March 21st marks Down Syndrome Awareness Day, symbolizing the three extra chromosomes on marker 21 that cause Down syndrome. I’m dedicating this post to my niece, Ella, who is a social butterfly with diverse interests. Ella’s mom, Jennifer, is an English professor at Bunker Hill Community College by day and a supermom by night. Jenn’s supportive network, including family, neighbors, and educators, has been invaluable in caring for Ella and her sister, Abby. Recently, Jenn shared a presentation aimed at fostering empathy for children with processing challenges and low tone. The activities discussed in this post can be adapted for various populations. Thanks to Jenn for sharing her experiences!
Enhancing Socialization on Down Syndrome Awareness Day
After six years of worrying, I found myself in a unique situation. My concern was that my child would have difficulty making friends because she has a disability. She does not have the same language skills as the typical six or seven-year-old.
We moved to a town where kids took an interest in my child, becoming friends who sometimes overwhelmed Ella with attention. So I took it upon myself to help my child’s peers understand her. I arranged activities in her classroom, letting students experience her perspective firsthand, thanks to her teacher’s support.
Understanding Auditory Processing
First, we divided the class into groups of four. Within each group, someone needed to volunteer to stand in the middle. Three participants received slips with information: birthdate, favorite meal, and favorite toy and shared details with the person in the middle. They all tried talking to the person in the middle at the same time. After about a minute of this exercise, we stopped and asked the children how they felt trying to communicate and listen. Those in the middle commented that it was difficult to listen to everyone, and they felt overwhelmed. It was equally frustrating for those who were trying to share their information to the person in the middle.
I then transitioned to discuss how this exercise could apply to my girl. We talked as a group about how sometimes she would respond with an automatic “no.” Sometimes she would push people away. I asked the group what did they think they could do to help lessen these behaviors. And the children had some insightful answers. “Approach her one at a time.” “If she does say ‘no,’ then just say ‘OK,’ but wait for about five minutes and then go back to see if she wants to play then.”
Increasing Compassion on Down Syndrome Awareness Day
The other exercise I did with them was a practice used by the Down Syndrome Society of Rhode Island. After making sure no one had food allergies, I handed out large marshmallows to the children. I cut the marshmallow in half because they were so large. Children stored marshmallows in their cheeks, realizing speech was difficult. They discussed understanding peers with low tone, suggesting repetition and slowing speech.
Concluding Thoughts
Overall, I was so happy with the way these exercises went and the children’s responses to them. I knew these exercises were effective when a parent approached me at the end of the year and said that her son had come home the day we did them and with enthusiasm, told her that he now knew how to talk to his friend at school. The fact that he offered this information freely, gave me the sense that he was listening that day. If these exercises helped him to communicate better with my daughter, then it was not only a fun venture, but also an effective one.
As you navigate the landscape of speech teletherapy, it’s essential to narrow down your options to a few companies that align with your goals and values. Once you’ve identified them, thorough research is key. Delve into their websites, seek input from colleagues, and leverage social media platforms to gather insights before scheduling interviews. Now, let’s address some common queries about teletherapy.
How many hours a week do you work in speech teletherapy?
I have worked for two companies and both required I work directly with clients for at least ten hours weekly. Additionally, I receive compensation for time spent on billing, consulting with parents, writing IEPs, documenting, and planning sessions. I am compensated for late cancellations or no-shows. Typically, I bill 10-13 hours weekly for therapy and related tasks.
How many kids are on your caseload?
I have worked with children in virtual school settings, meaning that they are either home-schooled and/or participate in charter schools with fewer hours than traditional school settings. Therefore, I typically have 9-10 clients on my caseload of 10 direct hours weekly.
How often are you paid for speech teletherapy?
I submit my bills on the last day of each month and then receive a direct deposit two weeks after invoicing.
Do you need to find your own clients?
No, if you contract with a company, then they assign you clients. This was important for me when I first started in teletherapy. I knew I could do telepractice independently, but entering this new world, I preferred starting with a reputable company and relying on them for assignments.
Clients meet me in “my therapy room” by logging into a HIPPA-secured space. We both need to use a device (laptop, iPad, Chromebook) with a webcam to see each other.
