ASHA-certified professionals are committed providing the highest quality care. Read below to learn more about how some of our members are making a positive difference in their patients’ lives.
How one speech-language pathologist is speaking up for her patients to try to get them the treatment they deserve
Starr Cookman is a speech-language pathologist by training, but her role has come to encompass so much more. “I become many things to my patients,” she says. “Sometimes a resource and a teacher, but more times than not, a counselor or adviser.”
Most recently, she’s added a new role to that list: Advocate.
When a patient that Starr’s team had successfully treated for muscle tension dysphonia — or, vocal cord spasms — was denied payment for the treatment by her insurance company, Starr found that her calling to give a voice to the voiceless took on new meaning. She became determined to speak up for her patient.
The insurance company had agreed to pay for the treatment, Starr explained, but when the bills arrived, the company balked, and Starr discovered the code was divided into two bulletins, which made it slightly misleading.
“That really bothered me,” she says. “It felt like a bait and switch, it felt illegal and wrong.”
Though not always the case, as some insurance companies do cover these services, Starr realized changes needed to be made. She scoured the provider’s bulletins, highlighted misleading language and noted what she described as cherry picking of research. Then she provided the company with signed letters and pages of references.
Starr is not sure if these objections made it through to decision-makers, but they did impact her. The experience transformed Starr into a dogged advocate for her patients who works closely and effectively with her colleagues to get the best outcome.
Now, Starr tries to stay knowledgeable about the current policies her clinic’s insurance providers have, and is able to give guidance to her patients during the appeal process. Furthermore, she always appeals insurance decisions at the state level to give patients a better chance at winning their case. Harnessing the advocacy support that ASHA provides, Starr works together with her peers and support staff to streamline the appeals process as much as possible.
In her line of work, Starr understands the importance of having a voice. “When a chronic voice problem comes into play — a chronic inability to sound like you, a fatigue and an effort every time you go to talk — the voice becomes this all-important, overarching problem and people are overwhelmed by the disability and discomfort,” she says.
Helping people recover that voice is part of what drew Starr to her calling as a speech-language pathologist. Now, as an advocate, she does more than heal her patients’ voices — she helps them speak out.
A Voice for the Voiceless
Video: Dr. Janice Trent – Maestro
As principal of Deep Run Elementary School in Howard County, Maryland, Denise Lancaster knows what it means to serve all children from preschool through 5th grade. And she also has a hidden advantage: she’s an ASHA-certified speech-language pathologist (SLP) with an intimate understanding of what is involved in supporting Deep Run’s students with autism and learning disabilities. Because Denise has been in her colleagues’ shoes and knows how well their certification education and training have prepared them, she highly values her team of three ASHA-certified SLPs.
We sat down with Denise to discuss the benefits of employing ASHA-certified SLPs and the positive impact they have in schools.
ASHA: Why do you think ASHA-certified SLPs are a top choice for the classroom?
Denise: There is a high level of professionalism that comes from so many parts of what is required to become a certified speech-language pathologist. Included in the required coursework are ethics courses, science courses, statistics and a clinical fellowship year when you are working under the supervision of a certified speech-language pathologist to make sure you are correctly applying what you learned. Then, there is the national exam to pass.
There are so many levels of competence one has to show in order to not only earn one’s Certificate of Clinical Competence, but also maintain it. In this county almost every speech-language pathologist is certified. So principals always know the SLPs they hire have had the training, coursework and practicum hours to effectively address the needs of students.
ASHA: What role do ASHA-certified SLPs play at Deep Run?
Denise: SLPs are valued members of the special education team servicing students from preschool through fifth grade. They assess and provide valuable input in determining educational disabilities. The SLP’s provide direct therapy services to students in and out of the classroom setting. If teachers have students who are not making expected progress, teachers can seek support from a problem solving team. I make sure we have an SLP as a member of this team because they have expertise in language acquisition and knowledge of the foundations for reading development. In that role, the SLP in the building is providing and sharing her expertise and offering consultation to teachers in addition to providing direct therapy hours.
ASHA: What impact have they had on children?
Denise: One of my biggest examples comes from a kindergartener with autism who came to the school this year. He’s a dual-language learner, Spanish at home and English at school. He didn’t have an effective way to communicate, which really impacted his behavior. His needs weren’t being met because he couldn’t communicate them.
