As we wrap up our “Bye Bye Bye” week, we want to take a moment to sum up all of our “byes” in therapy practice, augmentative alternative communication, and assistive technology.
"So now it’s time to leave [these] and make it alone
I know that I can’t take no more
And it ain’t no lie
I want to see [them] out that door
Baby bye bye bye "
Bye bye bye...massive therapy bags, high-prep materials, and high-stress to plan sessions.
One of the main reasons why we created The Fanny Pack Therapist, was to advocate for prioritizing your therapeutic use of self over creation of unique materials and lesson plans for every kid, every session. Further, although we have both been guilty of carrying around giant therapy bags, realistically, we never use any of the materials in those bags. I don’t even know what is in my bag half the time! Most of the times I ever planned a session, my kiddo wanted to do something different than my plan anyway, or did not think my activity was cool. We are all about function, so those high prep worksheets (and expensive...it adds up over years of practice!), and other materials are not motivating or functional. Let’s ditch the bags -- and with that will come reduced prep and reduced stress around your sessions!
Bye bye bye... to being a lone wolf.
Lone wolves are no fun. Wolves travel in packs; they look out for each other, and they each bring their own unique strengths and skills to the group.. Make sure you have a therapy pack to continue your growth as a clinician. Collaborate. Collaborate with others, both in your discipline and outside of your discipline. Learn from others. Everyone, whether it is a new grad or seasoned clinician, or doctor or paraprofessional, has unique experiences and expertise to bring to the table. You can learn from everyone. In order to holistically care for an individual on our caseload, collaboration with the whole team is key.
Wolves travel in packs; they look out for each other, and they each bring their own unique strengths and skills to the group.. Make sure you have a therapy pack to continue your growth as a clinician. Collaborate.
Bye bye bye...to not prioritizing yourself.
You can’t pour from an empty cup. The nature of our jobs is to give, to serve, to care. As fulfilling it is, it can be taxing and lead to burnout. Find what works for you in terms of self care whether that be working out, practicing mindfulness or meditation, seeing a therapist, taking a bubble bath, or arranging your schedule to participate in your favorite leisure activities, etc. Self-care is different for everyone. Even within our Fanny Pack team our self-care routines are completely different. Annabeth practices journaling, yoga, setting boundaries, and mindfulness. Mara got rid of her email from her phone, chooses one space to do “work” in (when at home, or if at work, leaves all work at work), takes walks, watches TV, and talks/hangs out with friends.
Bye bye bye...AAC that is not accessible.
When it comes to access, we mean both the way the communicator is physically interacting with the device in order to communicate and having the device readily available across environments so that there is always an option/way to communicate. In order to achieve this, AAC systems MUST be:
Visually and physically accessible
Complete with backup access methods
Created with routine and meaningful occupation in mind
Portable and/or mountable for easy and consistent access
Built with room for growth of both vocabulary and client maturity
User and communication partner friendly
Modeled with user’s access method
Equipped with sensory features
Designed with energy conservation in mind.
Bye bye bye...to the high stress of modeling.
So many communication partners are intimidated by AAC devices, so we see a problem with buy-in and use across environments. Being part of an AAC team, means that you are responsible for not only modeling, but also training and educating others on AAC implementation. Modeling doesn’t have to be scary. You also don’t have to model every word. Modeling every word can be confusing to a user if it is above their current communication level or if the vocabulary isn’t accessible in their device (yet)! Don’t get us wrong, “too much” modeling is far better than not modeling at all, but let’s simplify our demands! Start by modeling one level up from where a user’s current communication skills are. Pick a few motivating activities and practice modeling a key set of words, and then build from there.
You also don’t have to model every word. Modeling every word can be confusing to a user if it is above their current communication level or if the vocabulary isn’t accessible in their device (yet)! Don’t get us wrong, “too much” modeling is far better than not modeling at all, but let’s simplify our demands!
Bye bye bye...to thinking there are prerequisite skills to communication.
There are NOT any prerequisites to communication. Period. Done. There’s not. Gone are the days thinking individuals need a certain level of cognition, established imitation skills, etc. There has been a saying of “breathing is the only prerequisite to communication.” I’m not even comfortable saying that because, well, some of our AAC users even need help with breathing! So let’s try this: are they human? Yes? Cool. They can communicate. Everyone deserves to communicate (it is a basic right after all). Let’s assume that everyone can learn. “Presuming competence” is some of the lingo in our field right now, and while yes, the intention of this is correct, remember that our decisions for AAC are always evidenced-based and data driven.
Bye bye bye...to some of these common practices in AAC.
AAC devices or systems that are created or prescribed without extensive evaluation
Starting with only a small set of vocabulary
AAC evaluation and treatment that is a one-man-band
AAC systems that aren’t always with the user. Ugh, why is it in the backpack? Oh they are being distracting, I’m sorry, would you take someone’s vocal folds and articulators away?
Prerequisites to communication (I know I just said this, but BYE BYE BYE again)
This should NOT be a common practice, but it is still out there… but the biggest BYE BYE BYE facilitated communication, NOPE... Just nope. We’re evidenced-based here. Don’t assume you know what a person will say, we are not mind readers. Kids say the darnedest things. Most of the time, you’ll be surprised by what someone is talking about (surprise it isn’t always on topic or what you think they like). My favorite days are when AAC users are sassy to me in the most unexpected ways. I’ve been told “hurry up” “stop talking” “talk to the hand” and so much more which was NEVER what I was expecting to hear next.
This should NOT be a common practice, but it is still out there… but the biggest BYE BYE BYE facilitated communication, NOPE... Just nope. We’re evidenced-based here. Don’t assume you know what a person will say, we are not mind readers.
Last but not least, bye bye bye to teaching cause and effect.
What we want is to say goodbye to the semantics being used here. It is a pet peeve of ours to see goals written about teaching cause and effect for communication or through the use of switches. We just talked about how there aren’t prerequisites to communication. Communication, in its most basic form, is cause and effect (e.g., a baby cries, someone attends to the baby and tries feeding, changing, rocking, etc. to meet their needs). Communicators don't need to know how to use cause and effect toys to have an understanding or to communicate. Similarly, gone are the days to write goals of cause and effect specifically when it comes to switch access. Switch activated activities are amazing for empowering play skills, teaching motor control through repetitive practice, and reinforcing the motor patterns used to access communication. Using switches (for communication or switch activated activities) is a cause and effect, but so is any new skill. What we are taught when we use switches for switch adapted activities is to control the world around us. When we phrase it as “teaching cause and effect” we risk diminishing the perception of cognitive skills of our clients who are learning switch access. You don’t need to have the motor control to access a switch to understand cause and effect. Using the “cause and effect” language can be confusing to caregivers and others receiving a plan of care, insurance companies, and outside providers. Let’s be careful about our choice of words when writing goals. Instead of writing, “ X will demonstrate an understanding of cause and effect…” let’s think about what the purpose is and say, “X will (engage in play) (control their environment) (activate a preferred leisure activity) (request continuation or discontinuation of an activity) (learn core words through switch activation), etc.”
What are some things in therapy that you are saying bye bye bye to? Drop us a line, we’d love to hear from you!
lylas!
mara & annabeth