In addition to facilitating activity loading and data collection during sessions, most platforms offer a variety of interactive tools for engaging therapy experiences. These include circling answers, playing games with stamps, utilizing timers, and accessing video content for diverse speech and language tasks. Clients consistently find these features motivating and engaging, making it difficult to conclude sessions.
Do you need to be certified in other states?
Yes, as of right now, I need certification in the state I reside in and that of the client’s. The companies that I have worked for reimburse me for certification and renewal fees for licensure in states where my clients reside.
What are your contracted rates?
I can’t discuss salary, but some companies negotiate fees more than others. As a contract therapist, I anticipated lower reimbursement rates. My goal was to fill daily gaps and ensure steady income. Thus far, my contracts have fit both of those bills.
In December 2015, the ASHA Leader honored me in their Limelight section. Months later, emails flooded in with excitement and questions about playing with water in speech pool groups. Messages from SLPs globally, including Germany, and locally, such as Illinois, have been received and appreciated. In true SLP fashion, professionals asked poignant questions, inspiring a FAQ post about speech and language pool groups. This post later turned into a guide book: We Talk on Water (available on Amazon.) For detailed guidance on lesson plans, materials, billing, participant recruitment, documentation, and low-tech AAC, this book is essential!
FREQUENTLY ASKED QUESTIONS ABOUT SPEECH
AND LANGUAGE POOL GROUPS
Coursework and Training
How did you got started in doing treatment sessions in the pool? In 2003, I observed a pool group at a Jewish Community Center in Rhode Island. Soon after, I requested insurance coverage. It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center. My tasks were promoting the pool group, collaborating with a PT, and writing weekly service notes for billing submission.
Do you have any special certifications to help with your sessions in the pool? I acquired all of my training through experience. Hosting my first pool group with an exceptional PT taught me about water positioning and improving stability and attention.
Is there coursework or training for providing aquatic speech therapy services? One of the emails that I received following the ASHA Leader article was from Susan Nachimson who shared that she has been teaching a course titled: Speech Therapy in an Aquatic Setting since 1/2002 [California Board of Speech Pathology (PDP#129)].
Securing a Facility for Playing with Water
How would I go about looking for other facilities that offer aquatic speech therapy services? If you are not interested in starting your own group and would rather observe pool group therapy, then begin by calling rehabilitation facilities. Many of these locations have heated pools that they use for physical therapy with clients.
How did you secure the pool? Six months before the services were slated to begin, I actively researched for the pool group session I wanted to offer through my private practice. First, I called three facilities and ask to speak with the aquatics directors. I followed up by meeting receptive individuals who rented their pool to rehabilitative agencies. I chose Rush Copley Healthplex
Do you think a neighbor’s pool with an outside shower and bathroom work? I’m not a strong swimmer, so I’d feel uncomfortable using a neighbor’s pool and taking on liability for the group. I also like being in the community and being able to offer pool group services to up to 10 families. Having the ability to invite several participants also increases opportunities for peer modeling and expands socialization.
Billing, Insurance, and Liability Coverage
Do you bill for it like a normal group speech therapy session? Yes, I bill my speech and language services using the speech group CPT code 92508. This code is an “un-timed” one, meaning that you can expect the same reimbursement whether you spend ten minutes in the water or sixty.
Did you bill to insurance companies or do the group sessions private pay? If you did private pay, what were your rates? I do a little bit of both depending on the insurance carrier and my network participation. I advise families with high co-payments near reimbursement limits not to use coverage, to avoid taking away sessions. Research insurance reimbursements and set charges accordingly, ensuring rates align with coverage and state regulations. You can expect to make significantly less for group services than for individual sessions.
How did you go about getting liability coverage to work with clients in the pool? I asked the pool facility what they required and in my circumstance, I only needed to add the location name to my existing liability policy. This addition did not require any additional fees. You should ask this question while researching pool facilities as this may vary depending on your state.
Do you pay pool rental fees? There are non-refundable pool rental fees at the facility that I use for group services; however, I ask families to cover these costs. Families are expected to pay a designated amount per group for each of the six weeks of my program. This fee is not prorated if they miss a session. I cannot afford the risk of paying for weekly services for each family without being able to bill for a session if the family misses or decides not to continue for whatever reason.
