Friday, October 28, 2011
As I hinted in my previous (and brief) updates, I have quite a few changes coming to my blog. I hope to post much more often, and I am hoping I can provide more posts that will answer reader's desires. While I haven't had anyone directly contact me requested this or that, I have been closely watching the view counts for individual counts. It helps to give me an idea of what my coworkers (or the random "Googler") finds interesting or needs more information about.

Also, I have added a few things from Amazon to link to products I love. Just like the other ads on my site, but done directly through Amazon. They are one of the few sites online I trust *almost* 100%. *As an FYI to my readers, I do get paid a few cents (something like that) if folks click on the links for the products I discuss*

For now, I'd like to post on the week that has passed.

It has been busy my friends. I have been a working slave, but it is all for a good cause. I have my new SOAP note system up and running. On a whim, I decided that I would do digital versions of my daily take-home homework sheets that I give to parents. Usually on these sheets I note how the child behaves (using a checklist) and then handwrite the goals we are targeting and work to follow up with at home. That can take a long time to write (as I think I have lamented about in another post). But wowza - I'm loving the electronic versions! I have all my children planned and prepped for Monday. It allows me to spend more time creating fun take home activities that parents can utilize. I love to create personalized materials based on each child's particular difficulties and strengths, but sometimes I am strapped for time so that isn't feasible. Now it looks like I may have a bit more time in my schedule! You would think a sane person would use that time to... ya know... breathe and enjoy life. But, what can I say? I enjoy life by overworking. I am my father's child.

I also completed my second DynaVox AAC evaluations. Again, the process was relatively pain-free and easy to complete. One of the children was so excited, he kept saying, "Wow, wow, wow, wow!" over and over. He was practically jumping out of his chair at the thought of getting one of the devices to use.

I have to say... the biggest hurdle I have found in augmentative device trials (aside from making the sad decision if a child is not quite ready for a device) is the insurance process. For instance, Medicaid requires that we have the school sign a form saying that they are in agreement with the suggested device. It doesn't bind them to use the device *or* replace the device if it is broken. However, for some reason, some school districts are not so gung-ho about signing this wonderful form. The real people hurt in this bureaucratic business of the paperwork are the children and their families. This just delays the time before they can receive a device that will help them to communicate their wants and needs. Some insurances only cover a small percentage of the devices. Others will cover 100% with no need for a school concurrence form. It is a frustrating mess of a system, that is for certain.

*le sigh* is all I can think... for now, I will just have to dream of my "THERAPIST OF THE YEAR" award when I get a device to every child who needs one....
Tuesday, October 25, 2011
I reviewed a bubble machine a few months ago from Gazillion Bubbles, and it has attracted quite a bit of attention on YouTube. As this obviously appeals to readers, I want to appease readers as best I can. I am going to go through toys, games, and books for children that I have found useful in the therapy setting and write a brief description and review for each. I will include the product info as well. I will try my best to always mention any cons I may have found for the item along with the pros. It will be fun to write more on this topic. Also have to report, the electronic SOAP notes were so awesome the last two days of work, that today after work I took the time and made an electronic template for my daily home progress notes for parents. Usually I write out a brief description of our short term goals (with examples) along with whatever the homework assignment may be. It can get very timely with the amount of kids on my caseload just to complete that preliminary paperwork step. Now I have a personalized, printed progress note for each child that will be easier to read and easier to make! Let's look at time comparisons: 1. Spend about 1 to 2 minutes writing out the short term goals for the 15 or so kids I see each day. About 30 minutes. 2. Rewrite the same short term goals (as well as an example for clarity) each time you see a child... even if it is two to three times a week.... Time spent on that? Well, the time is more ticking away your remaining "sanity/patience threshold limit" minutes. 3. Have all goals and plans pre-typed on computer. No longer attempt to scribble a note while an antsy two year old attempts to open and close every drawer on your desk. (Try writing out a home plan while repeatedly saying "no, no" and getting up to redirect the child to a more appropriate activity. Again, why chip away at your sanity like that?) Solution = print out those prewritten goals and homework plans each morning. Time? Probably 3 minutes total. Adjusting a goal? A few seconds... 3 minutes. Total. Wow. Got on a tangent there. Will write more as I get more time using my new system... Goodnight! - Posted using BlogPress from my iPad
After spending a good hour or two fiddling, I figured out how to do an electronic SOAP note through Excel2007. Now, it isn't perfect, but it is a step in the right direction. Currently I'm trying to figure out how to make formatting a little cleaner looking, but like I said, it is a start.

I can't keep this electronic SOAPiness to myself though... so I took a few images of the basic formula used to create my SOAP note. Here is how it basically works: 
  • - A key exists on a second page of your document. It is in a table format. The first column is where you fill in a number based on the options for the blanks in your field. Each row stands for each blank in your form.
  • - In my form (the first page with the SOAP note), I would type everything that stays the same in one cell, and then in the next cell I would put in a formula. The formula is the "CHOOSE" formula. It allows you to automatically fill in that cell based on a choice you make from another cell. 
  • - Here is an example of the formula that I might place in my first cell, column A, row 1  (A1):    =CHOOSE(B2,"with cheese.","without cheese.").
  • - In this example, cell B2 (column B, row 2) will be the place that I will either type a 1 for "with cheese." or a 2 for "without cheese." You don't have to have a key for the formula to work, but unless you have a super memory, you will want it.
  • - Let's look at it in pictures!
In this step, my cell D9 is the blank in my SOAP form. You can see my key off to the right. The formula I have inputted will fill in data based on the number I type in the cell N6.

Click to see this enlarged!

