Welcome to FOXcast SLP. A podcast for clinicians made by clinicians. It’s brought to you by Fox Rehabilitation. Find out more at FOXRehab.org.
Maureen Colket, MA, CCC-SLP: All right. Well hello and welcome to FOXcast SLP. I’m your host speech language pathologist Maureen Colket. Very excited to introduce my guest on the show with me today is Lisa Marie. Lisa is a speech language pathologist practicing in Connecticut in home health and hospice. And she’s got a master’s degree in speech pathology from University of Maryland College Park. As well as her masters degree in linguistics from University of California San Diego. Lisa is the founder of eat speak & think. This is a blog for SL PT. You can find it at eatspeakthink.com. And she’s also on Facebook and Twitter. In addition to running her successful blog Lisa has earned the ASHA ACE Award three times for excellence in continuing education and she’s LSVT. Loud and McNeil dysphagia speech therapy program certified. Lisa welcome to the show.
Lisa Murray, MA, CCC-SLP: Well thank you Maureen. It’s such a pleasure to be here and thank you for that very nice introduction.
Maureen: I’m looking forward to talking with you today of course. Well earned. So you’ve really been in a variety of settings for treatment over your decade plus in the practice of speech pathology. Tell me a little bit about where you’ve been and how you ended up where you are.
Lisa: Sure. Well I’ve been a speech pathologist for eleven years and I started off in somebody else’s private practice working with children and adults. Which I thoroughly loved. And that was in Maryland when I moved to Connecticut. I couldn’t find another private practice similar to that to work for and I didn’t want to have my own private practice. So I started off working in the school system full time and per visit or per diem at a skilled nursing facility to try to decide if I wanted to work with children or adults. And I love working with children. And I also love working with adults. But eventually I decided that I wanted to work with adults. That’s how I ended up at a health center full time. I worked with three other speech pathologists and it was fantastic. I learned a lot from them.
Maureen: It’s hard to decide. I know I had that difficulty between the children and adult thing for a while too. Think a lot of us in the field had that difficulty. You just want to do everything and you kind of have done almost everything up to the point where you are now and you’re on this huge new journey which is amazing how the blog. What made you take that on?
Lisa: Well I started a blog for two main reasons. One was a little bit for my own benefit. As you mentioned I’ve done a lot of continuing education over the years. I have this problem called collecting and neglecting. And this is something that Gretchen Rubin I heard from her on her podcast happier. So collect and neglect means when you accumulate a mass of information but you don’t really do much with it. And I would realize you know when I’m working with a patient and I want to solve some particular problem that they’re having I’m doing all this research and then I realized I had the answer buried in my computer from two years before. So I decided by starting the blog they would give me a great opportunity to sort through the information that I have, to bring everything up to date and then to share it. But just one piece at a time. Otherwise it was just too overwhelming.
Maureen: Yeah so true I love that collective and neglect. That’s such a formal way to put it but at some times it takes the researchers to put it in such a way that we understand Hey this is what you need to do. And that’s not even the research of the speech pathology part yet. So how did you even begin to organize all the information that you had?
Lisa: Well when I when I started the blog in June of last year I was working with somebody who has Parkinson’s disease and he had a very hard time talking on the phone to his mom who was hard of hearing. So I was doing research into ways that they might be able to talk to each other and I discovered the government has like this free program where people can use speech to speech relay for example their other relay services for hard of hearing and for whatever reason I had never realized the scope of everything that’s out there especially now with technology with smartphones. And there are so many so many options. So I started off by writing posts about that. And then as I’ve been going through my posts have been inspired either by things that I was looking for in my own clinical practice or inspired by conferences that I was attending or continuing education courses I was taking. So I went to ash the ASHA convention last year and a number of posts are inspired by what I learned at the conference. And the best thing is is that a lot of the chairs very graciously allowed me to attach the materials from the presentations. So that’s great. Many of my readers can go in and go in and actually get like the pragmatic test. Materials for example and also went to the Assistive Technology Industry Association convention in January which just blew my mind. Well I do a lot of AAC especially with people who have ALS. And a reasonable amount with aphasia as well but I didn’t realize just this the full scope of AT and AAC so I’ll be writing a lot about that too.