Playing with Water: Goals and Session Outline
Do you have specific goals for each child while playing with water or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions)? Years ago, an EI PT and I devised a service form for pool group tasks, now adapted for my private practice. New students are offered a free consultation to align goals. I designed the SOAP note to allow me an opportunity to comment and expand on tasks and I used a local printing store to make carbons of the note so I can quickly provide families with feedback about the session. I also wrote an outline of all the developmental goals that you can address with children aged two through seven years old during pool group therapy.
Have you ever used pool therapy for middle school and high school students with autism? And if, what kind of activities did you do? No, I have only worked with children aged 2-7 in the pool.
What songs do you use in pool groups? The most popular songs are: The Wheels on the Bus, If you’re Happy and You Know it (I use this tune for a directions game to sing, “Put the duck on your head, on your head”), Head, Shoulders, Knees, and Toes, Five Green and Speckled Frogs, Hello and Goodbye songs, All the Little Fish were Swimming in the Water, One Little, Two Little, Three Little Bubbles.
Miscellaneous Questions
Did you have an ongoing day/time for a number of weeks? Yes, my summer groups are weekly at the same day and time for six weeks total.
Did you have the parents in the pool too? A caregiver at least 18 years of age is required to remain with each child before, during, and after pool group sessions.
Were your classes 30 min or one hour? My water sessions are 30 minutes long, but “therapy” begins in the changing room both before and after water play. We talk about our sessions, what we wear in the water, and temperatures that day just to name a few.
Did you co treat with a PT? I currently work as a solo facilitator for my pool group sessions, but highly recommend working with a motor specialist when possible, especially if you are just getting started with pool group therapy.
How do you advertise (word of mouth, flyers at your clinic, etc.)? I bought local ad space but got no clients. Last summer, participants found me on social media, through ABA meetings, and referrals.
Explore my top three organization tips tailored specifically for SLPs, ensuring efficiency and effectiveness in your daily practice. Despite transitioning to digital storage for most of my therapy materials, I still possess physical lesson plans accumulated over the years. Rather than print entire units purchased on Teachers Pay Teachers, I digitally store those, saving about a million trees, and only keep hard copies of smaller lesson plans. This post summarizes how I organize my materials in my private practice/ home office.
TIP #1 BINDER STORAGE FOR SLPs:
The BEST thing I ever did was invest some money in giant binders and page protectors to organize my paper and flashcard materials into seasonal units. While working in a private school, I organized a binder, which I revisit yearly to refine my sessions. I have even taken those binders that are overflowing and broken them into more binders. My winter binder was divided into sections: Christmas, Black History, Valentine’s Day, New Year, Snowmen, and Hot Chocolate.
In order to keep all the manipulatives that went with the seasonal units together, I purchased 10 small, 3-ring zipper cases at Walmart for a $1 each so I could store them in the respective binders.
For those materials that I use throughout the year, I compiled these binders:
Phonological- includes a book purchased for $1 at Walmart on rhymes
Articulation- I alphabetized pages to quickly grab and go.
Apraxia- parent education, worksheets, and lesson plans
Multiple Meanings- units galore
Feeding and Oral Motor- handouts, intake sheets, power point presentations
Autism- parent education, social story samples, social language group plans
Misc. Language lessons- includes mini units about categories, wh questions, and sequencing
TIP #2 LITERACY STORAGE FOR SLPs:
After sorting materials into binders, I quickly saw that I couldn’t store all of my literacy units in this manner, as the card decks are thicker and most contain object manipulatives. Luckily, I found a storage solution for my home office in the form of a corner cabinet with a hanging rod, hangers, and over-sized Ziploc bags for bulky units.
Some of my literacy units do not have objects/ props, so I decided to take another plan of action for books and paper companion activities. First, I laid all the books with companion plans on a table. Doing this helped me see how many sets I had for each season. As you can see, my fall and winter books filled the table! I only had a few books for spring and summer. I also made sure that the units fit into a hanging file.
