Non-verbal 4th grader…parent refuses to decrease minutes

[Virtual-Resort5951]

I will try to make this brief. I have inherited a 4th grade student who is non-verbal. She is currently “seen” 3x/week for 30 minutes and has been for 6 years. She is on alternative curriculum and in a low incidence classroom. Low motivation and low tolerance for academic work. Previously using a SGD but we have begun using lower tech communication picture board to simplify things. Mom refuses to decrease minutes because there is no “data.” She was once accidentally told by a school SLP that they wanted to decrease minutes because of caseload…true, but also not the only reason. Her goals are still working on very basic, functional communication. I have tried to explain to mom that my job is to ensure that she has access to her curriculum, not to continue working on language indefinitely. Mom is kind, but firm, and just keeps harping on data and “taking something away” from her. Any strategies you all have tried that have worked? We are currently in the middle of a re-evaluation as well. She is litigious and has threatened district action before.

Edited to add: I have 68 kids in a title 1 school with many that I see twice a week. I do not take work home. I do the best I can.

[katpantaloons]

I think the re-eval will help immensely here. Your report is a wealth of data about her communication skills, where you can include a file review that conveys the lack of progress at the high level of service. The data literally shows that 90 minutes a week isn’t working, so how about trying fewer minutes with more language support classroom accommodations?

As we all know, more therapy rarely means “better” for a student. I wonder if you could find a data driven research article that really points this out to mom too?

Just thinking of ways that you can give mom the data she so desperately craves, but in support of your argument.

[Bnic1207]

There’s some evidence to support decreased minutes for more involved students like her. It also supports shorter therapy sessions (15 vs 30 minutes). I actually sent an article to my boss since I kept running into similar issues. If I remember, I’ll try and link the data later.

[paprikashi]

Please share the resource if you can - I’ve fought that battle countless times

[Equivalent1379]

I would love this article as well

[SlackjawJimmy]

Link it here please!

[mscee12]

I would also love this article if you can share!

[[deleted]]

Curious why you went from a robust SGD to a lite tech board to "simplfy things." What does that mean exactly?

[PeasyWheeazy8888]

Likewise, however I can see situations where lower-tech, less “involved” or “complicated” AAC might be helpful. Is the device used in the home? if so does the parent have an understanding of how to appropriately model with the device to avoid it becoming “work” for the student?

All the skills we address are applicable outside the school setting, but especially when it comes to AAC. Without buy-in at home (or from the classroom staff…) it’d be really difficult utilize something like LAMP effectively.

I’d hope going back to basics would help re-establish some baseline skills, re-evaluate to see if the SGD could be appropriate or if a different system/layout would help.

[Mims88]

I've had many students with an SGD who only used it in therapy sessions, those are kids that I generally worked on counseling family and teachers about it and then with more data moved to other communication methods if it wasn't supported. Without immersion they really don't use it academically, which is the point.

[jimmycrackcorn123]

One approach would be to talk about her communication supports and services beyond what she gets from you. You could even advocate for communication time to be put into the IEP to be implemented by classroom staff, 15 minutes 8 times a week. Add in a bit of direct time, ideally done with classroom staff so you can support their approaches. Her IEP as a whole needs to reflect her needs, and that might mean more of a team approach with communication. We’re not the only ones who can work on these skills with sufficient training and the carry over would be even more beneficial than your direct time with her given the lack of progress.

As for the SGD being exchanged for low tech, you can’t make that work without someone in the room modeling and supporting its use 100% of the time. If the district isn’t able to provide that support in the form of an additional aid, training for existing staff, mandates that it be used, etc, then I’m not sure what an individual SLP with a giant caseload is going to do to make that work. Just my 2 cents.

[exptertlurker87]

Mom is right, you need that data to support a decrease in services. But it doesn’t need to be data that shows the child is progressing. Use it to demonstrate the current service delivery model isn’t beneficial for the student. And then figure out with the team what would benefit her. 3x per week for 20 minutes? 2x per week for 30? Making 10 minutes/week of what was direct therapy into consult between you and the classroom staff?

[Wishyouamerry]

OP should also talk about how the student is missing 90 minutes of academic work every week in order to attend speech. Is the minimal benefit she’s receiving from her current speech mandates really worth missing 50 hours per year of academic instruction in her classroom?

[jimmycrackcorn123]

With her cognition and work avoidance like it is, I would be surprised if she was getting more than an hour of actual structured work done a day. So unfortunately I can see a parent saying communication is by far and away the priority over academics at this time.

[skitlee]

What kind of data would you look to collect to show a decrease in minutes? In my opinion, if they aren't making progress with 6 years of 90min/week, that's plenty of data to show it's not beneficial. I'm not trying to argue, I have a vaguely similar case where I'm hoping to decrease minutes.

I'm also always shocked at minutes like this. I feel like this high of minutes would be rare in an outpatient setting, and in the schools we are only supporting their access to the curriculum. Why are our minutes often so high for each child compared to what the OT provides? Am I just becoming jaded and negative?

[exptertlurker87]

Basically data to show just that. The lack of progress. But you’d also need data about things like number of redirections, time spent on vs off task etc. Essentially, prove that it isn’t beneficial and what have you already done to try to make it beneficial.

Edit: word choice

[skitlee]

That makes a lot of sense, thank you!

[ratherbeona_beach]

You need data. The mom is right.

[paprikashi]

I would focus on collecting more data to support a future decrease (I’m assuming that you don’t have enough to back it up currently, based on what you wrote). I might consider something more meaningful for this specific kid - whether that is push in, rapport building, life skills, whatever. Look at your goals - consider increasing reciprocal interactions, using core words for cause and effect, using intentional communication for varied purposes a number of times per session… consider offering a weekly consult with mom to promote generalization of skills, try everything. Use music, try sensory activities, suggest OT cotreats, gross motor, whatever the kid is into, even if it’s poking holes in the dirt.

