welcome to SLP nerdcast the number one professional resource for evidence-based practice in speech language pathology I'm Kate Gru and I'm Amy Wonka we are both speech language Pathologists working in the field and co-founders of SLP nerdcast each episode of this podcast is a course offered for ashes CEUs our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need this course plus the corresponding short post test is equal to one certificate of attendance to earn cus today and take the post test after this session follow the link provided in the show notes or head to SLP nerdcast docomo advice we do not endorse products procedures or other services mentioned by our guests unless otherwise specified we hope you enjoy the course are you an SLP related professional the SLP nerdcast unlimited subscription gives members access to over 100 courses offered for ashes cus and certificates of attendance with SLP nerdcast membership you can earn unlimited cus all year at any time SLP nerdcast courses are unique evidence-based with a focus on information that is useful when you join SLP nerdcast as a member you'll have access to the best online platform for continuing education in speech and language pathology join as a member today and save 10% using Code nerd Caster 10 the link for membership is in the show notes welcome to SLP nerdcast everyone today we are really excited to welcome two guests we are here with Heather Casa and Karina kadi welcome Heather and Karina hi hi good morning thank you and Heather and Karina you you are here to discuss the slp's role in dyslexia but before we get started can you please tell us a little bit about yourselves yeah sure um so my name is Karina I'm an slpa um I have been doing this for about 10 years now U and my first job out of college so I got my bachelor's degree at the University of Arizona um and my first job out of college was uh with Heather she was my first supervisor so that's how we met um I've worked in Pediatrics ever since both a school and a private setting um and I just have a real passion for early language development um and Heather when Heather and I cross paths some of our like Niche areas kind of um lined up and that's how we are where how why we are where we are right now um personally I have two two daughters a six-year-old and a three-year-old um two yeah two girls and yeah it's a little bit about myself and I'm Heather I uh live here in Arizona uh in the Phoenix area just like a small little actually it's not small it's Get Growing quite a bit but a Suburban Phoenix um I also have been a speech language pathologist for just about 10 years um have worked in private pediatric most of my career I started in skill nursing facility and found out quickly that was not for me where I wanted to be um so I a couple years after I graduated and working in Pediatrics um I just found a passion for dyslexia I first was introduced to it in undergrad um through Dr Tiffany Hogan at the University of Arizona she was one of my professors and she's incredible um and so yeah I just started doing as much training as I could extra CEUs um I went and got some training through the Academy of Orton Gillingham practitioners and Educators on reading intervention um and then just quickly learned that there was such a need for education in our field um and how important our role is uh at in dyslexia and especially early identification and and early intervention and so again that's how Kar and I kind of cross paths because she just loves that early intervention I love the reading um and we just rolled with it so I decided to um start my practice uh in the middle of the pandemic uh craziest idea I've had but uh it just been been amazing ever since um I just knew that I really wanted to go out on my own and be able to educate slps and do trainings and workshops but also provide services for students so um I also have two kids I have a son who is also six and a daughter who is three um my son just started first grade we already started school here in Arizona my husband and I have been married for about nine years and yeah that's it no one could see my eyes go wide when you said you've already started school we're recording this at the very end of July um we don't start school here in Massachusetts until late August August September so um it's always fun to hear about how different areas of the country do things and we already talked about this before we hit the record button but Amy and I don't know very much about dyslexia this is not our area of clinical expertise so we're very excited to learn from the both of you today before we get into the content I do need to read our learning objectives and our financial and non-financial disclosures which are as required I'm going to get through those as quickly as possible and then we'll get on to the good stuff learning objective number one describe three additional Service delivery domains outside of assessment and treatment that are essential when working with students with dyslexia learning objective number two describe three barriers to Upstream thinking when discussing prevention and early identification and learning objective number three discuss three ways you can play a role in Upstream thinking for early identification of students who are already struggling with early literacy skills disclosures Heather's Financial disclosures hea Heather received an honorarium for participating in this course Heather is the owner of a private practice called HBC language and literacy Heather is also the co-owner of sore withwords LLC and co-manages the sore withwords educational platform on teachable Heather's non-financial disclosures Heather is the current president of the Arizona branch of the international dyslexia Association Heather also co-manages the social media accounts for sore with words Karina's Financial disclosures Karina received an honor Arium for participating in this course Karina is also the co-owner of sore withwords LLC and co-manages the sore withwords educational platform on teachable Karina's non-financial disclosures Karina co-manages the social media accounts for sore with words Kate that's me I am the owner and founder of grand B therapy and Consulting LLC and co-founder of SLP nerdcast my non Financial disclosures I'm a member of Ashes sig2 I serve on the AAC Advisory Group for Massachusetts advocates for children and I'm also also a member of the Burkshire Association for Behavior Analysis and therapy Amy that's me um my financial disclosures are that I'm an employee of a public school system and co-founder of SLP nerdcast and my non-financial disclosures are that I'm a member of Asha special interest group 12 and I participate in The aec Advisory Group for Massachusetts advocates for children all right now we're through that stuff Heather and Karina why don't you start us off by telling us a little bit about that first learning objective so what are three additional Service delivery domains outside of assessment and treatment because I have to say I I can't think of them what those might be um so the the way we kind of like to break it down is we like to think about um the in general the service delivery domains that fall under our scope of practice as speech language Pathologists and so um straight from Asha they break that down into those let me let me count them really quick 1 two 3 four five six seven eight eight of those um service de delivery domains and it's collaboration counseling prevention and wellness screening assessment treatment um that modalities uh Technologies instrumentation and then populations and systems so that's it's that's not new to us necessarily we know those and so the way that we like to um bring awareness to the role that we as speech therapists and speech pathologists can play um in dyslexia intervention is under each of those domains bringing attention to things that we could do to support these students under collaboration under counseling under prevention and wellness we um recognize that the direct intervention is most likely not our role especially in a school setting we know that we're not the reading Specialists um but we feel strongly that we can play um a very impactful role um in supporting these students because a lot of