Next, I purchased two large bins and one smaller.
Last, I dropped books and lesson plans (which were already in page protectors) into hanging folders, and then made tab labels. I had just enough red hanging files for my Valentine books.
TIP #3 WEEKLY LESSON PLANNING:
This tip is my personal favorite for anyone working with a small, private practice caseload. Every Sunday afternoon, I spend a couple hours planning the objective portion of my SOAP notes for the coming week’s session. This way, I have my game plans ready to go and I don’t need to stress in between sessions. It also gives me time to take mini breaks between appointments for snacks or a quick walk with my dogs.
BONUS TIP:
As a bonus, I’m attaching a “cheat sheet” that keeps me organized when calling insurance companies to verify coverage for clients. Make sure that you have both your NPI and tax ID number handy when calling to obtain information. You can grab your copy here.
Modeling AAC is a powerful strategy to boost communication skills in children using augmentative and alternative communication. This post will help you discover how AAC communication devices facilitate communication growth, enabling users to engage in requesting, greeting, turn-taking, commenting, protesting, and responding.
SGD and Modeling AAC
Speech generating devices (SGD) are an electronic augmentative and alternative means of communication (AAC) for people with limited verbal ability. These devices can be used to augment someone’s speech that may be difficult to understand or as an alternative to speaking to make one’s needs known. Considering so many options available, experts recommend a selective and comprehensive team approach for determining which device to trial. I have joined school team meetings, aiding young clients in selecting a speech device. Witnessing their newfound communication skills fills me with joy.
Initially, we want the child to explore and feel ownership with an SGD, but it is just as important to model language on these devices as well. I have often heard parents comment that their children do not like having anyone else touch their devices. Respect their ownership, but let your child know you also need to touch the device to help them learn. Simply modeling verbally is not enough; you must also show your child how to navigate to words not on the initial screen page.
Modeling AAC to Expand Communication
In my experience, most children begin using an SGD to request food and toys, which are tangible reinforcements for making your needs known. This can certainly support wanting to use a device again given the benefits. We often forget to model other communication intents beyond requesting, assuming a child will demonstrate them independently. Communication extends beyond “Ask and you shall receive.” We must demonstrate all aspects of engaging with others to our children. I’ll describe six communicative intents with examples for direct modeling on your child’s device. Teach diverse communication and guide children on SGDs to map and locate words effectively for various exchanges.
Requesting
In the opening of this post, I presumed that your child has already reaped some rewards in requesting foods/ toys using an SGD. That does not mean that we check the box on making requests, rather we expand on it. Using your child’s age and ability as guides, model simple phrases and/or sentences. A two-year-old or early language learner may find “I want a cookie, please” too complex without prior phrase development. A better option would be modeling “more cookie” or “no cookie.”
Greetings
This is a great way to elaborate on greetings beyond a wave hello and goodbye. Navigate to your child’s “people” page and model, “Hi, Nanette” or “Bye dad.” Go ahead and say hello and goodbye to toys as you take them out or clean up.
Turn taking
Asking for a turn using a word like “me” or combinations such as “my turn” adds variety to requests. It prevents overreliance on the device for food requests. You can model these during play or game time. This simple act is more powerful than you would think. Remember that the whole purpose of communication is rooted in taking turns to say or do something. Lay this foundation as soon as possible to open more doors to communicating with your child.
Commenting
Limit labeling items using “I see an apple” since it is not natural for us to walk into a room and start making these statements. Rather, teach sentences such as “I like this apple,” or “This apple is good.” Remember to model in the language structure appropriate for your child.
One fantastic opportunity for modeling comments is during shared book readings. Instead of reading your child’s favorite book to him, read it with him using his device by modeling things like, “Uh Oh,” “That’s silly,” “Oh no!” and “Great!” to make a variety of comments. Here is a video of an autistic youngster who mastered commenting independently with a Pete the Cat book.
Protest
Yes, I want you to teach your child to protest, but in a socially appropriate way using words and/or phrases. Model saying “no”, “mine” and “all done” and praise independent usage of making needs known. If your child routinely uses these to escape work activities, solidify responses. Then, explain it’s time to work first or offer another choice.
