Our Blogs

Many of today’s clinicians may not remember the days of cutting and pasting pictures from magazines and Golden Book dictionaries to create treatment materials. It used to be the method of choice for those of us not blessed with artistic abilities. Although commercial companies now produce an abundance of resources, the materials available may not fit the needs of a particular client, or clinicians may find satisfaction in creating some of their own materials.

Little pictures called “clip art” are available commercially. Programs such as Hyperstudio, Power Point, Adobe Photo Deluxe, and recent versions of most word-processing software also have clip art files that you can use to develop your own materials. With those programs you simply “insert” the clip art into your page.

The Internet is another important resource for clip art, and it is free! Using clip art, or any picture from the Internet, requires you to be able to do three things—find the pictures, download them to your computer, and insert them into a Word document to print out.

Note that icon collections each have their own conditions of usage. Typically, there is no problem if you are using the icons for non-commercial, personal purposes, such as making therapy materials for clients in your caseload. Look for usage information and restrictions on the various icon sites under links such as “terms of use” or “copyright and use information.” If you have specific questions, contact the site manager. I have always had positive responses to inquiries about using icons for non-commercial purposes.

“]Finding the Pictures

One helpful resource for finding specific images is the “image” or “picture search” on some search engines, such as:

• Google (www.google.com)—select “images” from the tab choices
• Altavista (www.altavista.com)—select “image” from the tab choices
• Fast (www.alltheweb.com)—select “pictures” from the tab choices

I have even found pictures of some of my ancestors using these resources. For example, type in “Aaron Payne” (my great-great-great-great uncle) in Google or Fast. Although you may find some other Aaron Paynes, too, my relative is the “old guy.”

There are at least two search engines dedicated to finding pictures:

• My current favorite, Picsearch (www.picsearch.com) “allows children to surf in safety as all offensive material is filtered out.”
• Gograph (www.gograph.com) does not have as extensive a database of pictures, but will produce pictures, clip art, and icons that are commonly requested.

There are also several Internet sites that are repositories of free clip art:

• Absolutely Free Clipart (www.allfree-clipart.com)
• Awesome Clipart for Kids (www.awesomeclipartforkids.com)
• Barry’s Clipart Server (www.barrysclipart.com)
• Best Clipart (www.bestclipart.com/index.html)
• Brian Brasher’s Collection (www.bry-backmanor.org/ikthusian/ikthusian.html)
• Debbie’s Garden of Graphics (www.geocities.com/SiliconValley/Heights/6355/)
• Discovery Channel School’s Clip Art Gallery (http://school.discovery.com/clipart/)
• Disney Clipart (http://clipart.disneysites.com)
• Icon Bazaar (www.iconbazaar.com)
• Kid’s Domain Icon Mania (www.kidsdomain.com/icon/index.html)
• Kids’ Turn Central (www.kidsturncentral.com/clipart.htm)
• Leo’s Icon Archive (www.iconarchive.com)
• Original Free Clip Art (www.free-clip-art.net/index2.shtml)
• Web Clip Art (http://webclipart.miningco.com/mlibrary.htm)

Downloading to Your Computer

The name of the images on the Internet typically ends with .jpeg, .jpg, or .gif. It doesn’t matter which. They will all work.

To copy an image from the Internet if you are using a PC:

1. Place the cursor over the image you want and right-click your mouse.
2. Select “save image as” from the menu bar that appears.
3. Select a destination to save the image on your hard drive or on a disk.
4. Click “save.”

To copy an image from the Internet if you are using a Mac:

1. Place the cursor over the image and hold down on the mouse until the menu window opens.
2. Select “save this image as.”
3. Select where you want the image saved.
4. Click “save.”

Inserting the Pictures Into a Word Document To insert the image into a Word document, use the “insert” command in your Word program and choose “picture.” Select the name and location of the file you saved. The picture will then be inserted. Some Word programs will allow you to adjust the size of the image after you have inserted it.

It is also possible to combine these last two steps, instead of downloading several images to your computer, by selecting “copy” (instead of “save image as”), opening the program where you want to insert the picture, and selecting “edit paste.” Since you are using word processing, you also will be able to add text to your materials. Consult the manual of your word-processing program for instructions.

Judith Kuster is in the department of speech, hearing, and rehabilitation services at Minnesota State University, Mankato. Contact her by e-mail at judith.kuster@mnsu.edu. All of Kuster’s Internet columns are on ASHA’s Web site in HTML format with active links (professional.asha.org/news/news.cfm), although URLs change and there is no guarantee that links from previous articles are still functional.

