Effective Communication: A New Health Care Obligation

Beukelman Effective Communication Image

By: Sarah W. Blackstone, David R. Beukelman, and Kathryn M. Yorkston
Editors of the new Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professionals

Prior to his accident, Frank was a 26-year-old energetic, physically active young adult with a wide range of interests and a full social life. A C3–C4 cervical spine injury left him unable to move his limbs. When medically stabilized, he was transferred to the surgical intensive care unit, where he was ventilator dependent and in halo traction. He was unable to speak and his only intentional gesture was a gaze shift. The hospital communication team helped Frank establish a reliable yes/no response (looking up to indicate “yes” and down for “no”). They encouraged his nurses and family to offer other choices as well (“maybe” or “later” or “I don’t know”). A speech-language pathologist showed him a speech-generating device (SGD), but when initially asked if he wanted to use it to “talk,” he responded by looking down, “No.” Later that same day, the team demonstrated the SGD again, showing him how he could use it to control the TV and a fan. When asked if he would be willing to give it a try, he replied, “Yes!” by looking up. Within 24 hours, Frank was using a template on the SGD to call a nurse, ask for medication, control a fan, and turn the TV off and on, all with a simple serial scan method and a switch. Over time, he became an active participant in his recovery process, asking doctors questions and participating in decisions about his treatment plan.

Effective communication between patients and providers is a core component of patient-centered and value-based health care. According to the Joint Commission (2010, p.1), effective patient provider communication is the successful joint establishment of meaning in which patients and health care providers exchange information, enabling patients to participate actively in their care from admission through discharge, and ensuring that the responsibilities of both patients and providers are understood. To be truly effective, communication requires a two-way process (expressive and receptive) in which messages are negotiated until the information is correctly understood by both parties.

The medical encounters that occur across the continuum of health care are usually time constrained and many are stressful, high-stake interactions. When communication breakdowns occur, the impacts can be devastating for patients, family members, providers, and the health care system. Research shows that communication difficulties are among the major causes of sentinel events and can negatively affect patient outcomes, safety, and satisfaction, as well as result in increased readmission rates, length of stay, and additional health care costs. Because of the diversity of patients and families served in our health care systems, successful communication can be very difficult to achieve. In fact, many patients present with multiple communication vulnerabilities.

At age 4 years, 6 months, Guillermo was in the ICU, intubated and awake following a series of surgeries for tracheoesophageal reconstruction. Guillermo and his family were from Honduras and spoke Spanish only. Guillermo was most relaxed when his mother or eldest brother were sitting next to his bed and rubbing his arm. Although hospital policy supported his family remaining at bedside throughout the day and night, there were moments when they needed to step away for personal care, to attend team meetings along with a translator, or for other reasons. The speech-language pathologist provided Guillermo with a simple voice output aid (Ablenet Little Mack) with messages that included, “Where is my family,” recorded in both Spanish and English, so hospital staff could understand him. The speech-language pathologists also made a 20-target Go Talk+ device (Attainment Company) available to him. It featured 15 target photos of family members with messages such as, “I want mom,” “You’re my best friend, Frederico,” “I love you,” and “Hold my hand,” as well as some medical messages. All messages were recorded in both languages.

We define “communication vulnerability” as the diminished capacity of an individual to speak, hear, understand, read, remember, or write due to factors that are inherent to the individual (e.g., disabilities related to receptive and expressive language skills, hearing, vision, speech, cognition, and memory, as well as language spoken, lifestyle, belief system, and limited health literacy), or related to the context or situation (e.g., a noisy environment, being intubated in an intensive care unit after surgery, suffering injury while traveling in a foreign country, having cultural practices, lifestyles, or religious beliefs that are not understood or accepted by providers).

Eleven-year-old Joshua had a bone marrow transplant. He was acutely aware of his suppressed immune system and created and used several communication tools during the time he required the use of a Bi-PAP noninvasive ventilator. Using a simple voice output communication tool, Joshua insisted on having the following message available at all times: “If anything falls on the floor, use the Sani-wipe to clean it before you let it touch me. Also, if your gloves touch the floor when you pick it up, change your gloves before coming near me.”