Here I create the next fill-in cell, E9. In this formula, it will fill in data based on the number I type into N7. You can see also that I have typed "1" into N6. This has autofilled D9 with the option 1 -- "with"

Click to see this enlarged!


In this final image, you can see that I have selected option 1 in N6 and option 2 in N7. These numbers are the choices for "with" "caregiver."
Click to see this enlarged!

Using this basic idea, you can create a form to select the types of treatment/behavior/etc. from a list of options you create.

What if you want to leave a cell blank? Just make that an option. The formula would look like this with a blank: =CHOOSE(N7, "parent.","caregiver", "  ")

If I were to type the number 3 in N7, it would fill in my cell with two spaces (the quotation marks do not transfer).

Please feel free to contact me if you have questions about how to implement it! I hope to create a form that has buttons to select instead of numbers in the future. Will take a bit more fiddling to figure that one out!
Friday, October 21, 2011
I work four days a week seeing clients in my private practice, but admittedly I could work an extra day just finishing reports, planning for therapy, and creating materials. Today I am headed in to do just that. I had an early doctor's appointment and decided I would come in to get some work done. Right now I am being extremely productive by getting my car washed. I have been researching online electronic methods of doing SOAP notes to no avail. It seems like the best options out there are just simply extremely pricey. I don't see enough clients to justify a monthly charge to document daily notes when I could do it for free written. Next week I will be completing my second AAC device evaluation with some wonderful kids. I am still waiting for my kids approved from my first evaluations to get their devices. It is a shame that the process has to be filled with so much paperwork, waiting, and crossing fingers. I have one child I am beginning to look into fundraising to get an iPad. On the topic of iPads, I recently purchased on for myself. It has a wealth-load of options and programs for doing therapy. I applied for a grant to receive a coveted Proloquo2go sponsorship and program. I saw their program first when I was in graduate school, and while it is not perfect, it is an excellent alternative to the thousands of dollars you can spend to get a dedicated augmentative device. With a 16gb iPad and the Proloquo software, a family would end up spending around $700. Much more feasible of a number than over $1,000 certainly. One issue with looking into an iPad or iPhone is the lack of insurance coverage. Because it is not a dedicated communication device, (one that is solely used for this purpose), insurance companies will not help to cover the costs. However, it is a good choice for a family whose insurance will cover only a percentage of the purchase of a DynaVox type system. Cost wise, the iPad may be a better alternative. One thing that amazes me is how resistant to the use of augmentative devices some folks can be. I think part of it is motivated by a fear, or lack of knowledge, about technology. And yes... I did say fear. It can be frightening to a person who is not comfortable or familiar with computers to suddenly have a very expensive computer under their care. There is always a fear that it could be broken, or a setting gets selected that is hard to find again. I hope through my work that I can help people to become more comfortable with the idea of using technology like this to better their lives. A little education can go a long way in empowering a parent to be successful using a communication device with their child. Parents are not the only ones nervous about using technology I'm their services... I highly encourage SLPs out there with an iPad currently to start exploring all that this wonderful device can do. It also is amazing how motivating the use of a touch screen device is to my kids. The other day one of my kids worked for about 27 minutes (out of a 30 minute session) to earn 30 second play periods of Angry Birds. We were doing intensive speech therapy drill, and oh yes, the child is only 6. Amazingly productive session thanks to my iPad. Better be off to do my paperwork now... Hope everyone has a happy and safe weekend! - Posted using BlogPress from my iPad
Tuesday, October 11, 2011
As I continue to get more comfortable in my role/job as a speech therapist, one thing I constantly find I need more of is... TIME!

Time is a hot commodity for SLPs. I have a caseload of about 40 kids I see individually in private therapy. I have to plan and print work for almost every one each week, and after each session I must complete a note that documents their progress. This kind of note is called a SOAP note. SOAP notes are used across the medical field, and we are no exception.


S - Subjective
O - Objective
A - Assessment
P - Plan

S -- In the subjective section, you give your subjective opinion about the client. This is where information about behavior would go. Was the child super duper or a stinker? Explaining in detail can help you to see patterns of behaviors. For example, if Child A had a tantrum every time that the parent came into the therapy room, I could see this and request that mom/dad step out.

O - In the objective section, we give information that is not based on opinion. For example, we would say what the treatment would included, if parent instructions were provided, etc.

A -In the assessment section, we assess how their work was for this session. Usually these needs to be stated in relation to their goals. For example:

Pt. will identify colors in a choice of two - 5/10 times; minimal cueing

You would want to be sure to document as clearly as you can the progress the child makes in a measurable way. If a child has not reached a goal, but is clearly making slow but steady progress, you will be able to see this in your assessment numbers. This will help you to readjust your goals as necessary. This is also where you would want to add information about how the child achieved this -- was it with minimal cueing or max cueing? Was it done independently (AKA spontaneously)?

You should document both long term goals (ex: increase receptive language skills) and short term goals (like the example above).

P - In the plan section you should document future plans for treatment. For example, when will the client return for therapy?


The A/P sections can kind of blur together a bit -- in some instances, I've seen long term goals only documented in the P section as it is a future plan. This is a rough outline for a format I use.


Currently, my company uses a template/checklist style list. We can check off for attitude, who the client was with, what treatment was included, etc. We still have to manually write out the information for each goal that was addressed. I'm hoping to think of a way to digitize this information so that we can simply do everything on a computer as a checklist. We will have to print the SOAP notes as we have a paper based system and not electronic, but the time I spend checking things, or writing out the goals feels like a waste of time.



If I find a good system for making a SOAP note that will automatically fills in your goals in the correct format, I will certainly share. If you are an SLP out there in the "interwebz" that has a good program they are in love with, please share!



Off to head home... hoping to get in some time with my new hobby (knitting)!