Meet Ellen Lunz, SLP

May is Better Hearing and Speech Month—just ask any of the students or staff members at Courtenay Language Arts Center in Chicago, Illinois. All of them are aware of the importance of communication, hearing, and speech, thanks to the efforts of Speech-Language Pathologist Ellen Lunz. For the third year in a row, Lunz is organizing and leading a series of special events at the school to help her colleagues and students understand the impact that hearing and speech have on their lives.

Courtenay is a busy prekindergarten-through-sixth-grade school on Chicago’s north side. Nearly half of the students have special needs, and most of the classrooms are inclusive. In addition, about 80 percent of Courtenay students speak Spanish, and some 50 other languages are represented as well.

All of this keeps Lunz on the go. She sees a caseload of 95 students every week, and works with two other speech specialists, one English speaking and the other bilingual in Spanish. Her days consist of leading classroom groups, working one-on-one with students whose needs are more severe, and consulting with teachers and parents.

Speech bulletin board at the school

Finding time for special activities

In the midst of all of this, she somehow finds time to organize activities at Courtenay to mark Better Hearing and Speech Month. With 23 years of service in the Chicago School District, 13 of them at Courtenay, Lunz is a senior staff member at the school. Three years ago, she took the initiative to build awareness with her colleagues and students. Now, she leads an annual in-service for the staff, writes articles for the school paper, educates students, faculty, and parents through bulletin board displays, and organizes a poster contest for the entire student body.

Students look forward to participating in the contest. Lunz spends four months collecting pictures, assembling a library of thousands of images related to speech, hearing, and communications. Students use the pictures to create their own posters illustrating the ways their lives are affected by these skills. “This year we have two age categories-one just for our youngest students,” says Lunz, noting the way her activities have grown in just a few years.

Student posters are put on display for their parents to see at Courtenay’s spring open house, so that parents are also learning about Better Hearing and Speech Month. Then, every poster (with the student’s name hidden on a tag on the back) is displayed for the school’s faculty. “I bring the Dunkin’ Donuts and they judge the posters,” says Lunz.

Student winners receive a ribbon and a prize. Their pictures are taken and published in the school paper.

A speech poster on the Speech Room door

Seeing the results-these activities work!

In the time that Lunz has organized activities for Better Hearing and Speech Month, she has been able to see the effect of her effort. There is a higher rate of referrals from the teaching staff—all of whom attend her in-service presentations and help judge the student poster contest. And the referrals she gets are appropriate, identifying students who can benefit from intervention with a Speech-Language specialist.

Thanks to the efforts of Ellen Lunz, the word is getting out in Chicago—it’s important to understand speech and hearing and their effects on students!

For more information on Better Hearing and Speech Month, including public service announcements, press releases, and more, go to: http://professional.asha.org/resources/bhs_main.cfm

A seed is planted

When Pat Baser was a child in Kansas, a close friend of hers named Wendy moved to Alaska. “I remember clear as a bell the day Wendy made that announcement at school,” Pat said. When she told her mother, they searched for a world atlas to find Alaska. While looking at the map, Pat thought, “I want to go there some day.”

Schooling and career paths

Her dream of traveling to Alaska followed Pat into her adulthood. Pat completed her undergraduate work at Kansas University and moved to Iowa to pursue a master’s degree in education. She later accepted a position as an itinerant speech-language pathologist for the public schools in the northern corner of Iowa near the Minnesota border. For five years Pat provided low-incidence special education services to children and some adults.

Pat returned to Topeka, Kansas and worked as a SLP for a state mental health hospital. After six years there, the Mental Health Reform Act went into effect. Pat explained, “Mental health hospitals were being closed and replaced with community-based services. I knew I had to move some place else to find work. I thought to myself, this is my time to consider Alaska.”

One phone call

Pat decided to take a risk and call the State Department of Education in Juneau about job openings. When she told them that she was a speech pathologist, she was asked to fax her resume immediately. “I’ve never known anyone to be that excited about my resume, ever. It was amazing,” Pat said. After faxing her resume from a local grocery store, she received three phone calls that same afternoon. Three different school districts encouraged her to apply.

The dream begins

That summer Pat and her two sons left Kansas behind and headed on a plane for Bethel. They arrived at a remote town of 5,200 in southwestern Alaska. Nestled on the north bank of the Kuskokwim River, they found Bethel surrounded by the Yukon Delta Natural Wildlife Refuge.

Pat said her parents did not believe she would go through with the move. She admitted that when the plane landed at the town’s small airport, she wondered if she had made the right decision.

Yet on first glimpse, Alaska offered a unique lens on the world. “When we arrived in August the sun was up for almost 24 hours. I can hardly describe the number of colors you can see in the sunrises and sunsets,” Pat said.