In the book, Patient-Provider Communication: Roles for Speech-Language Pathologists and Other Health Care Professions, we describe how health care facilities and the providers who work within them can begin to assume a more active role in supporting patients who are communication vulnerable. Speech-language pathologists, nurses, administrators, and physicians are key to improving the “culture of communication” within their facilities, spearheading interprofessional practices that benefit all patients and ultimately providers and the facility’s bottom line. Currently, the role of communication intermediary is assumed by a few providers or family members with a personal commitment; although a rising number of health care organizations are beginning to specify policies and role assignments regarding the coordination of communication support services, communication facilitation for all patients with communication difficulties (not just those who are deaf or have second language issues), or a legal or medical intermediary designated to ensure that communication vulnerable patients accurately participate in legal and medical decisions.

Examples of promising practices and strategies across health care settings are highlighted in individual chapters that focus on doctor visits, emergency services, Intensive and acute care settings for children and adults, inpatient and outpatient rehabilitation, long-term residential care, and end-of-life care. In this book, we have invited authors who have considerable expertise in patient provider communication services across the range of health care settings to share information about the policies, intervention strategies, communication materials, and technologies that are being implemented within their medical settings to support the needs of communication vulnerable patients.

The wife of a person with ALS described his end-of-life experience: He was having a great deal of difficulty breathing and simply could not get comfortable in his hospital bed or wheelchair. We decided to go with in-hospital hospice since his pain management was not well controlled. In hospice, he regularly used his (eye gaze-accessible) SGD to tell us what he did and did not want. I am so grateful that he was able to use it extensively during the last few days of his life. I do not know what we would have done without it.

The authors recognize that there continues to be a considerable gap between clinical research evidence, what is mandated by health care policy, and what is experienced every day by patients, their families, and providers during medical encounters because of the ways in which many health care organizations currently deliver care. In other words, we recognize that implementation, or the process of putting effective patient-provider communication policies into practice, continues to be a challenge within many health care organizations; however, in the final chapter of Patient-Provider Communication we discuss a number of implementation strategies.

References
The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient and family centered care: A roadmap for hospitals. Oakbrook Terrace, IL: Author.

About the Authors
Sarah W. Blackstone, PhD, CCC-SLP, is president of Augmentative Communication, Inc. She has authored multiple texts in the augmentative and alternative communication field as well as articles in Augmentative Communication News and other publications. David R. Beukelman, PhD, CCC-SLP, is the Barkley Professor of Communication Disorders at the University of Nebraska-Lincoln. He has served as director of research and education for the Communication Disorders Division, Munroe-Meyer Institute for Genetics and Rehabilitation at the University of Nebraska Medical Center. Kathryn M. Yorkston, PhD, BC-ANCDS, is a professor of rehabilitation medicine and head of the speech pathology division within the Department of Rehabilitation Medicine at the University of Washington Medical Center.

Are Your Services Educationally Relevant?

Jean BlosserSchool Programs in Speech-Language Pathology 5th Edition

Jean L. Blosser, EdD, CCC-SLP
President, Creative Strategies for Special Education
Author, School Programs in Speech-Language Pathology: Organization and Service Delivery, Fifth Edition, Plural Publishing, 2012

Educational Relevance—What an Important Concept!
Does a child’s disability impact his or her performance in the classroom? If yes, would services such as speech-language intervention, occupational therapy, or physical therapy make a difference? Should those services be intensive, provided face-to-face or via technology, or integrated into the classroom? The primary question is, if therapy services are offered, will the intervention provided make a difference in the student’s classroom performance, ability to access the curriculum, and/or ability to reach his or her potential?

These are huge questions that administrators, educators, clinicians, and parents ponder every day. When school teams evaluate a student, they seek to determine how the disability may be interfering with the student’s learning. Key educational areas that may be affected are academic, social-emotional, and vocational performance. If everyone agrees there is an adverse effect on educational performance, the student’s eligibility for services is confirmed.