Respond to questions
Teach how to answer WHO, WHAT, WHEN, WHERE, and WHY questions using words, phrases, then simple sentences. You can model further by elaborating with descriptive words like, “It looks yellow.”
I have become most familiar with the Nova Chat SGD, which allows you to program information about something that happened during the school day and/or over evenings and weekends at home. So, when asked, “What did you do in school or at home?”, your child can learn to navigate to the page with this information to respond to these questions. A client collaborated with her school SLP to learn answering “All About Me” questions, a wonderful, functional communication method.
Maximize Communication by Modeling AAC
I hope that this post provided some specific examples of modeling a variety of communication intents on your child’s speech generating device. These early conversation starters lay a foundation for expanding language skills and developing social connections. Do not hesitate to get your hands on your child’s device and teach them these skills through modeling. You will amaze yourself at all the doors you open for communication.
“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”
(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)
Natural Environments and Early Intervention
The idea of “Natural Environments” is a concept synonymous with Early Intervention. As specialists, we provide our services most often in the naturally occurring setting, the family’s home. Early Intervention sites often recommend structured group settings for socialization and peer modeling. Finding a ‘natural’ space for group instruction among typical peers posed a challenge for therapists at Hasbro Hospital. A team of us put our heads together and identified an innovative therapy approach of group speech therapy at the pool, where fun meets effective communication enhancement in a unique setting.
Starting Group Speech Therapy
One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island. She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist. Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow! We watched, listened and took notes.
Clearance was easier than expected. A couple of phone calls to the Risk Management office at Rhode Island Hospital sufficed. Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating. However, it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children.
Outreach for Group Speech Therapy at the Pool
Finding people to participate was quick and easy. Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group. We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children. Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines! Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)
“Sing, Sing a Song”
Music was an essential element to our group. We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner. Our sequence became predictable since we always started and finished with the same songs. Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.
The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization. We then noted that music and singing would be encouraged throughout several activities. Here is a complete description of Developmental targets for pool group.
What’s on the Group Speech Therapy Agenda
Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet. Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words. Following this description were summaries discussing target goals for slide and ball play. Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities.
Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities! The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels. Our clients included children with Cerebral Palsy, Down syndrome, Apraxia, Autism, and Expressive language delays to name just a few.
Starting all over Again
Flash forward to March 2015: Our family relocated to Illinois and I launched both this blog and my private practice: Naperville Therapediatrics. One spring, I transitioned to full-time work from my home office after completing a part-time contract at a Catholic school. Juggling administrative tasks and speech pathology, I’m committed to independent work and collaborating with a nearby OT/PT practice to enhance services for families, inspiring me to explore starting another pool group. For more information on how you can start your own pool group, then read my post about Playing with Water.
We Talk on Water
In June 2019, I launched We Talk on Water, a guide book available on Amazon primarily for speech pathologists, but also useful for occupational/ physical therapists and parents/caregivers wanting to enhance overall communication with a pediatric population at the pool.
If you’re interested in learning more about stimulating your children in a water environment, take a peek at my guide book which is divided into four parts:
Background information on finding the right location and asking the right questions; documenting sessions; advertising; and billing/ insurance for speech and language pool groups.
Seventeen lesson plans for 2-5 years old.
Seven lesson plans for 6-9 years old.
Sample documentation (SOAP note, augmentative communication board, list of developmental targets addressed at the pool, registration paperwork)
For more details, you can follow this link to the Table of Contents.
References:
“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995
Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035
Chances are you are using your iPad, phone, or laptop to read this post. Truth be told, I used my iPad to write it and later signed on my laptop to publish it. I was constantly on some form of electronic device, making it all the more important to find activities that promote communication with no screen time.
I disliked being connected to devices and despised the example I was setting for my own son. Alas, he was just as reliant on his devices as I was, as were so many children. Electronics have become our social time and way to escape the stresses in the world. During the pandemic, social media served as our only connection with friends and extended family. As a parent, we chose our electronic battles and set limits, but we need to model the behaviors we expect from our children too.
