16 kids in 6 hours, or New Math

On most Mondays, I’m supposed to see about 16 children.  The kids are at the center from 8:30a till 2:30p, so I need to see 16 kids in 6 hours, including my gracious 30 minute lunch, so that’s actually 5 hours 30 minutes, an average of 20.6 minutes per child.  Most children are supposed to receive 30 minutes of therapy, and some get 45 minutes.  How is this possible?  Well, it’s not new math, my friends; it’s grouping and getting creative.  Grouping, in a traditional sense, looks like 3-4 kids sitting around a table in a little closet doing flash cards or a board game working on telling stories or the /f/ sound.  In inclusion therapy, I’m “pushed in” to the classroom, doing therapy during circle time, center time, and outdoor play.  While it’s nice I don’t have to pull a child out of something as cool as making pancakes, or as important (to me, anyway) as storytime, it can be challenging to feel like I’m doing therapy sometimes.  Which is where creativity comes into play. 

Hey, Josie and Anna are both at the sand table.  Josie is working on social interaction with peers, and Anna needs to work on having two-way conversations with human beeings.  Instant group.  Another time, I sit down with Juan to play a board game, casually yet effectively emphasizing words he misarticulates, when A.J. wanders over, wanting to play.  Then Martina spies what looks like a rousing game of Chutes & Ladders.  Never mind that Martina is not on my caseload.  I justify having her as a mature speech “model” for the boys, and I work with Juan on his /s/ blends (spider, snowman, sleepy) while I gently drill A.J. on his /k/ sound.  Instant group.  Yet these are the easy ones.  There’s circle, outdoor play, and breakfast to contend with, not to mention “small group” (a curricular institution I have yet to fully grasp the concept or purpose of).  Sometimes, when I’m supposed to see 5 children in 2 hours (24 min/child), and one of them is supposed to receive 45 minutes of therapy, and they all have the nerve to show up that day, I sandwich myself between two of them at breakfast.  I dole out Cheerios for Anita as she smacks her bowl to ask for more, while talking with Charlie about what he did last weekend or where he wants to play today.  At circle time, I am able to “support” Parker by seating him on my lap so he’ll attend to the story, while modelling gestures, signs, and choral responses (so Gina can follow along, and to increase her participation, while encouraging Dominic say some of the words the teacher leaves out) to “We’re Going on a Bear Hunt” while the teacher reads.  And somewhere along the way, if I didn’t sit at circle with Parker for 30 minutes, I’ll add onto it later by cuing him to ask for help putting his coat on; for Dominic, I’ll sit down with him during free play and do a puzzle; and for Gina, I’ll sit in the kitchen while she doctors up a baby doll.  Each kid can’t get 30 minutes of my undivided attention, nor can I work directly on therapy goals each day.  Many times, it just looks like crowd control, or herding kittens, just trying to get everyone to go along with the classroom routine.  And that’s usually okay. 

Today, however, instead of my usual 16, I had 6 kids out!  Some of the medically fragile kids are out with regularity, and some kids, due to their diagnoses, take longer to recover from ear infections, but my Monday group is strong.  Not only that, when I checked the absentee list on my way to the classroom at 8:32am, only one name was on it — a child who is not on my caseload.  Yet when I arrived downstairs, I was informed that two were absent from one room, and two more from another class.  And in the afternoon, as I dashed in from my manic lunch/note-writing marathon, I found only 4 kids on my caseload, down from 7.  So I got ahead for later in the week by seeing 2 Thursday kids, but, more important, I felt good about the therapy I was doing today. 

I spent a focused lunch period working on imitation with a 3-year-old boy with autism.  He whose IEP said he was not imitating anything and had no words back in October was imitating myriad syllables for me today: ba, bee, bye, bo, boo, pa, pee, pie, po, poo, ma, me, my, mo, moo.  And on and on.  Each time I got to a ba, pa, ma, ha, da, or ka word, I’d linger on the ahhhhhhh long enough for his mouth to be open, and I’d slip some pureed bananas inside.  Working on eating at school (a goal) and imitation of speech sound (another goal) during focused practice.  Damn, it felt good.  Then, seeing how attentive the kid was to me, his “girlfriend”, one of the teachers threw 2 syllables together so the kid said my name.  And as lunch finished, I signed and said “all done”.  And so did he. 

The two little girls, Josie and Anna, really were at the sandbox together today .  According to the teacher, they’ve suddenly discovered each other, which is a real boon to me.  I was able to sit near them and observe as they made “pancakes” together.  I cued Josie to ask Anna for some sand, and she did.  I was able to convince Anna, the stubborn one who only wants things her way, to trail after her friend Josie to do puzzles together, even though she at first flatly refused.  They finished, then took my suggestion to trade puzzles, and finally to go find new puzzles.  As one left the table briefly, the other wondered aloud, “Where’s Anna?”  It was all I could have asked for. 