How Do We Guarantee Educational Relevance? Continue reading

Brand New Practical Resource for Voice Coaches

Body and Voice: Somatic Re-education by Marina Gilman

Body and Voice: Somatic Re-education by Marina Gilman

Body and Voice: Somatic Re-education by Marina Gilman, MM, MA, CCC-SLP, is an excellent resource for teachers of singing, voice coaches, and speech-language pathologists who work with singers and other voice professionals. It provides a new paradigm for working with singers in a way that allows for improved kinesthetic awareness needed to work with their body rather than against it. The text contains a series of lessons designed to train singing teachers, coaches, and voice therapists to recognize in their students the patterns of use and posture that interfere with respiration, phonation, and/or resonance. In addition, it provides tools for the teacher to guide the student to a level of self-awareness of habituated patterns along with strategies to implement change from the inside out. Continue reading

New Release of Counseling in Speech-Language Pathology and Audiology

Counseling in Speech-Language Pathology and Audiology

Counseling in Speech-Language Pathology and Audiology by Dr. Anthony DiLollo and Dr. Robert Neimeyer

For Immediate Release (San Diego, CA – June 6, 2014) – Counseling in the field of communication disorders is an essential dimension of professional practice, but just what it entails is often a bit of a mystery. Counseling in Speech-Language Pathology and Audiology: Reconstructing Personal Narratives addresses this common concern of students and practitioners by illustrating how to integrate the concept of counseling into clinical practice. Replete with a variety of case studies, clinical guidelines, and actual transcripts of counseling interventions with clients and their families, as well as a practical “toolbox” of specific counseling methods, Dr. DiLollo and Dr. Neimeyer offer a comprehensive, novel, and empirically informed approach to counseling, applicable to a broad range of speech, language, swallowing, and hearing disorders. Continue reading

Bollywood comes to San Diego to raise money for the ASHFoundation

Angie making dinner at ASHFoundation fundraiser

Angie making dinner at ASHFoundation fundraiser

This past Saturday, June 7th, Plural President and CEO Angie Singh hosted a “Bollywood”-themed fundraiser at her home in La Jolla, CA, with proceeds benefiting the ASHFoundation. Created in 1946 by a visionary leader in the field of communication sciences, Wendell Johnson, the ASHFoundation is a charitable organization that supports the advancement of knowledge in this field and seeks to improve the lives of people with speech, language, or hearing disorders. Continue reading

Guest Blog Post- The Frontal Lobe: Front and Center

The Frontal Lobe: Front and Center by Jennifer Hatfield, MHS, CCC-SLP

frontal_lobe

How often have you touched your forehead and told yourself to “pay attention” or “think, think, think?”

Also known as the cerebral cortex, the frontal lobe consists of a right and left lobe, located directly behind the forehead, that have the ability to solve problems by allowing us to think flexibly and express language. It also is responsible for our memory, monitoring our impulses and allowing us to get started by initiating activity. These skills, referred to as executive function skills, are what we know to be the process of “thinking.” We can see then, that the practice of touching one’s forehead, while not a sound technique for improving thinking skills, is based in some truth. Continue reading

Featured Article: One New Year’s Resolution to Keep

One New Year’s resolution to keep – learn more about being an effective speech-language pathology assistant (SLPA) supervisor

by Plural author Jennifer Ostergren

If you are like me, as 2014 swings into full gear, you look to your newly inked New Year’s resolutions. One resolution on my list this year is to expand my knowledge and skills as an educator and supervisor of speech-language pathology assistants (SLPAs). Those of you with similar aspirations know that serving as an SLPA supervisor can be highly rewarding, but also challenging, especially given a lack of resources and tools specific to SLPAs. This year, however, the American Speech-Language-Hearing Association (ASHA) continues to expand its efforts in this area, with new programs, policies, and resources specific to SLPAs and their supervisors. In particular, ASHA’s new Practice Portal on the topic of SLPAs, located at http://www.asha.org/Practice-Portal/Professional-Issues/Speech-Language-Pathology-Assistants/, is an excellent source of current information and resources on this topic. The sections that follow also highlight several key resources from ASHA that may be of help as well. Continue reading

Tips for Assessing Bilingual Children As a Monolingual SLP – by Leisha Vogl

Hello Speech-Language Pathologists-

We are re-posting an article from ASHASphere on bilingual patients written by Leisha Vogl. We hope you find it insightful.