Spectacular skies and scenery were always close at hand. “One morning during the winter, Steven, my youngest boy, and I were walking into town. It was very dark and the stars were out. You could see from horizon to horizon all the way around you. Steven said to me, ‘It’s like living in one of those shaky things.’”

Traveling to clients by plane

Pat began working for the school district in Bethel. She and another speech-language pathologist provided services to ten villages. They shared a caseload of over 100 students aged 0-21. The furthest village away was Kwigilinonk, which took an hour to get to by plane.

On an average day when the weather was cooperative, Pat would leave by 7:30 a.m. to go to the airport. “If you’re smart, you always pack pilot bread, a small container of peanut butter, a sleeping bag, and whatever else you might need to keep yourself going for a couple of days.”

At the airport Pat waited for a pilot to call her name. She always made arrangements ahead of time. She would find out which pilot had a mail delivery or pick-up in a particular village, so she could tag along. When getting the call, Pat grabbed her backpack and climbed into the four-seat plane. “Sometimes you would work it out so that the pilot would drop you off at the landing strip, deliver the mail, then come back to pick you up and take you to the next village,” she explained.

Once Pat reached a village, she walked to the school to meet some of her clients. The majority of people she served were Yup’ik, natives who live in the western coastal region of Alaska. At the school she conducted monthly evaluations and provided direct therapy. She also wrote treatment plans that could be carried out by special education teachers or other providers for the next 30 days until her return.

“I did have some children who clearly needed the services of an SLP. They could not even make minimal progress with someone who wasn’t certified. I would visit those children at their homes two or three times a week,” Pat said.

The first time Pat traveled to Kwigilinonk the weather deteriorated. Heavy snowstorms left her stranded in town. According to her, “the weather dictated everything.” On that day no one was going anywhere. “I had to sleep in the school building on the floor.” The airport was closed for three days. However, some of the men from the village were leaving to look for firewood with their dogs. Pat was able to return to Bethel by way of dog sled. “It was phenomenal!” Plowed in the winter, the Kuskokwim River provided the road for her journey home.

Learning about Yup’ik culture

Pat’s most rewarding experiences occurred when she was serving Yup’ik children in their homes. In the beginning, she worked hard establishing a relationship with the family. This takes time–sometimes several visits before being accepted. She found she had the most success when she was quiet and observant, and asked politely if she could come inside.

“You can’t just rush into a home and do your therapy. Instead you stay for a cup of tea and talk about things that really matter to the child and the family. They also want to learn about you and your family. If you are hesitant in sharing information about yourself, they will be hesitant in allowing you into their lives.”

Pat continued, “You have to be able to demonstrate sincerity and commitment. If you can do that bit by bit, you can become part of everything and participate in important events like sharing food. One of the greatest honors is to be invited to share stories with family members. Sharing stories is a significant part of Yup’ik culture.”

The need for services

In Alaska the incidence of children with special education needs is 20 to 25 percent higher than in other parts of the country. Pat saw many children who had head injuries caused by accidents involving four-wheelers. She also worked with children who were born with disabilities. Microcephaly and fetal alcohol syndrome were two conditions she saw that impacted children’s cognitive abilities.

“At times it was definitely overwhelming with the large number of children and the intensity of the need,” Pat added.

A different attitude

According to Pat, Yup’ik culture views children with disabilities from a unique perspective. Parents, along with the village as a whole, accept difference in individuals and view difference as what makes that person special. In Yup’ik culture, all children are loved for who they are. “The families love their children. They accept the handicap as part of the whole person.”

Subsequently, when contacted by specialists from outside the community, families often are resistant. They feel their children are fine and don’t need to change. “You have to mellow out and look at the issues from the perspective of the village and not from the perspective of how good your IEP is going to look,” Pat said.

Serving families with respect

Pat has made some discoveries on how to serve Yup’ik families sensitively and effectively. She has listened and studied Yup’ik culture. “Respect for another person’s culture is paramount,” she insisted. “You can’t serve a family out of context. The context is not always the school building. The real context is the family and the community.”

When using tests, Pat took into account the fact that many of the children know nothing of the world outside their villages, except for what they see on television. Also many of them have a quiet demeanor, making test administration a longer process. She spends whatever time is necessary and often involves the whole family. “A child’s issues are not seen as separate from the family’s issues,” she said.

Pat is very careful which tests she uses and attempts to reduce bias as much as possible. One test she views as helpful is Comprehensive Assessment of Spoken Language (CASL). “I have found CASL to be my most successful and nonthreatening measure. When I give a subtest, I do not come across as if I am trying to find the weaknesses. I use it to discover a child’s present level of performance.”