the skills uh with literacy overlap in our wheelhouse you know um so uh there's there's eight different ways that we can support these students besides just intervention um and we kind of want to go into each of those and talk a little bit about um how we can support these students I also wonder if we could take a step back just for a second before we dive into each one of those because that was those were all things I've never considered uh and thinking about the larger picture of Dyslexia in general could you tell us a little bit about first of all maybe defining it for us for any listeners out there who have been working in a sniff for the last 15 years and and need a refresher um could you Define dyslexia for us or talk a little bit about why early intervention is so important I think so this this is such a great question um and unfortunately there's not really an easy answer for what dyslexia is and it's actually one of the biggest barriers to identifying dyslexia is that across the board there's many different professionals that are involved in research for reading disorders and learning how to read um but there's not really a consensus on what dyslexia is so um I will read the international dyslexia association's um definition for dyslexia but then kind of also talk about another definition that we really like um so it's kind of a mouthful but Ida's definition is dyslexia is a specific learning disability that is neurobiological in origin it is characterized by difficulties with accurate Andor fluent word recognition and by poor spelling and decoding abilities these difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to the other cognitive abilities and the provision of effective classroom instruction secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge so quite a mouthful um a l i I love that it def it highlights and really incorporates that reading comprehension those secondary consequences that we see as far as the language development and and just reading comprehension um but one thing I don't love about it is the the line where it says these difficulties typically result from a deficit in the phonological component of language because more and more researches coming out showing that only about 50% of the kids with dyslexia actually have a phonological deficit and then we're talking about phonological awareness so there's a couple different subsystems subtypes of Dyslexia um as far as like you have an orthographic piece where that's more of like those letter sequences orthographic mapping um versus a phonological where someone's really struggling with that awareness of sounds and words and so I think that definition specifically kind of eliminates or maybe um if a if a child is tested and they have really great phonological awareness skills but they're struggling orthographically if you're looking at that definition then that child might not be classified as a student with dyslexia but but they are um so Dr Hugh Kats and Dr Tiffany Hogan put out an article in 2021 um that really talked a lot about more of looking at like multifactoral um basis of what dyslexia is and what these students are kind of experiencing and so um the article is called dyslexia an ounce of prevention better than a pound of diagnosis and treatment and so it's really talking about that early identification and prevention which is what we're so passionate about but they kind of propos this definition that dyslexia is a severe and persistent difficulty learning to read and spell words despite adequate opportunity and and instruction so we really like this model and this definition because it's highlighting that there's no single deficit or even like a small group of deficits that are consistently associated with dyslexia and so it's letting you look it's it's highlighting a prevent preventative model I also want to highlight that we do know that there's no really known cure for dyslexia but when we're talking about prevention what we're talking about is just identifying these students early and getting early intervention in place so maybe they might not need an IEP or they might not struggle or fall as fall as far behind in school they may we may still see you know some some difficulties that they have um because again we know that there's no cure for it but that early identification is so important um so I mean that's kind of a a a long-winded answer for that question as far as like what dyslexia is but that's really how complicated it is is that there's no um single definition yeah there's no checklist that you know there's nothing that you can just check these boxes um we really need to look at the whole child but um but yeah that's kind of the definition that we really like and educate others on seems like there's a really big missing piece then in terms of making sure that kids can get identified to get the services that they need can you this is sort of a tangential question um and maybe it's just because I'm not familiar with this area but in terms of that differential diagnosis process do you find that most kids are getting picked up through the school screening system or are they needing neuros evaluations what does that identification process look like with this very Loosey Goosey or inaccurate definition of what it is I feel like a lot of times in school settings the approach that we see is that wait and see approach um especially for um early identification of things like this um I kind of want to get into the dyslexia Paradox right now Heather what are you thinking okay um now I need to know what it is that you have to say it um so there's the um let me go over here so I get my resources correct one second um there is this idea of Dyslexia Paradox Heather can you help me with the um referencing who it is I know it's uh Dr Dr naen gab um okay and so it's the idea that uh intervention is most effective early on um preschool kindergarten years um maybe even first grade right but um most students with dyslexia aren't formally diagnosed or even like identified identified um until like second or third grade which means we missed that prime time for early intervention or identification in order to intervene early um and so there's this sweet spot uh early on where intervention just research shows is more effective um and so in in in school systems especially in Arizona what we're used to seeing is in kindergarten when um we might have students who have some um risk factors that we noticed um and most of them by the way are already on our case loads for speech and language Services right um that we there's a lot of push back with wanting to screen for uh other areas because their the approach is well they just haven't had time to adequate instruction so we don't know yet we have to wait and see um but going back to looking at the whole child yes they may not have had enough time for adequate instruction but if we know that there's a speech and language um history right if there's deficits in that area or if there's family history of things we could look at the whole child and kind of narrow it down and um decide that well now is the better time to intervene for that child versus the wait and see approach so we really like to um that's why we push so much for considering other factors in that because we see a lot of that weight weight in and by the time we see uh it's kind of late in the game for them in terms of intervention I think an important note too is a lot of states do have legislation or in the process of getting legislation in in place so Arizona specifically within the last couple of years passed the legislation where all students I think it's Kinder through third are screened um for dyslexia using a universal screener um and the state has approved screeners so once um once the screeners administered if they fall a certain below Benchmark then they are required to receive like tier 2 intervention so we're seeing huge leaps um Across the Nation I think um which is great uh but I think some of the missing piece too is then what intervention is being implemented and how how strong is that intervention and and that comes down to even just like educating teachers and and administrators specifically as to what needs to be done for these students so