Let’s discover five electronic-free options that ignite communication and engagement, offering enriching experiences beyond the digital realm for your child. These activities foster connection, creativity, and social interaction, laying a strong foundation for communication skills development in children.
Healthy Alternatives
Below are some electronic-free options to offer when the cell phones are on the charging station. These were games and toys that I had used with my own son over the years that helped him reconnect with his peers and family during social interactions.
Uno Roboto: Fun with No Screen Time
Uno Roboto is a portable, lively version of the traditional card game. This game allows players to record names and create “house rules” that they use during gameplay. It’s an excellent option for families looking for fun ways to reconnect and interact without screens.
Dry Erase Activity Cards: Creative No Screen Time Fun
One summer, I hole punched some dry erase activity cards, divided the cards into two stacks, attached them with a binder ring, threw a few markers and tissues in the swim bag, and watched the kids sit for at least an hour going through each and every card in their deck. This activity is perfect for stimulating creativity and communication without the need for electronics.
Hangman: Classic No Screen Time Entertainment
While writing this, memories surfaced of childhood games played with my sister at restaurants, before iPhones entertained us during waits. I remembered enjoying hangman and came up with an idea to draw a page and slide it into a dry erase pocket sleeve. This classic game is a fantastic way to engage children in a no screen time activity that promotes spelling and problem-solving skills.
The Alphabet Game: On-the-Go No Screen Time Activity
This next idea requires nothing more than your voice. No materials, pens, markers, or devices are necessary, and you can safely play it in the car with your kids while you drive. It is the alphabet game. All you need to do is call out something you see while driving that begins with a letter in the alphabet. The objective is to “spy” things in alphabetical order before the journey is over or until the next rest stop. This game is a great way to keep kids entertained and learning without screens.
Books: Timeless No Screen Time Engagement
Last, but certainly not least, there were books! When my boy was a toddler, I kept mini books in my diaper bag like First Words and Lift-the-Flaps. These kept him busy and entertained while in the shopping carriage or at the restaurant table. To this day, he has a book with him in the car, so it seems like we got him on the right track! Books are an excellent no screen time option that fosters a love for reading and learning.
Takeaway Thoughts
Great apps exist, but this post wasn’t about disregarding them. I suggest apps for therapy but advocate for balance. It is virtually impossible to build turn-taking and communication skills when a young child plays on a device. I rarely use my iPad as a reinforcer for completing tasks in speech sessions because it closes the door rather than opens one for expanding communication. Some time ago, I cleared all the games off my phone and I never looked back. You could do it too, it isn’t too late! If nothing else, turn off your phone when you’re at the park with your kids or during speech sessions you attend. You’ll be amazed by the interactions when you’re present.
The Teddy Talker™ program is a multi-sensory approach to speech sound acquisition created by Linda Siciliano to promote phonics and early sound production in young children by stimulating auditory, visual, tactile, and kinesthetic learning. This program aids children in grasping mouth movements for sound production through engaging visuals and rhymes, fostering successful articulation. I received a free kit suitable for both individual and group therapy, allowing me to introduce you to this program effectively.
Teddy Talker Contents
The Teach Together Toolkit allows me to create programming specific to each of my clients, which I can send home for carryover practice and instruction. These folders may contain some of the following:
Background information about the Teddy Talker program
Bear face and lips for coloring
Teddy’s tongue, teeth, and paper bag for modeling accurate placement
Teddy Talker™ Alphabet chart
Sound Assessment summary
Personalizing Teddy Talker
In my opinion, one of the most important products in the Teddy Talker program are the visual instructions. Since home practice supports speech sound acquisition progress, I send a blank Teddy face home with coloring instructions. I want my young clients to have some ownership for the program, which is why I instruct caregivers that scribbles or even a single line across the bear’s face are permissible. In addition to the teddy bear face, families need a sheet of various mouth visuals. It is important to be able to see these visuals clearly, so I have parents color the mouth pictures. After coloring, families return papers to my office for lamination and adding Velcro, allowing us to change Teddy’s face for sounds.
The colored alphabet chart pictured below came from the resource section of the Toolkit. I got a large, laminated copy for a visually challenged client. The alphabet chart is perfect for introducing speech sound targets.