-Plural Team

 

Tips for Assessing Bilingual Children As a Monolingual SLP

by Leisha Vogl

 

There are an estimated 337 different languages used (spoken, written, and/or signed) in the United States. Even bilingual speech-language pathologists will encounter situations in which the client’s primary language is unknown.  There are standardized, evidence-based tests for the Spanish-English population. But what about Russian, Vietnamese, German and so on? What do you do?

Here are some key practices that can aid any SLP evaluating a child who speaks an unfamiliar language:

  • Conduct a family/caregiver interview, which can help minimize cultural and linguistic biases. Understanding how others in the family view the client’s communication gives insight into expectations and the possibility for deficits. Is the client able to meet these expectations? If not, why and how? Do they differ significantly from others in that communication circle?
  • Use an interpreter. Meet with the interpreter prior to any contact with the family to review the process, terminology, and what you want him or her to do. If possible, use someone outside the child’s family and circle of friends to reduce the possibility of bias. Interpreters can provide key information, such as, “It was very hard for me to understand him,” or, “He doesn’t use prepositions correctly.” Using such information, along with additional testing measures can help support or negate a true disorder.
  • Use highly pragmatic tests if formal/standardized testing is not available in the child’s primary language. These tests will help determine the client’s grasp of conversational language, which is the first building block to more complex language. The same is true in monolinguals—that the first language we learn is social in nature. We e acquire more complex understanding and use of language by building on social language. You cannot report standard scores when using standardized testing not normed for that language. You can use the information as qualitative data to support the rest of your findings. I personally like administering the Oral and Written Language Scales (OWLS), now a second edition, for this population. It is relatively easy and quick to administer.
  • Employ Dynamic Assessment, which  involves pretest of a skill, an intervention to address that skill, and then a post-test to determine if there was progress. This method of assessment can be useful for evaluating multilingual individuals. If intense intervention is needed, this can indicate  impairment.Review the ASHA website for more information on Dynamic Assessment.

Things to be mindful of regarding typical bilingual language development include the following.

  • The silent period occurs when a client is first exposed to a new language. Typically this period ends between six months to a year. Some common misidentifications in this phase are Autism Spectrum Disorder, Selective Mutism, and language delay. It has also been noted that with a significant change in school, family situation and the like can trigger some children to revert to the silent period. This is why family and caregiver interviewing is so essential to diagnosing a language disorder.
  • Bilingual development is recognized in two stages. Basic Interpersonal Communication Skills (BICS), also known as “conversational language,” typically takes two to three years to acquire. Cognitive Academic Language Proficiency (CALP), also known as “academic language,” takes five to seven years to develop. Some common misidentifications during these phrases are Language Disorder and Specific Learning Disability. Be careful that the years refer to a 12-month period of constant and consistent exposure. Our academic calendars are typically nine months, so it may take more academic years to acquire conversational and academic language.

Remember when evaluating any child that there is variety among the “same” cultures and languages.

What additional information do you, or would you, include in an evaluation?

ABOUT THE AUTHOR: Leisha Vogl, MS CCC-SLP, is the owner of Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She’s worked in the field of speech-language pathology for about 7 years ranging from early intervention, school-age populations, and adults in an acute care setting. Leisha is proficient in Spanish and American Sign Language. You may follow Sensible Speech on Facebook or Twitter. Check out the website at www.sensiblespeech.com

Plural Authors Receive 2013 ASHA Awards

Each year, for over 70 years the American Speech-Language-Hearing Association (ASHA) has recognized and awarded many deserving individuals for their dedication and contributions to the professions of speech-language, pathology, audiology and speech and hearing science. We would like to congratulate and highlight our authors who were honored with awards this year’s ASHA convention in Chicago.