we're seeing a big push and some gains in that early identification um but we are still seeing a lot of that that wait and see but again kind of where Karina and I came in and we like as speech language Pathologists we like Karina mentioned already so many of these students are on our case load because of a speech or a language um disorder and so if we as slps are more aware of what some of these early indicators are and what dyslexia is and how we can kind of implement some of these early interventions into our speech and language therapy we have a huge role in that prevention because we know that most likely that kindergartener or that first grader is not going to get referred for testing in the school yet they are going to have to go outside and get evaluated by an SLP or a neuros psychologist um to for that that diagnosis or that identification I mean and we know that schools aren't going to diagnose um students like in the school they're identified as um sld you know specific learning disability in the schools typically under like basic reading or older students are often like under reading comprehension but can you tell us a little bit about any of the early indicators for dyslexia yeah definitely so some early indicators early on like in those younger years like maybe um preschool kindergarten um family history is a huge one family history of speech language and learning difficulties um on the intakes that we do um Heather mentions a lot that um oftentimes you you you'll get a skewed answer if you ask specifically for a history of Dyslexia right because most most of the time parents um don't have a diagnosis or don't don't realize that that's what they're struggling with but once you start talking uh it may come out that oh yeah mom and dad had a hard time uh with school or Grandpa struggled here you know and so um family history can really give us a lot of information um delayed speech and language skills um the comorbidity rate between dyslexia and speech and language disorders is about 50% um so that can be an early indicator especially for those younger kids that again we might already have on our case load so when we're seeing some of these other um just Oddities with them um that might stand out as an early indicator as well um difficulty um with learning labels and names vocabulary for things like shapes colors numbers days of the week or letters that um kind of speaks a lot to uh working memory and some underlying deficits that might um be associated with it um difficulty pronouncing words um obviously we already talked about the speech uh skills but these are more like abnormal pronunciations of things that don't won't really be picked up on like a gfta or an eval screener type thing um but you just notice something's off with the way they're pronouncing um some words and then they might even be like word specific um mispronunciations um we already mentioned uh difficulty learning new vocabulary um and rhyming and identifying sound so that those phonological awareness skills um might be low and then in uh slightly older students now maybe we're thinking second third older um difficulty with uh knowing left from right kind of that like orientation um struggles with site word recognition um in a sense all words become site words because we don't decode them every single time um but with those true site words they might still be struggling at that um slightly older age with recognizing those site words um poor spelling uh difficulty memorizing number facts um so kind of we mentioned it earlier but bleeding into that math realm right is it the math computation skills are more of like the language revolving around um math and math facts things like that uh frustration with school and homework going back to that social emotional piece um difficulty understanding what is read so comprehension um and written expression putting ideas into writing uh could might be really difficult they might tell you this elaborate story and they go to write it and all of a sudden it turned into like this super dull um sentence an example of that I have a student or I had a student years ago who um she was writing for me and she was going to write about the kitchen and she instead of writing kitchen when I looked over her sentence she changed it to the sh The Cook's room and I asked her why did you call it the cook's room that's interesting and it was um she changed the that whole sentence up um because she didn't know how to spell kitchen and so um getting those ideas into writing can be really difficult for a number of reasons either that sentence like generating the sentences or even making them more simple just to avoid uh words that are going to be difficult to spell so they're all some some indicators we might see in our younger and our older students I want to talk about some of these more specific components in our first learning objective about Service delivery and I have to assume that that is related to the slp's role here and you've already described the SLP playing a role in early identification right if these kids are on our case load you've also described the slp's role in um educating staff and piece that collaboration piece right so making people even aware of the holes in this definition everything from you know that to how to use a screener or which screeners they should use I can imagine that the collaboration and education piece is really wide can you tell us a little bit more about just the role of the SLP and how that might relate to um the different Service delivery areas I'd also love a review of those Service delivery areas sure so should we should we get into those and we can kind of go um kind of break down each of those areas and think about our role in them through the lens of um supporting literacy skills I guess maybe that's not what we're what we're thinking about when we go into our speech room and to do that intervention but that's kind of what we want to bring awareness too today so we could start off with collaboration if that's okay um we've kind of already um talked a little bit about that piece but we we know what what collaboration means and in terms of how we can support these students in a school or even a clinic setting through collaboration um is that education piece you already hit on that and educating the the rest of their support team right whether it's their teachers um whether it's if we're if we're working in a school setting and we know that they're getting intervention somewhere else collaborating with that therapist we all have that that common goal um in supporting these students and so um collaboration is uh could be a big one both in a school setting and in a in that clinic setting um especially with the classroom teachers I think finding um as an as the speech therapist at at the campus um the skills that we possess really overlap with um literacy and structured literacy which we'll get into a little bit later or next time but um and so realizing that we possess a lot of the skills to support these students even though we're not the ones doing the direct reading intervention um counseling is another one another big one that we really like to talk about and bring awareness to the role that we can play through that counseling uh domain um that just it just supporting our students with any um things that come from the speech or language disorder that they're dealing with right in this terms in or in this case thinking about struggles that they might be dealing with um secondary to difficulties with reading and writing um and we see that all that has been a huge one for us um especially these last couple years Heather and I have been working with um older students and we're typically used to working with I worked with a group of uh middle school students these past couple years and that my role in that counseling piece was huge for them because at that age um and at that point in their the game for them in in terms of their learning um they had a lot of Shame built around um their learning and themselves and their skills and they had already these literacy skills were have been hard for them since kindergarten right and at this point we're in sixth seventh grade and they have this wall up and they're they