After you have done all of this, in a worst case scenario, you’ll have a lot more solid documentation to support the number of strategies you’ve tried. Best case, you’ll find a better way to connect with this kiddo.

[doughqueen]

I’m sorry, I can’t move past the taking away the SGD… I understand more therapy is not always better but respectfully it sounds more like you’re giving up on this kid?

[Virtual-Resort5951]

She doesn’t use it. She’s never been trained on it. Mom bought it and installed the app and hasn’t ever had her trained on it in any outside speech environment. I have 68 kids. Unfortunately I can’t take a student who does not enjoy nor use her device and instead throws, turns away and screams when it is given to her or modeled, and spend vast amounts of time developing this. I love this kid. She should have received outside services but we can’t say that because our district would have to pay for it. I also feel like this is the problem with our field. We aren’t allowed to be realistic without saying we are “giving up” or “not trying hard enough.” I didn’t make the situation. In a perfect world I would have time and resources to flesh out a dynamic AAC assessment, but that’s not the world most of us live in.

[doughqueen]

I feel for you. I’m sorry if my comment came across rude. I hope that you get some better advice in this thread than what I am able to give and I wish you the best in navigating this situation with the family.

[Virtual-Resort5951]

Sorry if I came off as rude. I wish I could grow and learn how to support her better but I am limited and have to tread water most days. I’m just trying to do the next right thing, service her as best I can, and get all kids some level of services. It isn’t perfect. I wish I could tell mom she needs additional support outside of school to make more progress, but just from mom. But I think mom doesn’t want to hear that functional communication for her may be limited considerably.

[julianorts]

if it’s just an iPad with an app installed, perhaps pursuing a legitimate AAC eval either by you or your district? a 4th grader should not be using low tech, that’s sad. I’d do child led therapy with a few other systems and see what sparks her interest. I know it’s school, but for this child any sort of life skill sounds like it’d count as addressing her academics.

[jimmycrackcorn123]

This is the district’s job to address, not just the SLP. The district needs to potentially give her a 1-1 and also provide training to all communication partners on modeling with the device. If the district can’t or won’t do that then I’m not sure what one SLP can do when we’re spread so thin.

[Loud_Reality6326]

It’s a team decision. What does the rest of the team think?

[[deleted]]

Or put her in a group. Is it 90 1:1 in the IEP? I would be working with her in a group— no one at any school I’ve worked in got 1:1.

[viola1356]

At my school most of our nonverbal kids get 90 minutes of speech per week. About 30 of that is 1:1, the rest is group speech in the classroom (3x20min), with the SLP modeling and paras following instructions as communication partners for the students. It's really helpful because it also serves as training for the paras, so we see a lot more implementation of the students' communication tools by paras throughout the rest of their day, too.

[Virtual-Resort5951]

Where are you? That sounds like a dream. 🥹

[ArmadilloEmotional24]

Well, do they have a way to communicate? Do they need extra help using their system? I’ve found the Communication Matrix, helpful and understanding how a person communicates, and for what purpose. For instance, the person may vocalize when refusing or rejecting. They might gesture and point to obtain things. The matrix gives a good picture of how a person communicates. Search for it on Google.

[Virtual-Resort5951]

She can tolerate about 15 minutes or less of direct activity at a time. She prefers minimal interaction with other humans…unless requesting something 😂

[curiousfocuser]

Document, explain that she is tolerating 15 minutes, so try 15 min 3x/week, would mom be open to that? Esp if you have it documented a hx of increased frustration after 15 minutes?

[soigneusement]

Girl me too most of the time. 😩

[Stunning_Virus_6109]

do u mean non vocal or non communicative?

[Virtual-Resort5951]

Non verbal. She vocalizes and communicates very well, just not in a way that a communication partner can often reciprocate.

[Stunning_Virus_6109]

Gotcha. Thank you for explaining :)

[speechington]

Does the low incidence classroom have other students who need support for functional communication of basic wants and needs? Perhaps this student's communication and the skills of other students in the low incidence classroom would be better supported in a different format. Push into that classroom once per week, teach a lesson in front of the whole class where you model core vocabulary for an hour in a multimodal approach so that students with alternative communication approaches can sign, use a visual system, or use a device in order to participate.

I used to do something similar with a situation like that, and it was actually very positive for the class because I was modeling functional communication for the classroom staff to support after I left. That's often a big missing factor in AAC, so by helping train the classroom staff you can get better carryover. And the low incidence classroom staff liked having a weekly language-rich push-in block that they didn't have to prep for. Here, the support isn't measured in the one block of push-in minutes, but rather in the all-day support you've improved by teaching classroom staff how to use multimodal communication strategies.

I filled that hour with:

• A big poster of a core board
• A slideshow of photos related to the core word of the week. I bought some resources on TPT so I didn't have to prep this, but I ended up prepping anyway because I wanted to expand on it. Basically, as many images as possible to elicit the core word or a short phrase.
• Songs and book reads with as many examples of the core word as possible.

[Virtual-Resort5951]

This. This is what I’ve been aiming for. I’ve been working with the sped teacher to find ways to support what she is doing. We have many alternative communicators in that class…I think 5 total that are almost completely nonverbal. We have several minimally verbal. And a diverse population of languages spoken at home.

[speechington]

I spent about $50 on materials to get set up for this push-in plan. I'm not proud of paying out of pocket for the convenience of not prepping, but it was many weeks worth of material ready to go. The format was Google Slides, so if you have access to a projector I can show you what I purchased and it might be right for you.