ended up being a really amazing lesson, but we used the same framework where we go through the five steps of doing pre-story knowledge, activation of reading, comprehension, specific skill practice and all of that.

But with these students when we're working on vocabulary there's some research to show that pre-teaching the vocabulary is very helpful, and I was just learning this when I was working with this group of students.

So, I didn't do that initially, and we just read the article and I did the comprehension activities, and they didn't comprehend any of the article. Like, the vocabulary. Detective, evidence, victim, suspect, criminal. That was really tricky for them.

And so, we were able to go back, and we changed the order a little bit. It was like, an example of what I was talking about with that graphic. We changed the order and we started working on the vocabulary first, I taught them those words, I gave them tons of exposure, tons of meaningful exposures to those vocabulary words, and then we read it again and did the comprehension and were able to dive into all of those activities and comprehension just, it went through the roof.

And they even retained the words when they went into the classroom. So, this works with older students. I know I gave some more examples with the younger ones, but we can use the same framework and maybe not use Fisher-Price animals, maybe we should have just printed out pictures of ... Like, it would have been so fun to have pictures of people in magazines or something. That might have been a little more appropriate, but it worked for this example and sometimes you just use what you have.

But some really helpful sites are Reading A to Z. That's where I got the forensic science article. And that was ... A teacher was using that and I decided to support what they were doing in the classroom. That was really great. News at ELA is great. They offer leveled articles. So, that's really nice if one of your teachers happens to be using Newsela, and your students are at a lower reading level you could pull the same article at a lower level and still use that in your instruction.

And that is a really nice way to scaffold and support students, and then when they go participate in the discussion they still have an understanding of the basic concepts, which is really helpful. And then ReadWorks is one of my favorites too. And I actually started creating month long units around some of their articles. So, if you're looking at implementing this and want some materials I'd love to share some examples of that with you.