truly had um so much shame around their abilities and um so our role in supporting these students and building rapport with them was huge because it wasn't until that that we um got some breakthrough and were able to make some gains in their literacy skills um especially because at in that middle school age they're um more embarrassed about it right they're more sensitive to that and so coming in the speech room to work on this it was not always fun for them and so really building that Rapport and that trust in th with those students um was crucial to then the learning that could happen after that so our role in counseling whether it's with your student has dyslexia or not right like that Rapport is so important so our role in that counseling domain is really huge too um and one that in the last couple years has come to light for us um and the impact we can play there I think too there's a lot more research coming out as far as the relationship between dyslexia and anxiety and they've found that um researchers found that anxiety to be related to decreased academic achievement um and performance as early as first grade so we're seeing it early on in these students and again and remember a lot of these students aren't getting identified yet so there's definitely a bidirectional relationship between these reading difficulties and anxieties so like obviously as reading difficulties are in are increasing so are your levels of anxiety but then also like increased levels anxiety are going to negatively impact your response to intervention so I you know I have parents ask me a lot too you know I'm seeing a lot of anxiety in my Stu and my child you know around reading and I was like honestly if we're not addressing that piece there like if our students aren't mentally in a right place to learn um you know and and to and to build you know these cognitive um connections then no matter what intervention you can get the best interventionist and the best programs like it's not going to be as beneficial so I think we have to be really um mindful of that and really working with our students so um Dr Sharon Von and I think Dr Annie grills I think is her last name or gills I can't remember off the top of my head but they are doing a lot of research together as far as the anxiety and um and d and the reading piece we do have a couple links um on our Instagram and our bio to some videos um I think it was through one of the dyslexia um programs I can't remember off the top of my head but they have some free videos online of presentations they did and a huge um really really great resource um to kind of learn a little bit more about the anxiety piece and and dyslexia and kind of it we can tie this back to collaboration too is if if we're in a school setting where we don't have um a counselor or we feel like we are not able to support these kids knowing that we can um collaborate and refer out to get these students the support that they need talking to their parents to refer out or if we're in um a clinic setting talking to some of our other um the therapist and within other disciplines or again and referring out um so those kind of always go hand inand we can always kind of tie back to that collaboration piece where if we don't we don't know everything we're lifelong Learners right we can't fix it all although we think we can sometimes um and so knowing that we can um refer out to support this area or any of any areas that fall under our domain uh Service delivery domains um when needed I just want to take a minute to say thank you for unpacking the importance of mental health in the Journey of our Learners um I know when I am anxious I'm not available for much of anything no much less learning something that presents the a challenge for me or learning something that I have already learned is difficult for me or getting my you know getting that cool common collected feeling when you take on a challenge and you're really putting your all behind it I'm not doing any of that if I'm anxious absolutely and I really appreciate you reminding us of that um and anybody who is listening who is maybe reflecting on their Learners on their case load who might have dyslexia maybe considering the social emotional components of this as part of the treatment package instead of just oh that's something that the counselor down the hall deals with that's not my domain absolutely yeah it's our pleasure to do that it's some like I said it's something that has really um come to light for us in these last couple years working with a slightly older population um but quickly we realized that needed to be front and center um for that and then in terms of treatment a way like we could adapt that is noticing like when we have to put our goals aside right to address the child in front of us and oftentimes I think we get stuck in we got to collect data we got to have this we got to do this and we push our agenda right um not being mindful or noticing even um some of the struggles the student might be dealing with in front of us and so if we have to set our goals or aside for a second to address that student that is still um with we're still servicing them right just in through a different domain so I think you make such great points too just for all of us and and like you had mentioned I think Karina you know regardless of sort of the specific challenges that have brought the student into our into our therapy room just being cognizant of the importance of relationship Rapport but also just creating a safe space where our clients are feeling empowered that they are able to do these things and we're here to help them out but we're we're not the fixer of all their problems it's something that we're doing together and they can do it um and and their time with us is a place where they are safe to kind of be the full spectrum of all the feelings that they're feeling in relationship to um the challenges that they're experiencing so I think you make wonderful points for our people who are working with clients who have dyslexia but also I think that these are wonderful points for all of us you know kind of regardless of of who we're trying to help so looking at your learning objectives another term that I am not familiar with is the term Upstream thinking so I don't I don't want to rush you ahead um in your presentation but it's something that I'm super curious about I see it in two of the three learning objectives and I'm just curious kind of what what that means you're actually segueing us right into the next uh Service delivery domain so that was perfect um and so that kind of hits that next um one of those eight Service delivery domains we talked about um is prevention and wellness and so that idea of um Upstream thinking is stopping a problem before it happens right getting ahead of something before it becomes problematic um and so when we think about Upstream thinking and uh dyslexia Upstream thinking um and the SLP there's kind of three things that we can do to get ahead of something before it becomes or get ahead of uh reading and writing difficulties the difficulty with those literacy skills before it really becomes problematic um and so it's through education um early identification and then that early remediation are three ways that we can um be Upstream thinkers or apply that idea of Upstream thinking um to to to prevent further difficulty or um maybe even a need for like an IEP like Heather mentioned earlier um and then with Upstream thinking we kind of break it down into um like everything there's barriers right um and so with Upstream thinking we there are a few barriers that could get in the way um whether we're working in a school setting or a clinic setting um and so those three barriers are I can't see the problem so maybe um we have a student on our case load who just has articulation goals right there's no reading things here so why am I going to address this or the wait and see they're just in kindergarten it's not an issue yet um the problem isn't mine is another barrier maybe it's not within my scope of practice to address this reading uh I'm not the reading specialist so why am I working on this um and then another barrier is I I just can't deal with it right now right I don't there's