Maureen: Yeah great post already that I’ve seen but we certainly look forward to what else is to come from there. You spoke a little bit about this but generally speaking what can we find on your blog at eat speak and think?
Lisa: I have it organized in four categories in the first category as being an SLP so I almost burned out as a home health speech pathologist about two years ago just because I was not working efficiently and I really had to make some big changes in how I was doing my practice and I wanted to share that information because I see on Facebook these groups that home health speech pathologists are part of. There are a lot of issues that we all experience. I wanted to share the things that I learned and then hopefully get tips from other people as well. So there are a lot of posts about how to works smarter and better in a home health setting or in people’s homes. For swallowing I don’t have so much so far but I have nine free assessment tools that people can directly access and this week’s post will be on IDDSI using IDDSI the gravity flow method for thickening liquids. I have a lot of communication and a lot on cognitive communication. So you might find things such as voice banking and message banking tutorials how to write smart memory goals, how to focus therapy for people who don’t really know what they want except they just want to improve memory. For example like how do you drill down and figure out how to make that functional to have good outcomes?
Maureen: I love it. I love the organization because I find it very easy when you go in you know what you’re looking for or you don’t. You’re going to come out and find something great no matter what. And I love that you’re filling in for this home health group of people who in all reality are very much on their own. You know when you’re working in a hospital setting or a facility or something you’ve got some co-workers and things and many people in home health especially some of the very rural areas you’re out there on your own. And I love that you’re saying hey it’s OK. We can still work on this together. We might not physically be together but I’ve been there and these are the things that I know will work. And this is something that you can do to change it. You don’t have to change your career because I’ve heard that too and it makes me very sad to hear people who feel that they’ve reached that point of burnout and wanting to leave the profession because we we need a so. You know this I know this. Anyone listening out there listen to Lisa’s advice you can change you can make it better. So getting down to the suggestions that you have for yourself is specifically working in patient homes. Talk a bit a little bit about that for me.
Lisa: The first tip that I have is to target your goals for the specific outcomes that your patient or their family want. The mistake that I made was in the beginning I wrote a goal for every impairment that the person had which meant that I often ended up with six or eight goals. And when I’m seeing a patient eight times over the course of a month there’s not enough time to address those goals. And besides which if you move the needle a little bit on attention span for instance. Well really what’s the big deal. Is it affecting them in their daily life. Is it affect. Is it improving their participation maybe maybe not. So what I do is I take that first session and I really talk to the patient and their family and I find out what they’re having trouble with what they would like to get from the therapy.
Maureen: That seems like a simple thing but you can’t stress that enough. So I love that you make that point of really making it centered and including the caregivers as well. I think that’s excellent advice. Yeah I love it. What do you have next?
Lisa: The next one is point of service documentation which is really really tough. I think for a lot of speech pathologist, but it’s becoming more and more important that we do this or a variety of reasons. I’ve worked out some ways that I’m able to get a big chunk of my documentation done during the visit especially for routine visits. It’s very helpful if you’re if I sit face to face with somebody that way I can make frequent eye contact which I think is important and including them. And I ask for them their input and while I am typing I’m talking too, that way there’s not long gaps where I’m just looking at my computer and seemingly ignoring them. I engage them and I ask them for input then a lot of I don’t know everybody has a different documentation system but I open up the last visit note and a lot from one visit to the next is the same. So as I’m talking to the person in normal conversation we might look down or we might. Look away. So instead of just those normal eye breaks I will look at my computer and check the next box. So just in those little bit of time in normal conversation when we do break eye contact I do a little bit of documentation and just by doing a little bit of documentation. Bit by bit throughout this session a lot of it is actually done by the time I’m ready to walk out.
Maureen: That’s the way to do it. Very successful. I like this in particular for any SLP but some who’ve been in the field for a long time. It’s certainly hard to change things that you have done as we have or more towards supportive servers documentation dial. But for any new grads coming along you know this is how you do it. This is how you started out. Just get those habits established. I can’t stress enough how much these might seem to be basic things but they are so so important to your practice because these are the little things that then can turn into the upset of the clinician that lead to burnout. You know we all love working with our patients but this is that little stuff that we can often neglect. I know I’ve done it myself.
