So, overall, going bagless has been great.  I’m so excited to see how this transition continues to benefit my families and the children that I see.  There has been less of a focus on me “playing” with the children and more about integrating techniques into daily routines.  However, it has been far from a perfect transition.  In all honesty, some of my families that I transitioned to bagless have had a difficult time with the adjustment.  Here are some things in my transition to bagless that have not been “perfect” according to true bagless therapy:

• I still have a few toys/materials in my trunk.  Now, as you can see below, there are FAR fewer toys and materials in my trunk.  However, I allowed myself to keep one box-ish of toys including a few items:
  • Bubbles (aka the “Session Saver”)
  • Mr. Potato Head
  • Wind-up toys and pull-back cars
  • Interactive books
  • Squigz
  • Brown Bear slide book and other rotating books.
  • Oral Motor tools
  • Symbol communication book
  • Cariboo (with First 100 Words to use)
  • Kinetic Sand
  • iPad
  • Wipes
  • Other rotating toys & puzzles if needed – rare!

•  I’m just going to say it… Going bagless is more difficult than going in with a bag of goodies.  Some days it’s harder than I’d like.  Finding ways to implant language techniques in daily routines is not as comfortable to me as pulling out a great toy and imbedding language therapy into play with that item.  Because it’s harder, it’s easy to slip back into the comfort of a bag full of toys.  I’ve not been “perfect” in leaving toys behind completely.
• I’m still learning the best ways to counsel families and find routines to discuss.  As much as I have learned about RBI and bagless EI services, I still sometimes have the feeling like I did during my first IEP meeting.
• Sometimes there is so much to address that it’s difficult to choose just one routine to start with.
• Yes, some of my families do not have many, if any, toys.  If they do have toys, some of them have toys that are not very educational (a lot of cars, action figures, kids meal toys, etc.).  It can be difficult to find ways that the families can interact with the child and their toys that can assist their language.

It hasn’t been perfect.  It’s been pretty messy on some days.  But for the most part, going bagless continues to be a great choice for my families.  Despite being less than textbook perfection, here are the ways that I’m learning to overcome those imperfections and moving forward:

• I have tried to limit myself to bubbles and perhaps some wind-up toys or a book.  On occasion, if a parent is receptive to purchasing toys for their child, I will introduce a toy that I removed from my trunk as a “trial” before they purchase.  It allows me to show how to utilize a type of toy with their child.  Otherwise, I do my best to reduce the number of items I bring in and utilize them only if necessary.
• I have allowed myself to make mistakes and learn from them.  When something doesn’t go as well as I’d like in a session, I make it a priority to read more about the topic or find new resources to use or offer to the parents.  I have learned from these “mistakes” of course!
• I have been developing and printing handouts for families.  I have also started to leave “homework/session review” sheets with families to remind them of the week’s targets or techniques.  It isn’t always followed through on but visual reminders help some families.
• I have trusted the families’ priorities more.  I have followed their lead in selecting the routine that they would like help with or ideas for.  Sometimes they need suggestions or options, but they can usually pick one from that.
• While I still love finding a great deal at thrift stores, I have begun to “lend” those materials to families if they are duplicates.  I fully expect that the majority of these will not return in their original condition, if at all.  But hearing “wow, look… it’s your FIRST BOOK!” come out of a mother’s mouth when I left behind an Eric Carle book behind that I found for $0.59 at Goodwill and watching the child toddle around clasping this book makes it 59 cents VERY WELL spent!  And maybe, just maybe, that family will spend a little more time reading or talking about a great book with their child!
• Seeking training.  I am hungry for more knowledge in this topic and am in the process of finding and enrolling in applicable training sessions!  A huge part of being an SLP is continuing to learn.  Sometimes it can be a burden to get 30 hours every 3 years for ASHA… but then again, it can be just the spark we need to continue to provide the best therapy possible!

So, after looking back at the past 2 months and this change that I’ve made would I say that it’s worth it?  Of course!  The research and my experiences allow me to be confident in continuing with my bagless therapy.  As I continue forward, new clients will be approached entirely bagless.  I will be able to fully implement this with them as they are acquired.  I challenge you to do the same.  It’s not easy but it’s research-based and worth it!