all of those um different admin and procedures um Heather knows more about this area than I do I I don't do evals obviously but um just more of those uh admin and things that kind of get in the way of um just screening a kid or eving a kid kind of those precursor things that um need to happen before and so that that is that idea of Upstream thinking and we would like to think um of speech therapists and slps as the in the perfect role to really play a huge role in Upstream thinking when it comes to these students specifically I was was just going to ask I know you mentioned a little bit earlier I think Heather it was you who was who was talking about kind of other things that we might be able to do if we identify a student through a screen or they might get tier 2 intervention or something like that do you have experience working with like schools I guess in particular who do a a really nice job with RTI mtss and actually do kind of support kind of to your point Karina support some of these students well enough through that intervention model that they actually don't need to go on to develop an IEP and have more of those specialized Services what might that what might that look like I I that's such a great question um so I have you know I've worked in just a couple of different School District not even districts or like charter schools in the area and we're right now um where we have been working as a private school but as far as like what that would look like um I mean all schools in Arizona right now are doing early identific early identification as far as those Universal screeners but you know they do that two typically is looking like small group what I've seen done a lot is they're going you know they go to a different classroom but a lot of times it's a computer program um which I don't think is always super effective for these students you know it really just depends on the child so um I think I saw more so recently last year at a charter school I was I was working at a little bit they did a combination of both so they had a they had someone in there that was doing more Hands-On intervention and the other students were kind of getting extra practice on a computer while she was working with a smaller group and I think that can be really effective but I think just that tier 2 intervention if it's always just like a computer program where they go and they're sitting by themselves at a computer and they're just getting this extra practice of that phonics instruction is not always going to be super effective I still think that handson um in small group like inperson instruction with a body with a teacher um that that one is also educated in in dyslexia and what that intervention should look like um another piece that Arizona implemented is they have each school um each Elementary School K through five um must have what they call a dyslexia trainee design um and so it's typically a Kinder through third grade teacher one teacher that gets extra you know they they're kind of in charge of getting all of that dyslexia education you know continu education and they're kind of like the go-to person for that school so I always tell the slps Find Out Who Your Lexia training design is at that school and become best friends with them like together you to can make a world difference for those students um so I think that's kind of my big thing again you know there's great programs out there um but I just there's something to be said about that you know doing that intervention like with the student and having a body and not just putting them as a tier two like putting them on the computer program to kind of piggyback off of that Heather I think the thing that is that is said about that in person intervention is that the the clinical skills that the whether it's the reading interventionalist or the therapist can bring to the table um in terms of individualizing the the intervention right um these programs or like the online practice that Heather's mentioning things like that are it's going to be the same for the kid that logs for every kid that logs on nothing's really individualized in terms of cues or visuals or supports that they might need and so while it might work for one it's not going to be designed to be effective for every single student that gets on there right and that's where that those clinical skills really come in where we can individualize those supports and scaffold things appropriately um so that we can uh ensure like a Cognitive Connection there you know and not just exposure to material kind of a thing um so I think that's another um huge benefit of being able to support students um outside of just a an online program I have a question related to this concept of Upstream thinking is that what it is Upstream think so this concept of Upstream thinking and the general nature of the infrastructure that we work in so I always use this colleague as an example but I have a colleague who works in a public school district here in Massachusetts and she has a case load of hundred and some students and you know it's it's knowing that our for a lot of us working in schools our resources are limited um our the support that we have from our administrators is limited and our scope of practice is so wide that I can see the situation arise frequently where there's the and I think every state does it differently so your resource specialist or your reading teacher or whatever your designated person is I could see the the experience of well I don't have time to do that I don't know anything about X that's Linda's job down the hall um I don't have this in my scope of competence so I'm just going to work on phology how would you recommend an SLP get ahead or do that sort of Upstream thinking in terms of addressing some of these resource deficits or competency deficits in a way that feels a little bit more manageable what what made me think of it was when you said become their best friend because I genuinely do think that sometimes when we even have lunch with a colleague who has a difference and we're talking about our weekends there can be this experience of shared knowledge um and I just I didn't know if you had any suggestions for how to specifically address some of these real world issues that we're facing in terms of of the resources that we have available to us yeah that's and all of those things that you brought up are what we hear from slps all the time so some things that I would recommend doing is we're required you know for our license to get continuing education we have to do every year um so the international dyslexia Association they offer CEUs local branches even if it's not your state um different state branches offer CEUs and they offer Asha CEUs for speech language Pathologists so that's it's a great resource to get a little bit more education and competency in this area um and so the international dyslexia Association has a big conference every year just like uh Asha does so that's one way um and in you're if you're in the schools really advocating um to be part of some of these train literacy trainings um because like I said every Most states have some sort of legislation now with the schools and where they're having to have more education on it and so you might and I think even a lot of schools will require you to participate in certain a number of professional development every year just Advocate as an SLP like I'd like to be involved in some of these literacy you know trainings or for reading to to really kind of increase that competency and again we we recognize that slps cannot now just be like okay that kid has dyslexia they need to be on my case load that's not realistic and we completely understand that but just by kind of educating yourself and being a little bit more aware there are a lot of things that you can do just to support these students with what you're already doing so one thing we kind of always talk about is this common knowledge versus common practice so a lot of what we do in our trainings and what we tell slps it's may not necessarily be like brand new information like we're not going to really blow your minds but what we're going to do is help increase that awareness and help you identify activities and things that you