City life

Later Pat moved to Fairbanks and accepted a job with the school district. She also works with the Tanana Chiefs Corporation that refers Athabascan children in need of services to her.

Pat now sees clients in an office in Fairbanks–a space she’s designed to be welcoming and comfortable. Before initial meetings, Pat calls the clients’ families and introduces herself on the phone. She believes it’s vital to establish these connections.

Pat continues to love Alaska and it’s people. “It’s a place where you can turn your head in one direction and see the moon going down. Turn around and there on a parallel plane you can see the sun coming up. It’s absolutely astounding! When you’re 52 like I am and still have the passion and fire for your profession . . . when you love the families and the people you work with and for . . . hey, I think that’s wonderful!”

So, what are Pat’s plans for the future? “As soon as my youngest boy graduates from high school, I’ll put aside my town work, become a village person, and travel by airplane again. I can’t wait.”

Judi Jewett, Bosnia Speech and Hearing Founder and Director, with the first girl who inspired the Project in 1997. Photo by Jim Hackbarth © 2002

In 1997, when I was on a Bosnia Speech and Hearing Project work team at the Sarajevo Youth House, and not long after the city’s airport reopened following the war, I noticed an 8-year-old girl sitting in on an English class with her friend, even though she was unable to communicate in English or even in Bosnian. When I went to help her in the pen pal activities, her teacher told me, “She’s deaf. So there is nothing you can do. It’s a sad story.”

Wrong. There was a lot that could be done.

Ajla

We needed to find hearing aids to help Ajla—a challenge in a country with no phone books and few businesses actually running. The local medical center was only able to perform a pure-tone hearing screening (both air and bone conduction) on an ancient machine. No further tests were available.

And there was another problem—the audiologist did not want to give us a copy of the audiogram. He told us that the girl was not worthy of a hearing aid. She should first learn to talk to demonstrate that she would benefit from a hearing aid. Finally, he released the audiogram to us, but only after writing on the back that she should not be given a hearing aid. Fortunately, the hearing aid dealer did not choose to follow that advice.

Getting Ear molds made can be scary! Photo by Jim Hackbarth © 2002

We first tried hearing aids from the American Refugee Committee, but Ajla did not respond to those as well as the aids available for purchase from a hearing aid dealer in town. We had to “fit by behavior,” since no aided audiograms were available. An American church group—the Walnut Creek (CA) United Methodist Church Volunteer in Mission Team—pooled their money and two hearing aids were purchased for Ajla. Her smile was incredible when she tried the hearing aids on and was able to hear for the first time.

Of course, Ajla needed aural rehabilitation and speech-language pathology services. She understood about 20 words in her native language and had no expressive speech. She had no knowledge of Bosnian sign language. She used eight meaningful gestures with her family, but these were of limited value since her father was blinded during the war. She was withdrawn and sat quietly for hours.

This boy and his mother travel by bus daily from a village outside of Sarajevo so he can attend school, since no services are available in his village. Photo by Jim Hackbarth © 2002

The Last Bosnian SLP

The search for a Bosnian speech-language pathologist had to be undertaken from California after I returned home because the search for the hearing aids took so much of my time in Bosnia. Finding an SLP took about two months, since the Bosnians we met had never heard of such a profession and did not believe the service was available in Bosnia. We later found that many SLPs had left the country. The one remaining SLP in Sarajevo was employed as a teacher of students with hearing impairments at the Center for Speech and Hearing Rehabilitation. But no hearing services, aural rehabilitation, or speech-language pathology services were offered at the school at that time.

We contracted with this SLP for speech-language pathology services, and Ajla began receiving intensive treatment at the Sarajevo Youth House. By the summer of 2001, Ajla, now 12 years old, was typically speaking in four-word sentences.

The next year, the Bosnian SLP referred two more girls for hearing aids and speech-language services. After learning about their difficulties in school, I began to realize just how handicapping a hearing impairment could be in Bosnia. Students could attend one of two schools for deaf and hard-of-hearing students. In northern Bosnia, there is a school available for students who are considered to be unable to derive benefit from hearing aids. There is another school in Sarajevo available for students who are thought to benefit from a more oral approach. In this school, no signs or gestures are allowed. But the vast majority of Bosnian students with hearing impairments are unable to attend either school, and special services for them are virtually non-existent.

One of the children with a hearing impairment was attending a regular class and struggling. She had no hearing aid, no auditory trainer, received no speech or hearing services, and there were no accommodations or modifications made for her. As in many Bosnian classrooms, there were not enough textbooks for the students, and they were expected to learn from dictation. This student was failing because she was not able to take dictation while the teacher paced the room, her back frequently to the students. After receiving her hearing aids and starting services, this girl was better able to keep up with her class in school.