The highest honor ASHA bestows upon its members is the Honors of the Association. Individuals recognized at this level have, “enhanced or altered the course of the professions”. We are so proud to say that Plural’s own CEO and co-founder, Dr. Sadanand Singh was recognized at this level. This year several of our authors received the Honors of the Association for their pioneering work:

  • Dr. Maurice H. Miller, NYU Steinhardt, was recognized this year for his “distinguished contributions to the profession of audiology”. Dr. Miller is Professor Emeritus of Audiology and Speech Language Pathology and was voted Professor of the Year at NYU. He is the author of Hearing Disorder Handbook, a practical, concise and time-saving text that provides comprehensive, reliable and accurate descriptions of auditory and vestibular disorders, their frequency of occurrence, etiology, diagnosis, and management – all in a single resource.
  • Dr. Robert J. Shprintzen, The Virtual Center for Velo-Cardio-Facial Syndrome, was recognized for his “distinguished contributions to the profession of communication sciences and disorders”. Dr. Shprintzen is a found member of the Velo-Cardio-Facial Syndrome Educational Foundation, Inc. and is a professor and director of several programs at New York Upstate Medical University. He is the author of Velo-Cardio-Facial Syndrome, volumes I and II. This comprehensive two-volume set combines text and video demonstrating the clinical features, communication phenotype and the natural history of speech and language of Velo-Cardio-Facial Syndrome (VCFS).
  • Dr. Cynthia K. Thompson, Northwestern University, was recognized this year for her “distinguished contributions to the profession of communication sciences and disorders”. Dr. Thompson is a professor of Communication Sciences and Disorders and Neurology. She is also an ASHA fellow and recipient of the Walder Award for Research Excellence at Northwestern. She is the author of Aphasia Rehabilitation, a unique text that specifically contrasts impairment- and consequences- focused treatment with the aim of providing clinicians with a level playing field that permits them to evaluate for themselves the relative contributions that each approach provides.

The ASHA Committee on Honors awards the Fellowship of the Association to individuals who have “made outstanding contributions to the discipline of communication sciences and disorders”. This year many of our authors were bestowed this honor:

  • Dr. Maria Adelaida Restrepo, Arizona State University, was recognized for her teaching, research and publications and service to state associations. Dr. Restrpo is an Associate Professor and director of the Bilingual Language and Literacy Laboratory at ASU. She is a certified member of ASHA and author of Improving the Vocabulary and Oral Language Skills of Bilingual Latino Preschoolers.
  • Dr. Ronald C. Scherer, Bowling Green State University, was recognized for his teaching, research and publications and service to state associations. Dr. Scherer is a professor in the department of communication sciences and disorders at Bowling Green State University. He is the author of Speaking and Singing on Stage.
  • Dr. Rahul Shrivstav, Michigan State University, was recognized for his administrative service, research and publications and service to state associations. He is the chair of Michigan State University’s department of communicative sciences and disorders. He has served as an Associate Editor for many scientific journals and is one of our consulting editors.
  • Dr. Anne van Kleeck, University of Texas at Dallas, was recognized for her teaching, administrative service and research and publications. She is professor and Callier Research Scholar at the Callier Center for Communication Disorders at the University of Texas at Dallas. She is the author of Sharing Books and Stories to Promote Language and Literacy.
  • Dr. Barbara Derickson Weinrich, Miami University, was recognized for her clinical service, teaching and research and publications. She is a professor at Miami University and Research Associate for the Cincinnait Children’s Hospital Medical Center. She is the author of Vocal Hygiene as well as the forthcoming text, Pediatric Voice.
  • Dr. Edwin M.L. Yiu, University of Hong Kong, was recognized for his teaching, administrative service and research and publications. He is a professor and Associate Dean of the Faculty of Education at the University of Hong Kong, He is the founder of the Voice Research Laboratory and holds and Honorary Professorship at the University of Sydney. He is also the author of Handbook of Voice Assessments.

The Certificate of Recognition for Outstanding Contributions in International Achievement recognizes “distinguished achievements and significant contributions in the areas of communication disorders revealing great international impact from their work”. This year Plural author, Dr. Brooke Hallowell, Ohio University, received this award. Dr. Hallowell is the president of the Council of Academic Programs in Communication Sciences and Disorders. She is the author of two forthcoming Plural books.