can do um to be a little bit more intentional with what you're already doing to support these students and most of what we do in our therapies um like in our clinic and with our students we don't have fancy materials we have a whiteboard Legos and dry and dry erase markers you know so should see my pictures yeah I and we create we create materials for students um like therapy materials for them to take home with literally construction paper or index cards and markers and we have them drawing and I mean there's a ton of great resources out there for dyslexia intervention um and materials but we also understand that like that's not always realistic to have to have those accessible to you so there's a lot that we do and we try to share a lot on our social media of like practical things we're doing in our therapy sessions um that you with things you already have in your classroom um I want if I could add something to that another thing that Heather does really well in terms of that um kind of addressing the issue uh with um resources in a school and getting these kids identified and stuff is um collaborating with the rest of the evaluation team and like the school syes and stuff she does a really great job at that and even sometimes Heather maybe you can go into more of that but like breaking up the um like the subtests and like ones that you may do versus the psych and um so I think she does a really good job and and maybe that kind of um helps with some of those um access to the resources and things to make this um a smoother process yeah I I've definitely heard horror stories from other slps about their relationship with like the school psychologist that they've worked with I fortunately have never had that experience you know because I think sometimes we get that push back like hey stay in your lane like I you know I'm the school psychologist and nothing against School psyches but I have had the absolute pleasure of working I've worked with two School psyches um in my career and have developed like the best relationship with both of them um they another one that you should definitely try to to make your bestie in um when you're working in the school setting and we have just collaborated so well as far as um the evaluations you know and there was one time where there was um student that was referred an older student that was referred due to academic concerns like reading comprehension and they're like I don't think we need speech you know it's just academics it's just reading comprehension and I was like whoa hold on and I was like you do need us and I said because reading comprehension is decoding word recognition and then language comprehension like we are the ones that should be they do they will you know School SES will assess language to an extent but we're going to do a more in-depth thorough analysis of their language skills and so we absolutely should be involved in those and again I know people be like well I can't add any more evaluations to my schedule either and I and I understand that but at least Consulting being Advocate to be consulted um when it comes to these other referrals especially if it comes to to reading I mean and I see this in even with math students that are really struggling with math is it math computation or are they struggling with the language of math the word problems you know um and so we definitely have like a big role when it comes to and again all this ties in right this goes back to the collaboration piece and um and that prevention because again we'll prob we're probably more likely to test these students in Kinder in first grade than a school psychologist would so I really recommend making sure you're incorporating if there's a there is you know it's a speech sound disorder concern and you're testing for articulation you should also be assessing phonological processing as well and phonological awareness you know to make sure that there isn't something going on um because Mo most of the time there there is yeah um so you're kind of getting your foot in the door before the school psychologist is going to come in which kind of takes us to that next um do Service delivery domain Heather of screening which kind of might even uncover a little bit more information on how we're identifying these kids in order to have them on our radar and then collaborate with those other professionals and stuff so um yeah one of those other areas Service delivery do domain sorry um is H screening and um that's kind of in the realm of what we're already talking about in um identifying these kids these kiddos early and stuff and so we can um get into maybe some areas to screen if we have students already existing on our speech and language um case load for speech sound like whatever they're already on there for um we could be more aware and intentional about some of these other early indicators um or even do little screenings with them um if we suspect something yeah I think too to add on to that krina is when you again Most states most school districts are probably already doing some of these Universal screenings um where they're meeting these requirements so like kindergarten you want to make sure you're assessing phonological and phonic awareness like segment segmentation blending um letter sound correspondence looking at nonsense word fluency rapid automatic naming those are a lot of skills like in kindergarten so those are typically probably already being done by the teacher but if this student is on your case load you know check in with the teacher how does they do with their screening you know how did how did they perform are any areas come up as you know concerns are they meeting Benchmark on everything and if not then how can we also support that skill specifically so um you know like let's say they're really struggling with that sound letter correspondents but you're working with them for like articulation or speech sound disorders then you incorporate that that visual that graphine with it so if you're working on that snake sound you better have that s up on the board and talking about this is the letter so when you see that this is a sound it makes and so that's going to be another really important piece um as far as maybe you're not the one doing the screening um but check in goes back to that coll collaboration check in with the teacher are where are they struggling are they struggling anything I can do to support them while we're working on you know whatever you may be working on in the classroom because that funny mic awareness can EAS easily ties into right that articulation therapy that we're doing well and it sounds like just to it back to some of those learning objectives one of the things we can do as slps to sort of get on that Upstream thinking is making sure we're acting asking these really specific questions with the other you know particularly if we're school-based but also if you're in a clinic you know you can as long as you have consent like reach out and collaborate and have those ongoing conversations with the other with the other members of the child's team and I think I liked your point just about asking asking questions about the the specifics of the things that they're looking for in the the classroom too not just oh how generally how are they doing but how did they do on this measure that you looked at for all of the students in the classroom was there a pattern in their errors or something like that so I think those are really helpful points and again not not limited to the setting in which you're working like be part of be part of the team as much as you can no matter where you know no matter where your office is that makes me think of another point that we going again back to collaboration um that I didn't mention in but I want to highlight um just that collaboration even within your own discipline within your own team I always like to highlight the relationship between an slpa and an SLP um because most of the time I'm the one that's doing the intervention and Heather is doing the the assessment and and the evals right and so I'm it's the SLP the one who's doing or the slpa rather who is going to notice these um maybe early indicators or these red flags or um these areas to screen and so that