Lisa: OK. So the next step is to be strategic when scheduling. And by that I mean if you like. Well I’ll put it myself if I let my patients dictate my schedule I’m going to find myself traveling all over the place back and forth criss crossing my path. And that’s just not good. So what I’ve done is I I always preplan for the next week. I will keep track of my patients preferences and I am aware of what they have coming up because with most of my patients were using their calendar in therapy anyways so I know that maybe they’re gonna be gone all day Wednesday for a big doctors appointment. I preplan my my visits for the next week keep my patients preferences in mind I take their schedules into account and I lay out how I want my next week to be. And it’s important that I include my own workout schedules and my own appointments to go ahead and block that off first. Then when I go in to see the patients I will confirm at those times are good for them. And I’m also very polite and respectful in the way that I ask. Sometimes my sessions overlap with other therapists and the other therapists will come in very heavy handed and say I’m going to be here at such and such time and such such today and that just sometimes gets people’s backs up. I find that politeness goes a long way. And when I confirm those appointments and if there’s some problem since I’ve already thought it out and my patients are kind of group by area oftentimes I know Oh I’ll probably be able to switch patient with patient B and it will work out fine. So it’s a lot less hassle.
Maureen: Awesome. Yeah. Really really good tips there. All right are there any other suggestions for clinicians out there in the world of health. House calls.
Lisa: One final suggestion. You know as a speech pathologist we are a master problem solvers. We teach people executive function skills. And if you’re noticing any friction in your day any points that are giving you some problem and whether it’s information that you’re having to look up constantly or some paperwork that you’re always having to search your bag for if you take a couple of minutes and just think how you can solve that problem to make it go more smoothly then it will save you time and stress down the line even if it’s a tiny thing. So I’ll give you an example my company handed out work phones about a year ago so I had to learn the new cell phone number. I had two options one I could memorize that number to the point where I didn’t second guess myself or I don’t trust my own memory. So I kept looking it up to double check. So what I did was I just wrote it down on a little piece of paper and taped it to my laptop that way if I’m typing in a family member asked me for my phone number which happens all the time then I can read it right off or if I’m on the phone with a doctor then it’s right there I don’t have to pull anything out look at it and I’m not second guessing myself which saves me stress.
Maureen: It’s as if you set up a care plan for yourself when you were hitting this almost burnout part you successfully met your goals and now you’re teaching everybody else and your patients as well.
Lisa: Well I’m teaching as I’m learning but I’m learning too and I can definitely learn from all of you as well.
Maureen: That’s just it. I mean you obviously have done a ton of continuing education you’ve gone to a ton of conferences but you don’t step back and say OK I’m done. I’ve learned everything. Obviously you go for it. You want to learn more you’re ready and willing to absorb and take in any new information. I think that’s the way all of us should be all the time. And I’m just so glad that you have this blog to share with everybody.
Lisa: Well thank you. I really appreciate it.
Maureen: I also revealed that we have a tradition on our show which is called the FOXtale and your FOXtale is why did you go into work with people in their homes in the home health setting. Why was that something that you decided to do. Let’s hear FOXtale Lisa?
Lisa: Sure. Yes. So I. Working in people’s homes because therapy I find therapy is very powerful in their own environment. When I was working at the Medical Center I found that I was doing a lot more with workbooks and worksheets and flashcards. And to me it felt like I was struggling to help with how to make that functional how to make it meaningful and how to make therapy relevant to them in their daily lives. When they went home so I decided to give home health a try to see if I felt more fulfilled working with people in there. I find that it’s very powerful to be in my patient’s home with their calendar with their mail with their family in their environment.
Maureen: Yeah absolutely awesome. That’s great. Lisa thank you so much for talking with me today. I’m very excited to share all your information again. Lisa’s blog is eat speakthink.com.
Lisa: Right now I’m posting every other Friday and my letter goes out every other Monday.
Maureen: Eatspeakthink.com. So much information links principle tests principal therapy tools but most importantly those good recommendations for functional therapy and how to keep both you and your patients happy. Again Lisa thank you so much.
Lisa: Thank you so much Maureen it’s been a pleasure.
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