The Certificate of Recognition for Special contributions in Multicultural Affairs recognizes “recent distinguished achievement and contributions by ASHA members in the area of multicultural professional education and research, and clinical service to multicultural population”. This year Plural author, Dr. Celeste Roseberry-McKibbin, California State University Sacramento, received this award. Dr. Rosberry-McKibbin is a professor of speech pathology and audiology and is an ASHA Fellow. She is the author of Increasing Language Skills of Students from Low-Income Backgrounds.

Plural author, Dr. Audrey L. Holland, University of Arizona, was awarded the 2013 Frank R. Kleffner Lifetime Clinical Career Award in honor of her “exemplary contributions to science and practice”. Dr. Holland is a core member of the Life Participation Approach to Aphasisa movement and Regents’ Professor Emerita of Speech and Hearing Sciences and the University of Arizona. She is the co-author of Counseling in Communication Disorders, now in its second edition.

Every year the editors and associate editors of ASHA journals “select an article they feel meets the highest quality standards in research design, presentation and impact”. This year Plural author, Dr. Lorraine O. Ramig’s article “Innovative Technology for the Assisted Delivery of Intensive Voice Treatment (LSVT LOUD) for Parkinson Disease” published in volume 21 of the American Journal of Speech-Language Pathology, was chosen to receive an Editors’ Award this year.

Congratulations to all the ASHA awardees and special thanks to the great work produced by our award-winning authors!

Guest Post by Matt Honaker: Career Advice for New SLP Grads

Career

 

Foreword:

With graduation fast approaching in the coming weeks for many SLP students, we have invited guest blogger Matt Honaker from Advanced Medical, a therapy staffing company that provides travel physical therapy, occupational therapy and speech language therapy jobs in specialties and locations nationwide. We hope this will give new graduates some practical advice on job-seeking in today’s market. Enjoy.

–Plural Team

Career Advice for New SLP Grads 

 

For most novices to Speech-Language Pathology, the stress of grad school doesn’t disappear on graduation day. While classes are over, your brand new career is just starting, and now, applying for jobs is on the agenda. But before diving into the application process, there are several things to consider. For instance, in many cases, the job you get now will set the standard and act as a basis for all other work to come. So, it pays to do just a little bit more homework and pave out a pathway to future success in your field. Choosing your job setting, position style, and career focus can help you better design a plan for your future that both suits your professional interests and supports your personal needs.

Job settings for Speech-Language Pathologists often come in the form of a school or a hospital. Understanding the expectations of each can help you gauge your interest in one or the other. SLPs in hospitals tend to work with adult patients with acquired disorders, while therapists who work SLP school jobs work with children with developmental disorders. Of the two, hospitals also necessitate a faster pace, heavier caseload, and less flexible schedule. However, hospitals also offer higher salaries.

In the way of position style, traveling speech pathologists often gain more freedom than those in permanent positions. However, travel positions do only last 3-months at a time. Still, there are far more benefits to starting out in a travel position than diving right into a permanent job. In addition to the substantial pay and all-inclusive benefits, traveling speech therapy jobs allow therapists to try various job settings before choosing one. It also provides an opportunity for newly graduated SLPs to do some traveling while they continue to enhance their role as a Speech-Language Pathologist.

Finally, if your career focus has not already been determined, keep an open mind. Set a five-year plan, but don’t force yourself to actualize everything on your agenda. Ultimately, your career focus should be based on what interests you most and what will make you the SLP you’ve dreamed of being. For example, if you grew up bilingual, feel comfortable teaching and counseling others, and are happy doing so, then focus your career around language disorders. Even if you are working in all facets of SLP in your day job, your interests and outside study should still be actively pursued. Be true to yourself and focus in on a career track that best suits you.

–Matt Honaker

About:

Advanced Medical, is a therapy staffing company that provides travel physical therapy, occupational therapy and speech language therapy jobs in specialties and locations nationwide. By focusing on quality and integrity, Advanced Medical has emerged at the forefront of the travel therapy staffing industry.