collaboration with your supervisor as well even amongst your own team um is really important because oftentimes the SLP who is going to who might be doing the collaboration with the um other disciplines um they may not know that student as closely as the treating therapist right so even uh collaboration within your own team helps these other um Service delivery domains like screening and and other ones we've mentioned that's a great Point can you tell us a little bit about the assessment process and all of this I know we've sort of touched on it briefly in terms of whether or not the school is going to do the assessment you know how but what is the slp's role in all of this you all obviously have a a unique relationship and that one of you is an slpa so that role is clearly delineated but for a lot of us working in the schools I say us I never worked in a school for a lot of slps who work in schools you know based on your state based on your case load that might not be in your case yeah in in your role on the team that might not be part of your role so what is this Upstream thinking how does that how are those two things related so the first thing I would I want to highlight are just the areas um that we always assess when we're trying to identify a student with dyslexia so we're always looking at phonological awareness executive function working memory rapid automatic naming skills receptive and expressive language phonic so that's that nonsense word and real word um assessments reading comprehension spelling um oral reading fluency so just like reading fluency at the word level sentence level and then even paragraphs and then written expression so again like the spelling and sentence fluency so a lot of those skills are we're already assessing anyway as an SLP and I always tell parents too that come to me like in just in a private practice ractice setting I'm going to give the same assessments maybe not the exact same test but I'm going to be assessing the exact same skills that were assessed or would be assessed by the school psychologist and the SLP in the schools so it definitely overlaps but again the difference is the school's not going to give you a formal diagnosis they can't that's not what they do they are going to find you eligible under certain criterias and different categories um so if I have a student and they say well they were just assessed at the school by the school psychologist you know within the last few months um and the SLP then I'm just going to ask to review that testing I don't necessarily need to do a full-blown evaluation the data is there they C they may not be able to give that diagnosis um there but based on that data and I typically will do a little more like Baseline assessments or screeners um a lot of times you're not as they don't do as much oral language testing so maybe that's what I do as I add more oral language testing in um you know to kind of look at that there's a big debate in our field whether or not slps can diagnose dyslexia and I'm a big Advocate that we can um it falls what what under our scope of practice um but again it's not something that if you're not well trained or knowledgeable in Reading development reading disorders then you shouldn't be assessing and diagnosing without the education just like I'm not going to walk into a hospital and try to give um you know like a thieves exam or something like that it's under my scope of practice I technically could do it but I don't know anything about that you know and so it's it's kind of the same thing we do have a very broad scope of practice um you know and and it depends you know the diagnosis codes and you know that kind of gets into a whole other ball game but um like within our state there is like a scholarship that's that parents can get through the state you know to get services and recently one of my one of my students was given you know sent their their evaluation in that I did um he was diagnosed with a mixed expressive receptive language disorder a reading disorder um and I always just put in you know fits the profile of a child with dyslexia kind of like in my writeup and then they were denied because they were told that I'm not a qualified professional and I like and so it's it's infuriating as an SLP who is a lang we're language experts um there's no diagnosis code for reading comprehension so if they're struggling with reading comprehension which is well within our scope of practice I mean it's language right um that were still being seen as unqualified professionals and so that's kind of like my next mission is like I'm gonna get that changed because you can't tell me that a that a a pediatrician or a doctor or a licensed psychologist is more qualified to diagnose the student with a language disorder and I think part of it comes back to like I the fact that there was a reading disorder diagnosis on there too but I was like that is reading falls under our of practice you look at Asha like how how are we still being seen as unqualified Professionals for this like it's it's so maddening obviously I feel very strong have very strong feelings about this because um it's it's it's just frustrating like and I I think that happens to us a lot in our field you know where we're not I mean acknowled recogn we're not acknowledged or recognized you know for for how much we do and how much knowledge we we possess you know and what a difference we can make and so it's it's just frustrating but um I could talk about that all day so um but yeah so as far as like just being part of that assessment process it really just it depends on your role but I I'm a big Advocate that we should be involved um there's a really great uh quote from Dr Alt from Mary alt she's a professor at University of Arizona and she um her and Dr Shelley gray there's a there's a whole collection of of professors um from all over that are working on some working memory research and they had a podcast episode with Dr Tiffany Hogan where they were talking about some of their results as far as working memory and word learning um and she said we don't always do a great job figuring out when kids have both oral and written language issues and there's a lot of research that they're you know from their research that they're finding that you students that have both oral and written language disorders struggle there's there's they there's they're significantly slower to to to learn you know and word learning so we have to get a lot better at being part of that and identifying you know it's not just academics there's probably some oral language things going on as well and that ties back to Upstream thinking just with that early identification piece the the the sooner and and kind of that dyslexia Paradox idea the we can play a role in Upstream thinking through assessment by um ident identifying early assessing early and therefore remediating earlier um and really um getting a a hold of these students if you will um during that time when intervention is most effective and I think to the point that you both made too sorry just to connect back to assessment by conducting that comprehensive assessment not only are you ideally remediating early but you're remediating in all of the areas in which there are deficits so if you're absolutely ignoring kind of that oral language component and you actually have a student where that's a big challenge area for them and nobody's remediating in that area um that's probably also going to really influence their ability to have success and make progress in the way that everybody wants them to absolutely so we have a few um like three more um Service delivery domains to touch on um one that we can kind of do quickly is so one of those eight is treatment um but treat treatment I think we're going to cover H our role in treatment how we can support these underlying literacy skills in the speech and language therapy that we are already doing um on on our next one that one's going to be all about treatment it's so it's such a indepth one that um treatment gets its own uh little dedicated spot but so for those of you listening if you are really dying to know about treatment stay tuned because they're going to come back for another episode that was a teaser sorry