Each child’s folder may also contain a consonant and vowel checklist for baseline collection to establish targets for programming. As a parent, you may want to see your child’s progress and this checklist is a great way to track gains.
Bear Tracks Card Deck
Besides the Toolkit, I was provided a Bear Tracks card deck, which would be a great resource for home practice! I use mine with children as young as 2.5 years old to assess strengths and needs in determining therapy programming. The card deck includes instructions for game play that your child may enjoy, so be sure to ask your speech pathologist if this would be a good investment.
Worksheets
My approach with Teddy Talker™ involves selecting a suitable speech sound target, then copying relevant tool pages for weekly practice. The Toolkit offers 13 adaptable tool pages for any speech sound and various activities such as drawing, coloring, writing, and listening. There are two types of worksheets in the Toolkit: target pages and generic tool pages. For my purposes, I started with the target pages using the following:
Build and Say: tells you which lips to Velcro onto Teddy’s mouth and provides detailed sound cues
See and say: focuses on Teddy’s face
Trace and say: introduces muscle memory for target letters with one inch, bold faced capital and lower case letters
Rhyme and say: great rhymes describing how to make target sounds
I’ve successfully used this program with children aged 2.5 to 6, addressing a range of speech delays, from mild articulation challenges to pre-verbal.
Below are pictures of some supplements in my speech materials collection that I have added to the program. I believe that using a mix of materials helps generalize speech sound practice outside of the Teddy Talker program. I hope that this review helped share more information about this dynamic program created by a speech pathologist to make our lives easier! Happy talking!!
A to Z Coloring pages purchased on TpT from
Lavinia Pop titled: Letter of the Week
Free bear rhyme from my local library about body parts on a bear
Target dollar spot puzzles and Good-Night Owl book.
Both include animal sounds.
Working in the public school system was probably the most demanding and taxing job I had during my career. Caseloads were always astronomically high and more kids were added to the roster with fewer discharges every year. You had to balance report writing, evaluations, screenings, teacher collaboration, classroom lessons, therapy planning, documentation, and group sessions. It makes my head spin all over again just writing about it! School speech pathologists nowadays juggle duties, create resources, write blogs, and manage life before returning to work early. Despite challenges, collaboration remains invaluable. It made me the therapist that I am today and fueled my drive to pursue private speech therapy.
When I set out on the private journey, I had three C’s in mind: Consult, Collaborate, and Connect. I believe that these three actions help create a bridge between private and school speech pathologists working with the same client.
Private Speech Therapy & School Consultations:
Before moving forward, caregivers must obtain and sign school consents so I can start connecting with school professionals. Once the paperwork is complete, I typically send an email to the school SLP introducing myself. School SLPs appreciate the collaboration during IEP updates. Caregivers are especially grateful of this networking because it gives them more information about specific activities targeted at school. I have found that my presence at a client’s school setting is far less intrusive and distracting than a caregiver’s. Most children hardly notice that I am there, which likely wouldn’t be the case if mom or dad was visiting!
Collaboration Between School & Private Speech Therapy Programs:
When I visit my client’s school, I typically bring something that we have been working on in my practice. I honor IEP goals but also create my own based on data, evaluations, and parent input. Parents may send PECS books or snacks for observations, while I bring pacing boards and oral motor tools like a Z-Grabber. Sometimes, I don’t bring anything. Instead, I collect as much information as I can and follow-up via emails later with school staff.
Personally, I have found that I can obtain so much more valuable information during an hour observation as opposed to exchanging emails and phone calls with the school SLP. It helps me to watch and listen to my colleagues because we all have our own unique styles and expertise. Being a visual learner, I comprehend better when witnessing events unfold firsthand, which might explain my preference for visual learning methods.
Making Connections With School & Private Speech Therapy:
The crucial last step is linking my consultation and collaboration with the school team to the client’s family. Sometimes, I write my SOAP note during the visit and leave a copy for families. Most often, I type out my chicken scratches at home and review the documentation with caregivers at the next clinical session. I can honestly say that every visit that I have had to a school setting has been a worthwhile, successful trip. I’ve seen changes made in a child’s diet, increased use of picture exchange communication, and improved execution of voice output devices.