Kevin Miller and the Bosnian co-therapist working together. Photo by Jim Hackbarth © 2002

In 1999, the Bosnian SLP and I addressed the need for hearing aids for children in Sarajevo. She provided me with audiograms, and I searched for donated hearing aids in the United States. An American audiologist evaluated the children’s audiograms, tested the donated aids, and matched them to the audiograms. The dealer in Sarajevo is unable to perform audiological evaluations, but he could fit the hearing aids to the children’s ears. New hearing aids were purchased for children when donated hearing aids could not be found that matched their needs. These students then began to receive speech and language services as well.

The hearing aids are maintained annually or as needed. New earmolds are crafted annually. Audiological evaluations are provided, although the families need to travel to Croatia for anything more than a simple unaided audiogram.

Anita Ouellette enjoys a game of Go-Fish with her client and the Bosnian Co-Therapist. Photo by Jim Hackbarth © 2002

New Developments

This year, more sophisticated services are available within Bosnia. In Sarajevo, there is now a second hearing aid dealer with an audiologist who can perform audiological evaluations. And at the end of 2001, a pediatric sound booth was donated to a clinic in Medugorje in southern Bosnia. Although it will be years before cochlear implants are available in Bosnia, they are at least starting to be discussed. The best news is that the government has finally decided to approve an expenditure of up to 400 Bosnian marks ($200) toward the purchase of one hearing aid for each child who needs it.

The Bosnia Speech and Hearing Project travels annually to Bosnia to assess the progress of the students we have treated and to develop the next year’s goals in conjunction with the Bosnian SLP. The Bosnian SLP then provides speech and language services to the children throughout the year. Seeing the students’ progress from one year to the next is wonderful. When I left one summer, one boy was working on CV syllables. When I returned the next summer, he was asking questions like “How long do we have to wait for the bus?” He also had been mainstreamed into a regular classroom.

The boy’s father had been shot through the throat in Srebenica and had a paralyzed vocal fold. Previously, their communication was limited to affection and play since the son’s hearing loss had been unaided and the father’s speech was difficult to hear. This boy had a close relationship with his father, and it was rewarding to see they could now communicate with words.

Monica Bein playing Tic Tack Toe. Guess who's the winner! Photo by Jim Hackbarth © 2002

Sharing Treatment Methods

In the summer of 2001, three SLPs—Anna Taggart from Southwest Missouri State University, Jerry Gallagher from Buffalo, NY, and I—went to Bosnia to work with these children. We adapted the Ling Phonetic Evaluation for use with Bosnian phonemes, with Dr. Ling’s permission. Anna said that we seemed to be the ones with the speech and language disorder when we tried to discriminate and produce some of the phonemes that were new to us and communicate basic ideas in Bosnian! We worked with the Bosnian SLP on an exchange basis. We learned about the “verbo-tonal” method that she uses, and she learned about the Ling method for teaching speech to those with hearing impairments.

When we were familiar enough to start working with the Ling phonetic evaluation using Bosnian phonemes, we introduced it to the children and held a training session for the parents as well. We also presented the Bosnian translation of the Ling Phonetic Evaluation and the Ling system to the university students at the University of Tuzla in northern Bosnia.

While at the University of Tuzla, we were able to learn more about the practice of speech-language pathology in Bosnia. There is a four-year training program that includes special education classes as well as speech-language pathology, and students may choose to focus on hearing children or children with hearing impairments. Now approximately 12 students can graduate annually from the University of Tuzla, but they work primarily in special schools as special ed teachers since there is little integration and mainstreaming in Bosnia.

Jean Anne Jordan and Mitzianna Atkinson test hearing aids. Photo by Jim Hackbarth © 2002

We learned that there is now one SLP in the regular school system in northern Bosnia. He serves seven schools and has a caseload of 70 students. There is also now a second SLP in Sarajevo. He works in a clinic at the hospital. With an entire city to serve, he has little time for more than consultation. The first SLP, the one we worked with earlier, is at the Center for Speech and Hearing Rehabilitation and also continues with us at the Bosnia Speech and Hearing Project.

The interpreters that work with us are a valuable part of the team. They are able to interpret English, Bosnian, and Bosnian sign language. Some of them now have four or five summers worth of experience in translating for us and are becoming very familiar with speech-language pathology jargon.

Over the past 4 1/2 years, the Bosnia Speech and Hearing Project has provided over 1,500 hours of treatment and 21 hearing aids, maintained and repaired hearing aids for 13 children, and provided new earmolds annually. It has been rewarding to see the students’ progress in their ability to communicate.