So… what questions or comments do you have about this topic?

Check out the previous posts in this series here:

 Welcome back!  Or, if you’re just joining in on this series, head over to Part 1 to see what this Bagless SLP series is all about!  In the last post, “This Isn’t Mary Poppins’ Bag”, I let the cat out of the therapy bag that I was going (gasp) BAGLESS!  The response has been great and I have loved hearing from fellow SLPs and Early Intervention SLPs about their experiences with “the bag”.  It has been about a month since I left the bag behind, cleaned out my trunk, and started venturing into homes with only a few or ZERO therapy items.  I wanted to come back and write about how it’s been going… the good, the bad, and the unexpected!

First, a confession… going bagless scared the bubbles out of me!  I was terrified of irate parents, inattentive toddlers, and stagnant therapy sessions and progress.  I was almost so scared that I stuck to what I had known… the bag.  It was my security blanket.  It allowed me to control therapy, look like a magic speech wizard, and feel comfortable entering the unknown of a family’s home.   But, I did it anyway.  I did it because I believe that research and the results that it garners are an important part of our job.  We are to learn from research and utilize it in our therapeutic approach when appropriate.  Even ASHA’s Scope of Practice states that “an important characteristic of the practice of speech-language pathology is that, to the extent possible, clinical decisions are based on best available evidence. ASHA has defined evidence-based practice in speech-language pathology as an approach in which current, high-quality research evidence is integrated with practitioner expertise and the individual’s preferences and values into the process of clinical decision making (ASHA, 2005).”  So, I did it… I went bagless!

The Good

Let’s talk about the good stuff first… the bits that have made me absolutely positive that bagless is the best thing EVER!

• Can we talk about how awesome it is to have a trunk again?  I’m not sure if you remember but my trunk used to be filled to the brim with some incredible therapy toys! And then I took nearly everything out!  And it has been incredible!

•  I bet you’ve had those parents that leave the room or sit far away during sessions when you’re baggin’ it, right?  Well, when you go bagless that really decreases.  I discussed why I was going to be bringing fewer/no materials with me with my families before cutting the cord.  And now… many of my families are WAY more involved than they were previously.
• Planning time has decreased!  I definitely still know what I want to be targeting with the families and we discuss it more now that I don’t carry a bag.  I plan with the families for the next session at the end of the current session.  I might say things like, “You talked about wanting to try adding language to his meal times.  Could we try doing a small snack next week during our session?”.  We take a few minutes to talk about what we will be attempting at the next session if it’s anything outside of play.
• And finally, one hyphenated word: Carry-over.  People swore up and down that carry-over would increase.  But, I knew my families and I knew that those who would carry-over activities already were.  I think of everything that I was told, I believed the carry-over hype the least.  I’m happy to report that I was very wrong.  Do all of my families follow through with activities and techniques throughout the week… nope.  But more of them do now than when I toted around that bag.  Getting to know and beginning to use their family routines and materials has been huge for several of my families.  It’s so great to hear about what a family was able to do between sessions.  And, do you realize that it means that the child did not have 1 hour of therapy each week… they had MORE?!?

The Bad

I hesitate to use the word “bad”.  I think that maybe “less-than-desirable” would be more appropriate… until I realize that it was bad.  And that’s okay.  Here’s the bad bits of going bagless… no-holds-barred!