Now, thanks to one of our SLPs, she created a low-tech communication system with pictures that he can reference. As he became proficient using pictures to communicate his needs, we began to see a decline in his bad behavior and an increase in his interaction with his peers. Providing him with a communication system he is able to use, as well as training all of the adults involved, has made a huge difference in his success in school. His parents were also trained so now he has an effective communication for the home environment.
Going the Extra Mile: Q&A with School Principal and CCC-SLP Denise Lancaster
ASHA-certified speech language pathologist Emily Kinsler helps students learn valuable life skills by venturing outside the classroom to explore the world and their passions
As a speech language pathologist and Coordinator of Countywide Services in Howard County, Maryland, Emily Kinsler knows some lessons don’t come from a textbook. She came to that realization early in her career while running social skills groups for adolescents on the autism spectrum who had trouble communicating verbally. Whenever she worked with them on how to interact socially, classroom time always seemed too short. She needed more hours in the week to help them gain valuable skills for communicating, making friends, and finding jobs.
She also believed that by observing students in settings that resembled their lives outside of school, she and other educators would be able to better understand how to boost each student’s social skills. Students could benefit from the real-life settings, too.
“There is some level of appropriate behavior when we are out in the community and interacting with others,” says Emily. “So being able to talk about and see what is appropriate in regular conversations and why it’s appropriate makes students more independent.”
With permission from parents, Emily created the Leisure Time Activity Group. Students and some of Emily’s friends whom she had managed to recruit as chaperones hopped in the school van one Saturday a month and went to bowling allies, corn mazes, arcades, baseball games, lunch spots and museums. Often, the students gave input on where they wanted to go.
Over the course of the program’s two-year run, the impact was significant and clear. Emily remembers one particular student who knew all about fires and fire prevention. A trip to a Rockville, Maryland fire station gave him the chance to come out of his shell.
“He was just so excited,” Emily says. “They were speaking his language.”
Throughout the experience, the student was just a regular kid — because of the practice he’d had on the monthly outings and his passion for the topic at hand. People talking to him might not have known he was on the autism spectrum or had any difficulty speaking and interacting with others, Emily says.
“People spend a lot of time making connections with each other, and these kids have a weakness in their ability to do that” Emily says. “By giving them a chance to work on it in a natural setting, we give them more opportunities to see what’s out there and what they’re capable of doing.”
Speaking Their Language – Helping Individuals with Autism Develop Social Skills
Video: Alexis Alston – Architect
Speech-language pathologist Dr. Fred DiCarlo, assistant professor and clinical supervisor at Nova Southeastern University (NSU) in Fort Lauderdale, Florida, draws on the arts to enhance communication skills and inspire new confidence in clients and patients with speech-language disabilities.
“Quite often, when someone loses the ability to communicate, they become invisible,” observes Fred. “But when you give them an outlet that allows them to express themselves another way, people look at them in a different light.”
Fred works every day to inject a sense of creativity into the lives of his clients, most of whom have aphasia or Parkinson’s disease, and his speech-language-pathology graduate student clinicians. His lifelong passion for the arts motivated him to earn an undergraduate minor in theatre and dance, and he knows how the arts can increase social interactions and instill confidence and self-esteem.
“I think it’s really on the clinician to be creative when developing treatment plans that foster communication and engage clients,” he says. “That’s why I try and pull from the creative components of music, art and acting to motivate my clients to interact.”
When it comes to using the arts to treat his clients, Fred considers these events most memorable:
Introducing the Parkinson’s Players
To give some of his Parkinson’s clients the opportunity to tell their stories comfortably, Fred invited them to compose and later perform dramatic monologues that described their experiences with their disability. The idea came to him as an ode to the Vagina Monologues, an off-Broadway play in New York that tells individual stories of the” feminine experience”. The play inspired Fred to present monologues that instead would show the “Parkinson’s experience.”
The result was The Parkinson’s Players, a group of adults who participated in a weekly support and treatment group at NSU that not only helped them deal with their struggles with speech and language, but also turned them into actors with a capital A. By the time the players stood on the university stage and delivered their soliloquies to a 150-person audience, they were speaking with a clarity, conviction and confidence Fred always knew would surface if they had a more creative platform to express themselves.