Another measure of success, however, has been the acceptance of these children within their families. After beginning to work with one student, the SLP, Azra, and I made arrangements to go to a restaurant with the family to discuss the girl’s progress. The parents ended up tricking me to get us to the restaurant without the little girl. They were not comfortable with having their little girl seen in public. So she was not allowed to go to the restaurant with everyone else and had to stay hidden away at home. Today, when I am in Bosnia, all of the families go out to a restaurant together, with the children as the centers of attention.

Grace McPherson, the Bosnian Co-Therapist, and the interpreter, pilot the Bosnian Articulation Test. Photo by Jim Hackbarth © 2002

Future Plans

The Bosnia Speech and Hearing Project is actively recruiting SLPs and others to join the 2003 work team in Bosnia on a volunteer basis. The duration of the project is three weeks, although participants are welcome for shorter time periods. The project is also seeking donations of behind-the-ear hearing aids and financial assistance to support year-round therapy services in Bosnia.

For more information, contact Anita Ouellette, info@bosniaspeechandhearing.org or Anna Taggart at ant635s@smsu.edu. You can also visit www.bosniaspeechandhearing.org for more information.

Judi Jewett started the Bosnia Speech and Hearing Project in 1997. She is an SLP with the Antioch Unified School District in California and has a background in both deaf education and communicative disorders.

Jerry Gallagher works with a diverse caseload at Windermere Blvd. Elementary School in the Amherst Central School District near Buffalo, NY. He is currently co-president of SHAWNY, the Speech-Language-Hearing Association of Western New York.

AnnaMarie Taggart is a graduate student at Southwest Missouri State University. She will graduate in May and hopes to begin her career in pediatric trauma in the hospital setting. She plans to return to Bosnia this summer.

Reprinted by permission from The ASHA Leader, Vol. 7, No. 5, pp. 1, 20-22, March 19, 2002. © 2002 American Speech-Language-Hearing Association.

Photo by Jim Hackbarth © 2002

Alecia teaching students to request snack items using PECS (Picture Exchange Communication System.) They exchange a picture for the item desired.

Today, five students with autism and two neuro-typical peers (children who have average language and cognitive abilities) are enrolled in Alecia Ellis’ model demonstration classroom. The two neuro-typical students model “appropriate language and behavior” for the others.

Although fairly new, the classroom has made an impact. Three of Alecia’s students with autism entered first grade this year. One five-year-old boy she describes as crying, screaming, and covering his ears all the time has improved significantly. “It was heart-breaking to see him because he was so over-stimulated . . . . He was miserable at school. It was not easy. He spent five years without any effective intervention,” she recalls.

They began using principles of ABA, reinforcing calm, attentive behavior. It took about a month for him to be able to come into the classroom, hang up his backpack, and participate without screaming. He would still scream when he was over-stimulated or frustrated because he had no means of verbal communication.

To help him communicate, Alecia used PECS (Picture Exchange Communication System). She explains, “We taught this student to communicate beginning with primary reinforcers such as food. At lunch and snack time we taught him how to request what he wanted to eat . . .. We would start with one picture—the object or food—and then add another icon, which means ‘I want.’ The child learns to put the pictures on a sentence strip to ask for what he wants. Even though he can’t talk, he gives us the sentence strip, points to each picture, and we are his voice. Pretty soon he can create a six-word utterance with the pictures. It takes a lot of work to develop that kind of communication.”

In addition to her work for the school district, Alecia teaches courses on language disorders and their assessment at University of Nevada-Las Vegas and San Jose State University. She also lectures on understanding autism around the country and trains speech-language pathologists and others how to use CASL (Comprehensive Assessment of Spoken Language) and interpret the results.

According to Alecia, children with autism can vary in their ability to communicate, from not talking at all to being very verbal. However, they all have difficulties with their social use of language. Tests in CASL, such as Pragmatic Judgment, Meaning from Context, and Inference, can measure deficiencies in social communication which are often missed on language tests that only assess form and content. “CASL is a great instrument to use with students who have high functioning autism, or Asperger’s Syndrome, because you can measure the primary area of deficit,” she adds.

Alecia recommends taking the child’s whole environment into account and involving parents and caregivers as part of the remediation team. “Parents are an extremely important part of any educational program. They are the child’s best experts. By developing a collaborative relationship with families, it will give you a great advantage.”

Teaching children with autism how to use PECS helps reduce inappropriate behaviors.

Parents have indeed appreciated Alecia’s efforts. On September 22 of this year, FEAT (Families for Effective Autism Treatment) of Nevada presented Alecia with the Outstanding Educator Award. She is touched by the recognition and says, “It was the most wonderful recognition anyone could ever receive.”