• Some things never change.  Yes, the majority of my parents have become more involved in sessions after I decreased the amount I was bringing into homes.  However, I have a few parents that want nothing to do with sessions.  I invite and invite and invite… it doesn’t happen.  I’m lucky when some of them even observe the session.  It’s the not-so-pretty side of EI… And going bagless hasn’t been a magic bean for getting ALL parents on the floor and working alongside me with their child.
• The “why” questions have been there.  I’ve re-explained to some parents several times why using their materials and routines will be better for their child.  Some still believe that my bag did, in fact, belong to the magical Mary Speechins.  Like many other aspects of EI, going bagless will require you to educate parents/families.  So, you’ll want to know your stuff… I listed some great resources in my Part 1 post!
• The comparison to Developmental Therapists:  I think one of the major problems that I’ve run into with buy-in has been from families that also receive DT.  The majority of DTs in the Chicago area bring enormous bags into sessions (I thought mine was big…) filled to the brim with every toddler goodie you could imagine.  The crazy part is that they do this even when the family has OODLES of age-appropriate toys… even using their own toy when the family has the exact same one on the shelf behind them.  Parents see this and then see me and it doesn’t compute.  I’m not here to fix DT therapy provision… I do question it but I can’t fix it.  What I can do is explain that they target play and concepts and occasionally language… but I target communication.  And they don’t make a toy for communication… they make people for that.
• Feeling inept: Yep, I’ve left sessions swearing under my breath. (wait, SLPs swear?!?)  Some sessions flabbergast me and I know that it would have been 100X easier to have done that session with my blankie bag!  I have to get into my car, blast some music, and remind myself that it may not have been a picture-perfect session but it was real.  And I’ve learned more about my families, clients, and how to adjust future sessions.

 The Unexpected

I like to think that not much surprises me.  I’ve worked in the field for a while and have seen many of the incredibly surprising scenarios that are out there.  However, going bagless has surprised me.  There have been so many unexpected moments.  Here are some of the most unexpected!

• I have parents leading therapy with their child… what?!?  I’ve always tried to have my parents assist but have held on to the lead position more than I should have.  The first few sessions were a bit rough but after parents started to get their feet wet… they took ownership!  I model or talk about a technique, we try it together, and BAM!  Many of my parents don’t require more than that and some additional feedback throughout the activity.  It really blew me away!  And I love it!
• Taking therapy outside has been incredible!  It’s still been a little chilly in Chicago (6″ of snow yesterday) but we’ve done a few walks so far.  I’m so excited to see what it looks like when we are really able to get out into the splendid summer weather in Chicago.  You can do bagless therapy anywhere!  Since you are wanting parents to carry-over techniques throughout the day, you really should be able to be with the family anywhere and doing therapy.  It sounds crazy but I’m not ruling anything out.  Restaurant, Target, park, bathroom, yard, living room… I’ll go bagless anywhere!
• Routines are a great way to target communication.  I’ve had breakfast with clients, talked about language during a poopy diaper change, and emptied a cabinet of every plastic box and lid the family had.  These are things that families do each day and I wasn’t taking advantage of them.  They are lost minutes of intervention if you aren’t showing families how they can be language rich activities.  Get creative and get involved in routines!
• EmPOWERment is POWERful!  Families are naturally hesitant to believe that they could be the one to make a change in their child’s communication.  I’ve made it a personal goal to be very empowering for my families.  I compliment them when I see them using a technique, celebrate goal progress, and have tried to become more of a coach and partner for them.  It has really enhanced the relationship that I have with several of my families and I can’t wait to see how it continues to do so.

Going bagless has been terrifying and terrific.  I definitely feel like it’s in the best interest of my clients.  However, it hasn’t been perfect and my version of bagless therapy isn’t perfect either.  So, I will address imperfection in Part 3!

I’d love to hear more about your experience with bagless therapy below.  Or any resources that I haven’t included in Part 1 that you feel are important!

Today I’m beginning a 3-part series about becoming the Bagless SLP.  As an EI therapist, I had become the Bag Lady with my insanely large bag stuffed to the brim with toys and materials to use in the homes of my clients during sessions.  This series is about doing away with that bag!  This post is the first part and will be followed by:

I realize that bagless therapy can be controversial in the world of EI therapy and I am by no means an expert on the topic.  This series is meant to discuss my perspective and real-life stories from my choice to rid myself, and my clients, of the bag.  It has been messy… and it has been incredible… and it has been the best decision for my caseload.  I’m excited to share this series with you and welcome any discussion as well!