spoiler um but in terms of our our role in uh under treatment I think the biggest thing to point that we want to point out is that our roles are going to be different in different settings right in a clinic setting versus a school setting our our role for treatment in a school setting is not going to be directly um those the reading goals or the writing goals it's their speech and language goals but to understand that we have we do have a role in supporting that through the speech and language that we're already addressing and then obviously in a in a private practice or clinic setting you have a little bit more flexibility where you might be actually addressing um some of their reading or writing goals um another service delivery domain that falls under um our scope of practice is that modalities technology and instrumentation um and I like to call this just assistive technology um these past couple years working with that older population again I've learned so much about um how to support them under this domain um have you guys heard of read and write it's um yeah no I I have not okay so they use it a lot in the schools um uh so it is an amazing plugin that you add on to like your Google accounts and it the tools that it gives you I can do like the basics of like you highlight things and it'll read it for you um or you can like the voice to to to type voice to text thing um but also some more uh complicated things like you can if you're if you have a student who's researching something um it can minimize the text on any website so it makes it more manageable for them versus like this whole web page that not only I have to read and then somehow understand it can it will minimize it for them so there's some algorithm it uses where it just minimi simplifies the context so that they get the main idea out of it um you can generate vocabulary lists through what you're doing like just amazing amazing supports and I was lucky enough last year I was working with a a a girl who um she really took hold of this and found just she was so empowered by access to her regular academic stuff guys just on her computer right like she was so excited to be able to have access to this and um participate in the class activities like the rest of her peers so um read and write is awesome there's a ton of things so like orbit note um so many uh audiobooks obviously are a good one too so so many things we could be doing under this domain to support these students as well um and then that brings us to the last area populations and systems um he you want to talk about this one yeah so this kind of really just ties everything together so as far as population and systems is you know we can play a big part of helping um kind of streamline everything a little bit more whether you're in the clinic setting I mean we my my company specifically we obviously we specialize in dyslexia um you know and so that's kind of what I've based my whole practice around but in the schools it goes back to collaborating you know be part of that team really Advocate you're going to learn we have so much to bring to the table but then we can learn so much from others supporting the classroom teachers collaborating with you know if you have something like we do here in Arizona like the dyslexia training designate occupational therapist reading interventionist a school psychologist um and then just always supporting those demanding those demands you know like Kina said just being more aware of you know that the at and how can we support that in the classroom um and then educating you know that's the big piece too really just educating others on our role like what we can what we do and and how great we are um and how much we can support you know other other professionals um and parents and students so that's kind of the big piece too it goes back just keeps going back to collaborating and educating and you know just being aware of of what we can really do those it what it really goes back to is those three areas of Upstream thinking and those things that we can do to that so that um that education that early identification and that remediation and that brings me to my favorite question which is what can our clinicians do from here what are your words of wisdom for people who are listening to this what action steps can we take take from here oh great question so we always like to end with a little bit of self-reflection and a plan of action um and then we want to leave you guys with one of our favorite quotes too so I'll start with that um this quote is by Rita Pearson every child deserves a champion an adult who will never give up on them who understands the power of connection and insists that they become the best that they can possibly be and so um we want to be our students Champions right we want to help them um get through those difficult things and help them know that they can and that it's possible for them and so um a plan of action we like to break it up into two like short-term and longterm so shortterm going back to school in a now if you're in Arizona or um here in a month or so um what what is it that you can Implement when you get back to work Monday or next time you you get back there like what is something that you can um start doing in the your speech and language intervention that you're already doing what else can you start incorporating what other which one of those other domains um can you uh maybe support them better or do something differently maybe something you're not doing yet um and then try to think of two students on your school case load or two clients that you might have um that might have some of those um early indicators of um later reading difficulty and if they're already on your case load for speech and language goals um then that's a a kind of an indicator that there's some things you can embed into your intervention to support those underlying skills so those are um kind of two reflecting prompts we like to do for short term and then long term I some things that we like to recommend is do some research find out what your dyslexia legislation is in your state um you can literally Google just put that in the Google like Q would be Arizona dyslexia legislation um we have a dyslexia handbook through our Department of Education and so Most states will have that as well too um I also really encourage you reach out to your local International dyslexia Association branches all states have them um if that and that could mean literally just following them on social media because then you're going to stay in the know of when they're offering um workshops or CEUs things like that um and then also just thinking about how can you support kind of like what K was saying that and Implement some of that early identification um you know so just maybe pick one of those specific Ser Service delivery domains at first it feels manageable and and what can I do like C said differently or or Implement new this has all been so incredibly helpful thank you so much for sharing your knowledge and your time with us for anyone listening if you heard us discuss anything that piqued your interest we will have a list of references in the show notes including some hyperlinks to some resources that you all discussed today and as they both already mentioned you can get in touch with these two lovely human beings at um at Sor withwords through their through their social media channels at Sor withwords um is there anything else you'd like to say thank you yeah thank you so much for having us this has been really great thank you so much for being here thank you so much for joining us in today's episode as always you can use this episode for Ash's cus you can also potentially use this episode for other credits depending on the regulations of your governing body to determine if this episode will count towards professional development in your area of study please check in with your governing bodies or you can go to our website www.s SLP nerdcast tocom all of the references and information listed throughout the course of the episode will be listed in the show notes and as always if you have any questions please email us at info@ SLP nerdcast docomo much for joining us and we hope to welcome you back here again soon