What qualities are needed most for working with children who have autism? Alecia responds from her own experience, “You must care about children, be dedicated, and ready for extremely hard work.” Patience is important, too, “You have to be prepared to accept small successes and to accept that there may not be successes right away. We feel that we’ve done something phenomenal when a child looks at us and smiles . . . . Or when a kid in the classroom walks up to another and says, ‘Hi.’ Small successes are big celebrations for us.”

“Learning should be fun.” That’s Alecia Ellis’ philosophy of teaching children. “We have fun every day . . . . We take things that children naturally like to do and teach them how to enjoy them, interact with them, and share them with others.”

Alecia is talking specifically about her work with children who have autism. Autism—a spectrum disorder—is a complex developmental disability that can impact a child’s ability to communicate and interact with others and the environment.

When Alecia was deciding on a career over two decades ago, she knew she wanted to help people. At first she began to pursue nursing, but switched to speech-language pathology on the advice of a school counselor. “After the intro class I was hooked for life,” she remembers.

Alecia later accepted a position with the Clark County School District in Las Vegas, Nevada and has been there for over 22 years. During the last three years she’s worked as an itinerant speech pathologist on the Low Incidence Disabilities Team. The team provides technical assistance, staff development, support, and training for all district professionals who work with students with low incidence disabilities.”

Alecia became deeply involved in working with children with autism. She describes the impetus for this interest: “Parents were demanding more appropriate services for their children with autism from our school district. These are parents who are involved in parent support groups and are quite knowledgeable about the disability and the laws related to it. One of the things the parents requested more than anything else was a methodology called Applied Behavior Analysis (ABA) . . . . They were concerned that students weren’t getting meaningful benefit from their current program.”

Alecia working with a student in the model demonstration classroom

She elaborates, “We had to respond to their requests . . . . Unfortunately, educators are not prepared by current teacher training programs to teach children who have autism. We decided to look into ABA. Although this method wasn’t new to us, our impression was that it was too rigid for our needs.”

But, Alecia wanted to remain open-minded about the possibilities of ABA and decided to learn more through a staff development opportunity. She and another colleague from the district participated in a six-week internship at Douglass Developmental Disability Center at Rutgers, the State University of New Jersey.

“We wanted to help teachers find a way to provide effective education for students with autism . . . . We gained intensive hands-on experience in ABA and found out how it can be used as a very effective methodology for helping students with autism learn how to learn,” she explains.

Alecia provides more details: “ABA is based on the principles of the learning theory, operant conditioning. It gained popularity with a landmark study of students with autism done by Ivar Lovaas in the ’70s at UCLA. The results from his longitudinal research demonstrated moderate to very impressive gains for students. That’s what brought the approach to the attention of so many educators. Along with a book titled, Let Me Hear Your Voice, by Catherine Maurice. The book describes one parent’s struggle through the diagnosis and remediation of not just one, but two of her own children with autism.”

While participating in the internship, Alecia also learned about Discrete Trial Instruction, an important component of ABA. It’s the teaching method of “breaking skills down to their most learnable units.” She gives an example, “If I wanted to teach a child with autism how to label pictures, I would begin by teaching the child how to attend. Basically this means to teach the child how to sit down, look, and focus on what is being presented to him or her. Believe it or not, this is really hard for young students with autism.”

When Alecia and her colleague returned to the district after their training, they submitted a proposal to create a model demonstration classroom. She explains, “We discovered by poll that many teachers in the district had never had any educational training on the disability. We thought it was important to find a training model that could impact more teachers and give them the opportunity to practice this methodology hands-on. So we decided to develop the model demonstration classroom.”

An organization called Autism Partnership was the driving force behind the classroom’s creation. Alecia received tremendous input and guidance from Dr. Ron Leaf and his staff at Autism Partnership in developing the class and the training program. She found Dr. Leaf’s application of ABA more “school-friendly”—in other words, more functional for students in a school environment.

Structured play activities promote peer interaction.

The model demonstration classroom was designed to serve preschool- to kindergarten-aged students who meet the eligibility requirements of autism spectrum disorder. The classroom was set up like a typical early childhood education classroom with fun, theme-based activities.

Alecia describes how the classroom works, “For a six-week period, a classroom teacher, a teaching assistant, a speech-language pathologist, an occupational therapist, and other service providers are trained together in the model demonstration classroom. They receive hands-on training in ABA and Discrete Trial Instruction. They also receive extensive feedback.” Alecia emphasizes that the approach they use is natural and flexible with “generalization built in right from the start.”