“The Bag”

When I started working in Early Intervention I began to acquire toys at an alarming rate.  I was visiting children who had few, if any, appropriate toys for their age and development.  They were typically being “babysat” by television and tablets a majority of their day without a second thought.  So I filled up the trunk of my car with all of the goodies I could find: Books, puzzles, play food, Cariboo, kinetic sand, wind-up toys, bubbles, cars, sorters, dolls, potato heads, interactive books, and much more.  I was very organized about it but there was a lot going on back there.  I grabbed a few large zipper bags from IKEA and started seeing children and their families.  It took only a few short sessions before I began to realize that it was “All About That Bag” (go ahead and hum Megan Trainor’s tune in your head with that).  Parents knew that I provided the toys and the kids knew exactly where to find them.  (Keeping 2 and 3 year olds out of those bags should be a new Olympic sport!)  My clients would dive into those bags like they belonged to Mary Poppins herself!  No, you aren’t going to be able to pull a lamp out of that bag, sorry!  Now, I will say that some of my families had incredible toys and I did not bring in the big bag.  But, I felt a little empty-handed and insecure without ANYthing, so I still stuffed one or two things into a smaller bag for those sessions… just in case.  Some sessions went well and many of my clients were making progress.  But…

Buy-in and Carry-over

As sessions progressed, I was seeing more and more progress from my children in homes that provided their own toys.  Yes, you could definitely argue that those parents were already more likely to carry over activities and I would agree with you.  However, I was seeing very little, if any, carry-over in the homes that I was bringing toys into.  I found that parents were disengaged in the sessions despite my encouragement to participate.  I was at a loss.  What was I doing wrong and why weren’t these parents being the perfect little EI parents that I needed them to be?  When I attended ASHA in November I went to several Hanen sessions.  They were very well done and I brought back so many ideas to implement in therapy to increase parent participation and carry-over.  I was successful in getting some parents to participate more in therapy but was still toting in toys and seeing very little carry-over or change in the clients.

The Change

I am a member of the Early Intervention SLPs group on Facebook.  This is an active community of over 2,400 EI SLPs from across the world who participate in discussions, sharing, and more!  The discussion of therapy materials and bagless therapy had come up a few times in the group and recently I began following a thread that was discussing this extensively.  Many SLPs were providing information and testimonials about their bagless therapy.  As I began to look into the research and resources that they were providing on the topic, I began to think about my own service provision.  Was it best practice to bring in bags of toys that my clients would only have access to for 1 out of 168 hours a week?  What I learned from my research is that there is evidence to support that when developmental interventions are embedded in children’s regular routines and activities, skills learned are functional and meaningful for children and their caregivers (Kashinath, Woods, & Goldstein, 2006).  Is my awesome Melissa & Doug puzzle a regular routine or activity for a child?  Do they have access to it after I leave?  If not, will the parents understand how to target similar goals with what they do have at home?  What if, instead of playing with my toys, I show a parent how to work on language during meals and snacks?  Instead of 1 hour of therapy, they will most likely receive 20+ hours of intervention in the carry-over of that strategy during the rest of the week.  I don’t know about you… but this made such incredible sense to me!

So, I made a decision… To empty the trunk:

Before

& After

(I kept a few things in there that I’ll discuss in a future part of this series.)

What do parents think about no toy bag?  Here is a great video from FGRBI:

So… after clearing out the trunk and leaving the bag behind, how is it going?  Check out Part 2!  If you just can’t wait, check out the links/information at the bottom of this post!

Haven’t had enough?  Here are more resources and readings on this topic:

Using Routines-Based Interventions in Early Childhood Special Education

Florida State University Family Guided Routines Based Interventions Website

Early Intervention in Natural Environments: A Five-Component Model

Post References:

Kashinath, S., Woods, J.W., & Goldstein, H. (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Language, and Hearing Research, 49, 466-485.

I recently started working in Early Intervention full time.  I must first say that this switch in my career has re-lit my SLP fire.  I love my job again and enjoy each of my clients!  It is great to work with families to help these tiny clients learn and explore right before my eyes! It also doesn’t hurt that therapy involves play and lots of toys! My friend Kristin at Simply Speech wanted to create a blog post about what we have in our EI therapy bags.