… And the Aphasia Dancers
Several years later, when Fred became actively involved with an aphasia group at NSU in 2015, he found out two of his aphasia clients were ballroom dancers who came to life on the dance floor. Aphasia is a communication disorder that results from damage to the parts of the brain that contain speech and language, making it very difficult for individuals to communicate and engage with others.
It struck Fred that learning the waltz and foxtrot could nudge other aphasic clients out of their shells, too, and move them to interact and talk to others. When his clients agreed to give it a go, the “Dancing with the Aphasia Group Stars” show was born.
Over the course of a semester, Fred’s seasoned ballroom-dancer aphasic clients taught others the steps while he and his graduate student clinicians planned an event modeled on the Dancing with the Stars TV show. While they learned to dance, the clients followed specific instructions and used words tailored to their needs.
In the end, more than 50 people attended, from faculty members and students to clients and their families. After the dancing, the judging (by two speech-language pathologists and an occupational therapist) and the awarding of winners’ trophies, one patient’s spouse stood up to share her ultimate praise for the show and care received by her and her husband.
“Dr. DiCarlo, students, NSU, you changed our lives. You make every day worth getting up for. Now my husband is talking more and is more engaged.”
The effort proved so successful colleagues in Fred’s department have come to look to him for ways to inspire clients’ communication skills through creativity. He hopes his artistic movement in future therapeutic projects will continue and include those from other disciplines to foster inter-professional education and practice at NSU.
“It’s been a chain reaction ever since that show happened in December of 2016,” he says. “My plan now is to, at least once a year, have some artistic project that will showcase the students, the clients and NSU.”
Creativity at Work: How an ASHA-certified SLP Inspires Patients with the Arts
ASHA-certified audiologist Julie Martinez Verhoff says a team approach helps her get to know patients and find the right treatment for each
Julie Martinez Verhoff thinks of herself as not just an audiologist, but also a listener and a coaxer of stories.
“All of the kids I work with have some story,” says Julie, who in March 2017 became director of pediatric audiology at Joe DiMaggio Children’s Hospital in Hollywood, Florida. “No child just has hearing loss.”
Stories, in other words, give a picture of the whole child. And understanding a child’s story, Julie says, requires multiple points of view. Previously, she was director of audiology at The River School in Washington, D.C., an infant through third grade independent school that includes children with hearing loss in every classroom. In that role, Julie served on a team of occupational therapists, audiologists, speech language pathologists, educators and psychologists.
“I’m not sure I could have done my job unless we had each other and each other’s expertise,” she says. “If I worked with a parent and heard something that sounded like a red flag, I could walk down the hall and talk to someone about it. I rely on getting second opinions from professionals who know more about a subject than I do.”
For each child with hearing and language disabilities, Julie and her team pieced together a narrative that enabled them to ensure students got exactly the treatment they needed, with parents actively engaged in the process.
Bundle of Issues
One 18-month-old child had difficulty with balance, speech and language development because of hearing loss caused by meningitis. Julie and her team knew immediately where to start. They observed how the child interacted with the surrounding world through each of the five senses. Then they observed, tested and treated the child to improve function and performance.
They came away with a story whose progression toward a solution involved the whole family. The parents soon enrolled in a 16-week parent-child interaction therapy course, in which psychologists coach parents on communicating with their kids. Because parents who have children with disabilities tend to treat and talk to them differently, it’s important to help guide those relationships and that language and support the family as best as possible, Julie says.
A Wrong Fit Righted
Another child, four years old at the time, wore a loaner hearing aid that didn’t work consistently — and that she didn’t want to wear. The child’s mother said she tried to get attention in dangerous ways, like unbuckling the car seat belt and running onto the road. The family’s finances were tight, which explained why the hearing aid was on loan and hadn’t been replaced. Furthermore, the parents were overwhelmed and the mother needed support and guidance.
Julie and her team devised a solution that combined tactics for managing the girl’s behavior and helping her hear consistently. Drawing on each person’s expertise, Julie managed to weave together a care approach that more properly framed the child’s diagnosis and subsequent treatment.
“Every story is important,” Julie says. “And every story can have a happy resolution that sets children and families up for a positive future.”
Finding Patients’ Stories to Pinpoint the Right Treatment