Finally, with a boy who takes most of lunchtime to process that we’re having lunch (seriously — lately he’s been starting to eat during the last 5 minutes of lunch), I got some fabulous imitating and requesting for stickers.  He sat next to me, and 25 times said “Shickuh” or “sickuh” when I asked him what he wanted.  This from a kid who usually mechanically pats his chest — a sign which is supposed to mean “me” or “mine” — to mean anything from “I want more” to “My turn” to “You took my toy” to “I want to play in the block area” to “It’s time to get coats on to go home.”  Somehow he was just cued in today, had taken up residence on the planet.  He liked my goods (stickers, of course), he had a plan (to cover the perimeter of his paper with circle dot stickers), and all he needed to do was ask.  Sometimes it’s so simple. 

Days like this, when I only have to see 11 children, when I feel like I’m using my education, when I’m seeing children make change and progress, are days when I feel like I’m doing good therapy.  Not all days can be like this.  Many more are insane because teachers are out and kids are in, because lunch is late or the fire drill lasts too long, or because I’m grouchy and so are the kids.  Yet days like today, where I feel like a real speech therapist, will hopefully get me through the other days where I feel like a coat zipper, a shoe tie-er, a nose wiper, and a seat belt.  You know, days like tomorrow.

The Caseload — She Groweth

I am the only speech therapist at the center I work at 3 days/week.  The other 2 days, I am in the field, itinerant, going into head starts, daycare, and church basements.  My center, unfortunately, has a caseload more suited for a full-time person, or at least, 5 days’ worth of a therapist.  We had that back in September, actually, but the other gal left november 4th for a new job, leaving almost half the kids at the center without speech therapy.  I picked up as many as I could while still managing the new kids coming into the classrooms I was already committed to.   At present time, I am seeing 38 kids in 3 days.  Logistics are a bitch, as I overlap with the kids only on certain days.  Many only come in 3 half-days, so I end up having to see Johnny on Monday morning, and Quadir on Thursday afternoon.  And of course, for every child who’s highly capable and only needs service 30 minutes a month, there are 2 kids who need extensive support 60 minutes a week.  So the number 38 does not tell the whole story.

What about the other 27 kids not receiving any speech therapy?  Well, we say that they’re “unmet needs” kids.  We acknowledge — to those who ask — that we have no therapist for them.  They’re still in a special ed or regular ed classroom environment, a language-rich environment with highly trained teachers, etc.  But we’re not able to fully meet their needs as per the IEP.  So they go on a wait list, waiting since November for speech to pick back up, or (for new kids) to begin at all.  All of which feels pretty yucky. 

How do parents feel about this?  Well, for the ones who don’t ask, they don’t know.  We offer full disclosure, but it’s kind of a don’t ask- don’t tell policy.  Who gets service?  Who doesn’t?  Is it based on need?  Which classroom the child is in?  Which teacher has a louder voice or asks nicely?  Nope.  It’s based on which parents know their rights.  They’re the ones who demand service, my friends.  And they’re the ones who get it.  I now have 2 extra children on my caseload who came in after November 4th, in a classroom where I do not support any other children officially.  One child’s parent seemed so anxious, so eager to have speech therapy, that I was asked by our director to support that child.  He has a new diagnosis of autism, after looking like a typically developing kid for the first two year of his life.  He has a young mother who does not speak English.  She is desparate for support, for help, for herself and her child.  So I took it.  Kind of as a favor.  The other child is the most beautiful child at the center.  He’s a tiny round-headed boy with straw-blond hair and elfin eyes.  All he’s missing are pointy ears and you might believe he had been born out of a flower with dew on his freckles.  His mother knew her rights.  Demanded service.  And probably compensatory time as well.  His level of service: 60 minutes a week.  Guess who stepped up to avoid getting taken to due process?

It’s not that we’re doing anything illegal.  Really.  Our parent agency tells us to take in children even though we cannot fully meet their needs.  We report them.  We have them on a list.  But the parents, many of whom do not speak English, do not know their rights, or are too new to the world or early intervention, just do not know. 

The second child’s evaluation report read like a parent’s worst nightmare.  Autism spectrum diagnosis, global delays, poor social connection, avoiding eye contact, tantrum behaviors, and resistant to talking.  The child I encountered when I first began seeing him in March was a different child altogether.  He’s highly social, and has a best buddy in the classroom with whom he plays cooperatively.  He makes eye contact, shows adults his work with pride, and is now imitating 3-word phrases with me.  When I gently frustrate him to elicit language (e.g., block his path so he has to tell me to move), he readily responds verbally, sometimes by signing and saying “move” or “beep beep”.  Either he has made untold gains in 3 months of just being at the center in a preschool setting (could be; what do I know?); or the evaluation was criminally wrong.  Why does this matter?  Couldn’t it just be an assessment taken on a bad day?  Couldn’t his natural development have spontaneously accouted for these leaps and gains?  Yes, and yes.  But it does matter. 

That evalation report read so ominously for this poor child’s future, that the parents flipped out.  That report, written when he was scarcely 3, freaked them out so severely that they needed to seek out every single option for intervention.  And when they found out it was not being provided, they saw their child’s future jeopardized.  If it were my child, and I read that report, I would have done the same thing.  I have to hope my children will all be healthy and have typical (nay, exceptional) development, but if I were in their place, I would have fought tooth and nail to get my child what he was allegedly provided under the law. 

Give me involved, interested parents vested in their child’s education.  Give me parents who show up for conferences and read the mail I send home.  Give me parents who show you they care, and I’ll show you better therapy, faster progress, and a happier speech therapist.