(Click the image above to return to the original post and see other therapy bags!)

There are so many other items that I use in therapy but these are my most frequently used.  However, I must also say that a large portion of my therapy is done with the toys/items already in the home.  It is important to coach and empower the parents to continue the work throughout the week.  Using toys/items already in the home can be an important technique.  Introducing new and tried-and-true toys can both motivate clients and show parents new possibilities for toys to target language for their children.  Be a teammate!  So, what’s in your therapy bag?  Comment below and check out the linky for more ideas!

Today’s post is a first in a series.  We start today with 5 supplies any SLP needs if… they work with clients with severe disabilities.  This is a population that grabbed my heart and has never let go.  They are the most wonderful clients and are the reason that I became an SLP.  It can be a highly rewarding and extremely challenging position.  If you work with clients with severe and profound disabilities (including Down Syndrome, Cerebral Palsy, Autism, genetic disorders, etc.) there are a few supplies that you will need to be successful!

Velcro –

Velcro is magic and is a must in any SLPs toolbox.  However, if you work with clients with severe disabilities you will definitely need oodles of velcro.  You will use this for PECS books, materials, books, and organizing materials.  Velcro helps you to be flexible and address clients’ goals in many different ways.  Velcro dots are a quick way to use velcro but any velcro is helpful.

Board Books –

Paper books are easily torn and do not stand up to saliva and other bodily fluids.  One of the best investments I made was in popular therapy books in board books.  Many of these books can be adapted for clients who use devices and will last much longer to disinfecting, throwing, and much more.  These can usually be found at thrift stores, discount stores (like TJ Maxx) and from friends who have children that are getting too old for board books.

Fidgets – 

Many OTs will recommend that children have access to “Fidgets” within their classrooms.  Speech sessions are another great place to have fidgets available for clients.  Some examples of fidgets are: squeeze balls, velcro under the desk/table, coil keychains, weighted lap pads, sensory brushes, putty, tangles, foot bands, and more.  Consult the client’s OT for the best recommendations based on the needs of the child and what behaviors you are seeing during sessions.

Tablet case – 

If you utilize a personal or workplace iPad or tablet  you will want to invest in a quality case.  I go for cases that are somewhat waterproof – at least enough to be able to wipe down and/or sanitize the device if it is drooled on or something else.  There were countless days where my device had been bespeckled with many things during the session.  My case (OtterBox) allowed me to wipe it off with a clorox wipe with no negative effects on the tablet.  You will also want a case that provides protection for your tablet.  My clients typically threw, dropped, or jumped on my tablet during any given therapy session.  However, my iPad is still alive and kickin’ because of the quality case that I had on it.  You paid hundreds of dollars for the tablet and apps… you might want to pay $50-100 for a great case as well.

Highly motivating and easy-to-use toys –

Many of my clients were working on basic communication skills.  Highly motivating toys are universal and are easy to create communication opportunities with.  Some great examples of these “toys” are: bubbles, cars, balls, blocks, dolls/baby dolls, pretend food/kitchen toys, toys that move, etc.  Find toys that are easy to clean, target multiple clients’ goals (don’t buy something that only works with one client), and is sturdy.  I love exploring my local thrift stores and garage sales for these items.

If you are lucky enough to work with clients with severe disabilities, I hope that you find this post of 5 must-have supplies helpful!  What are some supplies in your “toolbox” for this population?

]]> http://sublimespeech.com/2014/08/5-supplies-you-need-if-part-i.html/feed 2 http://sublimespeech.com/2014/08/10-great-ikea-toys-for-early-speech-language-development.html http://sublimespeech.com/2014/08/10-great-ikea-toys-for-early-speech-language-development.html#comments Sat, 09 Aug 2014 21:27:59 +0000 http://sublimespeech.com/?p=1750

When you hear “IKEA” you think furniture and meatballs and that little instruction booklet guy who “helps” you interpret directions that don’t have words.  I have LOVED their organizational goodies and decorations for years.  However, until a few years ago when I moved near an IKEA store (well, actually we have 2 in Chicago!) I had no idea that IKEA had toys.  I wanted to share with you a few toys that IKEA has that are great for speech and language skills!