Once they have finished training, the educators return to their own classrooms to apply the methods and techniques they have learned. Their classrooms become “replication sites” of the model demonstration classroom.

Reprinted with permission from MASHA News, January/February 2001

Jacquie Frerichs

Adventures as a Itinerant Speech-Pathologist

Jacquie Frerichs spent a number of years working as an itinerant Speech Pathologist in southwestern Minnesota In this demanding role, she routinely drove 2,000 miles a month, visiting clients in small towns across her region. She reminisces about her experiences and her continuing excitement about her work.

About 13 years ago I went back to school to study communication disorders. After 20 years as a piano teacher and church organist, I was interested in doing something different. Although the three years of commuting from Worthington to Mankato were long, going back to school was invigorating. A new chapter in my life gradually emerged.

Where the rubber meets the road

Jackson County, Minnesota

Following graduation in 1993, I began my adventures as an itinerant speech pathologist for Habilitative Services, Inc. a locally-owned company based in Windom, MN. We had contracts with hospitals, nursing homes, group homes, developmental achievement centers, and home health agencies in many small towns dotting the prairie.

I learned so much those first few years. Topics which I understood theoretically now arrived at the rubber meets the road stage. Selecting vocabulary for and programming a Touch Talker? And worse yet, completing the paperwork for prior authorization for a trial period and then a purchase? Doing video swallow studies? I was just lucky if I didn’t get lost driving from one little unknown village to the next. In fact, I did get turned around while taking a shortcut from one Western Minnesota town to another. I realized it only when I passed a sign reading, “Welcome to Minnesota.” Yes, my territory was very close to South Dakota.

During those first years, I relied heavily on friends in the field. I was not too proud to make yet another phone call. My memory was challenged with so many different staff and patients seen on a weekly basis. It was interesting to notice how each facility had its own distinctive character. In addition, each had their own system with forms I needed to complete, staff I needed to inform, etc. I became skillful at sensing where the 3-whole punch was kept at various nurses’ stations.

Typical morning

Winter in Minnesota

On a typical morning I would load my car with all the files and supplies needed for the day: my map, car phone, lunch, schedule, and winter survival kit from October through April and headout. Most months I drove 2000 miles or more. I monitored the weather forecast religiously. I discovered that driving across the prairie, often with no other cars in sight, was a calm time for thinking about patients or listening to tapes. I think it would be safe to say that I was the only driver between Windom and Jeffers listening to Dr. Arnold Aronson’s wonderful tape-Dysathria: Differential Diagnosis. At other times, the driving seemed endless, and I wondered why I was doing “this crazy job”.

I stuck with it for the patients

The patients were an important reason why I stuck with it. Many of them I would see in their homes after they had returned from rehabilitation programs in a metropolitan area. They graciously and gratefully, or sometimes skeptically, invited me into their homes, entrusting me with the pain and dismay they felt with their loss of language, speech or swallowing capabilities. Many times their return home startled them and their families with the reality of their disability.

I was touched by their trust and honesty. Sometimes their spouses became co-therapists; reminding, encouraging, thickening those liquids. And, of course, some homes were unpleasant, even painful, to visit. In those instances, I looked forward to the date when it would be reasonable to discontinue therapy.

Some situations were just plain unique. For instance, one summer I had two clients on my caseload who were both living with their wives in the same campground. Invariably, I would get disoriented driving through the maze of campers. Then I would spot a site with a myriad of pinwheels blowing to beat the band in the prairie breeze. One of my clients lived there. He would be standing out by the narrow road, grinning and flagging me down. We did aphasia therapy out at the picnic table. I still remember his wife’s low chuckle. What delightful memories!

Switch to the school setting

Jackson County Central High School, Minnesota

Several years ago, I decided to switch to the school setting. I work for Jackson County Central Public Schools now. My caseload includes all ages in four different school, but I never have more than 40 students at one time. Now and then, I long for the autonomy of my other job, the freedom to pull over and pick Queen Anne’s Lace at 2 in the afternoon while racing to the next little town. But I am spending much more time doing my work now instead of driving. And I appreciate the stability of working in the schools and not having to worry that my caseload is taking a dangerous dip.

I miss sitting around the dining room table, hearing stories about what it was like being in New Guinea during World War II. But I love the eagerness and freshness of the children who are just realizing that “cat” starts with a /k/ and not a /t/ sound. I still do some work for my previous employer to a limited extent. Since SLPs remain scarce in this part of the state, I have the best of both worlds.

Occasionally some of the teachers I work with wonder aloud how I can cope with taxiing from school to school. Little do they know!

Email Jacquie Frerichs at: frerichs@rconnect.com