My goal with this post is to commend school speech pathologists and enhance collaboration for better outcomes in both school and home settings. Share your success stories below! Regardless of your placement, what do you look for when collaborating with colleagues? What would help you improve your service delivery model?
Improving the Foundation for Speech & Feeding Development
The jaw is the foundation in the house of speech musculature. Working on chewing helps improve jaw stability and strength to support both feeding and speech sound productions. Speech pathologists can help your child eliminate jaw sliding through jaw sliding speech therapy using a variety of oral motor tools. Before walking, infants must learn to crawl, developing muscles and coordination necessary for balancing and moving on two limbs.
The same can be said for speech sound productions. Children who do not chew various textures and/or have motor speech delays may not appropriately develop a stable, supportive base for lip and tongue movements, so sometimes it is necessary to teach a child how to stabilize and strengthen the jaw. We do this through oral motor work using tools known as Grabbers. Thankfully, Ark Therapeutic has helpful tools we need to eliminate jaw sliding in speech therapy. Years ago, the owner sent me tools tailored to my caseload needs for a hands-on review, free of charge.
Grabbers for Jaw Sliding Speech Therapy
Over the last two decades, I have purchased materials from Ark Therapeutic, who sell a large variety of Grabbers to assist with jaw stability, biting, chewing, and tongue coordination. These tools are perfect for children who do not need gentle vibration, but benefit from any of the following:
Alternatives to chewing on hazardous non-food items
Decreasing grinding teeth and/or biting knuckles and fingers
Transitioning from pureed (pudding) to foods with more lumps/ textures
Increasing mouthing for feeding and/ or speech development
Improving lip and tongue control
Establishing the idea of biting and chewing
Strengthening the jaw in stability and control
There are several different types of Grabbers to meet your child’s needs from those with smooth narrow parts that suit tiny oral cavities to those with harder textures for older clients. You can even purchase textured grabbers for additional mouth input. Consult with your speech pathologist about the right match for your child.
Z-Grabber for Increased Stimulation
The Z-Grabber is a vibrating chew tool that combines the best of both worlds, vibration (Z-Vibe) and chewing (Grabber) in one. You can either use the loop end as a handle or for chewing exercises. Your speech pathologist will use this vibrating option to provide more sensory input/information to support feeding and speech skills.
Practice biting with a Z-Grabber: Place it on molars, do a 3-5 second bite and hold, 10 times on each side. You want to make sure that he is not tilting his head back to bite. As children progress in their ability to hold that position without sliding the jaw, then I increase the challenge by gently tugging the Z-Grabber to provide an increased, jaw workout.
The multi-functional Z-Grabber allows you to switch a variety of probe tips on the opposite end of the grabber portion. With over 35 tips available, there is something for every child in various shapes, sizes, scents, textures, and resiliencies. Though various methods exist, I’ll offer only a few examples of jaw strengthening exercises using these tips.
Z-Grabber Tips for Jaw Sliding Speech Therapy
Bite-n-Chew Tip: This tip is a great option for children who have a hard time starting with the Z-Grabber as it is smooth and more flexible. Align this tip laterally on your child’s lower molars, then gently press down to lower the jaw and hold. Tell you child to push up as you press down. Repeat this exercise 3-5 times on each side.
Bite-n-Chew Tip XL:This tip is an inch longer than the one above to help reach all the way back to the molars. It is also available in a textured version if your child needs even more input. Place either of these tips lengthwise along the molar surface one side at a time. Next, move the tip front-to-back and back-and-forth across the molars for 3-5 reps per side.
Animal Tips: There are three, friendly shapes for this tip of a cat, mouse, or dog with any of them appropriate for feeding or jaw work. You can perform similar jaw work as mentioned above using these tips. The ears on each double as spoons!
Concluding Thoughts About Jaw Sliding Speech Therapy
While there are many options with and without vibration for working on improving jaw strength and stability, I hope that this post helped defined some of the basics. Always consult with your child’s speech pathologist about the necessity of using oral motor products before making an investment.
For more information on oral motor “wake up” routines that can be performed before feeding or speech practice, head to this post.