Baby (0-3 years):

MULA stacking rings – $5.99 (In stores only)

This is a nice wooden stacking rings toy.  Great for motor development as well, you can utilize this toy for requesting, colors, size concepts (bigger, smaller), location concepts (top, under, above), and much more!

MULA shape sorter – $4.99 (On-line & In stores)

Another great wooden toy that can help with fine motor skills.  This toy is also great for colors, sizes, shapes, location (in, out, on), and requesting.  You can also work on following directions with this toy (e.g. Hand me the circle.  Put the square in the house.)

Children (3-7 years):

IKEA has several glove and finger puppets that can be used with children:

VANDRING UGGLA – $4.99 (In stores only)

This adorable (and super-soft) owl has arms that move.  Great for imaginative play, working with clients who take a while to warm up to people, social skills, etc.

LASKIG – $6.99 (In stores only)

This glove puppet is a dragon (how cool?!?) and has a mouth that moves.  There is also a dragon tongue in the mouth which can be a great tool for use with artic clients (e.g. See where the dragon puts his tongue?  Do what the dragon is doing with your tongue.).  I also love that this dragon is not scary.  He has a very friendly face that will work well with younger children.

JATTELITEN – $4.99 (On-line & In stores)

These cute little 7 finger puppets come with a castle for performing puppet shows.  They have very interesting/unique clothing and are very colorful.  You can utilize these for SO many different goals including social skills, articulation, following directions, expanding sentence lengths through “plays”, describing, and more.  For older children, they could work to write and perform plays for language skills or artic carry-over.

TITTA DJUR – $4.99 (In stores only)

These have been some of my FAVORITE puppets for my speech room.  I’ve used them with 3 and up.  There are 10 adorable animals and we have used them for language, requesting, artic carryover (SHark sounds, etc.), and so much more.  They are also very colorful and would pair nicely with the JATTELITEN puppets.

IKEA has a lot of great food kits.  I recently picked up a few to use with my EI clients.  They are machine washable which will be very handy:

DUKTIG vegetables – $7.99 (In-Store only)

Great veggies – Cucumber, leek, lettuce, tomatoes, mushrooms, garlic, & carrots are included as well as a “crate”.

DUKTIG fruits – $7.99 (In stores only)

9 pieces of fruit are included in this basket set – watermelon, grapes, 2 apple halves, 2 orange halves, banana (that peels!), and kiwi.

LATAS shopping – $7.99 (On-line & In stores)

A fun 11-piece shopping kit that includes a basket and green pepper, cheese (with a “slice” that velcros off), fish, chicken, pasta, sausages, pineapple,  and eggplant.

All of these food kits are excellent for language development.  They can work on goals such as categorization, color, basic concepts, following directions, expanding expression, and so much more!  I also love that these are cloth.  I wouldn’t have thought that I would (wood toys like Melissa & Doug are easy to clean) but with these being machine-washable I don’t find it difficult to keep them clean.  Also, if you have a kiddo that loves to toss toys and may not understand that a piece of wood into the face isn’t a pleasant experience… these might be perfect.  If you are a traveling SLP you will like that they are lightweight and easy to tote in a bag.

LILLABO train set – $9.99 (Online & In stores)

Who doesn’t love a train set?  This classic is very affordable.  There are expansion packages that IKEA sells as well (3-piece train for $3.99, 12-piece set for $9.99, and  10-piece rail for $6.99) but this 20-piece basic set is perfect for the SLP.  Targeting requesting is easy with this toy.  You can also work on problem-solving, color concepts, location concepts, following directions, and much more!

Yes, IKEA is known for furniture and Allen Wrenches but I’ve found that they have a very large selection of toys for  young children.  If you purchased every item on this post, you would only be paying a grand total of $66!  Not too bad for 10 toys with multiple parts and uses!  What surprising IKEA finds have you had?

(You can check out other great toys from IKEA on their Children’s site.)