Documentation for therapy services can be a time-consuming yet essential component of service delivery. Many practitioners and clinicians attempt to streamline their daily note process. Some critical details should not be overlooked, though it is still possible to create a concise note while including everything that reimbursement experts need to see.

Many professions, including occupational therapists, physical therapists, speech-language pathologists, ABA therapists, and others, use SOAP notes for their daily sessions. SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. SOAP notes are valuable because they provide information about different therapy components, and since therapists use them widely, the interdisciplinary team can use them as a means of timely communication.

S: Subjective: What is the client saying about their experience?

Subjective information may include reports of pain, challenges since the last session, or what the client shares they can or cannot do. You may record behavior during the session for pediatric clients, including arousal level and engagement in therapy. You can also include reports from the client’s family or teachers.

O: Objective: What are you observing? What data can you collect?

Include any compensatory strategies your client uses, physical or cognitive strategies for participation, and data you collect. The objective section could include the percentage of trials completed correctly and the client’s level of support needed to perform the activity. If your client needed any adaptive equipment, assistive technology, or modification of a task, include that information here as well. It is vital to make sure that you focus on the active experience of the client rather than the therapist. For example, note that the “Client needed moderate physical assistance for bathroom mobility” rather than “Provided moderate physical assistance to the client.”

A: Assessment: What is your interpretation?

Consider what you wrote in the subjective and objective categories. What does this mean? You’ll use your clinical expertise to interpret the information into an analysis of the client’s performance. Note any improvement, regression, or progress toward your client’s goals. Refer back to the subjective and objective categories to support your assessment.

P: Plan: What is going to happen next?

Include the frequency, duration, and location of recommended services. If you are recommending discharge, include specific information about recommendations for follow-up. Otherwise, include detailed information about your intervention plan and how you will use it to address the problems noted in this session.

CBS Therapy is the premier provider of school-based and pediatric special education staffing services in the Northeast.

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Transitions are a part of everyday life at home and school. However, they can be challenging for children and adults alike, and the demands can be complex! During transitions, the sensory environment is more stimulating, and expectations are often higher than during lessons or structured activities. Often there is more noise in the room, lots of movement, and visual distractions. We expect students to follow multiple-step directions and navigate their bodies through the room while their peers do the same. The following strategies offer ideas to support our students during this frequent occurrence in the school day.

1. Calendar
Younger classrooms often have a visual schedule, but older kiddos can benefit too! Offer a written plan for students who can read. When a child asks what is next, refer them to the schedule to teach them to use it. As adults, we often use our planners or apps to keep track of our days. Learning to check a calendar is a tool that kids can use in their childhood and beyond. Be sure to keep your schedule updated to prevent unexpected changes.

2. Provide a Warning
Unexpected transitions are more challenging. Think of the last time you experienced a surprise fire drill. It feels alarming and dysregulating! Many children feel this way during routine changes. A simple way to prevent this is by giving the group advance notice of the upcoming transition. You can direct this by announcing how much time they have left or making it more concrete. For example, let them know they can color one more shape, and then they will wash their hands.

3. Keep It Structured
We have children with a variety of needs in our classrooms. It can be challenging to develop a transition routine when you have students who need different supports. Some children will complete the transition quickly and become impatient or unsure of what to do while waiting for the next direction. Offer an activity to keep the structure going. For example, when children complete an art project, they can grab a book and return to their seats. When they finish lunch, they can pick a center.

4. Sing it! Move it!
An efficient strategy for younger ones, singing provides a constant familiar activity while students complete their transition. You can use the same songs for daily changes to give an extra level of consistency. Similarly, offering a movement activity can provide a motor break and support the flow of the transition. Try marching to the bathroom, tip-toeing to cubbies, or walking heel-to-toe to another room.

5. Recognize a Job Well Done!
Transitions are a complex routine to learn for young children. Provide plenty of praise for students who follow directions and stay regulated. Providing positive reinforcement helps students understand what expected behavior looks like by observing what their peers are doing well.

CBS Therapy is passionate about helping children with special needs and serving the schools, therapists, and families who support them. New England’s premier provider of school-based and special education staffing services in the Northeast, CBS Therapy also has therapy clinics that offer speech-language, occupational and physical therapy services.

Learn more: https://cbstherapy.com/

Children with ASD often qualify for an Individualized Education Plan (IEP) or a Section 504 plan. Each of these programs promotes support for students to access their learning environment.

Anyone on the IEP team can suggest accommodations: Teachers, behavior analysts, speech-language pathologists, occupational therapists, and even parents and administrators. Each student should have accommodations in place to best support their unique needs. Common adaptations fall into the cognitive, sensory, behavioral, emotional, and communication domains.

Cognitive:

1. Pre-teaching. This involves giving children a heads-up before diving into a lesson or new routine. You can use this accommodation to pre-teach an upcoming fire drill, a new teacher joining the classroom, or novel lesson concepts.

2. Provide short, concise directions. Clear directions that are understandable to the student can give a child a successful start and reduce confusion.

3. Active learning opportunities. This might include experiential learning, incorporating movement, or selecting materials that align with the child’s interests.

Sensory:

1. Reduction of visual clutter. Students overresponsive to visual input can become highly distracted by busy posters, toy shelves, and excess writing on a printed page.

2. Access to a quiet space or noise-canceling headphones. This will allow the child to regulate if the classroom feels too loud.

3. Flexible seating. The opportunity to move and change positions can help many children with ASD self-regulate and attend.

Behavioral:

1. Preferential seating. Specify if the student needs to sit near a teacher, facing away from a visually stimulating area or somewhere else.

2. Positive reinforcement. Reward appropriate behavior with praise, incentives, or a token system.

3. Small group instruction. This can be a behavioral or academic accommodation and reduces sensory and social demands.

Emotional:

1. Deep pressure breaks. Deep pressure helps many children feel calm and connected. You can carry out deep pressure by giving the student a weighted ball massage, presenting a weighted lap pad, or letting them wear a Lycra body sock.

2. Zones of Regulation. The Zones curriculum can be carried out across school and home environments and give children the language and tools to practice self-regulation.

Communication:

1. Modeling. A common strategy that is often included in an IEP is adult modeling for peer interactions or self-talk.

2. Assistive technology. One essential accommodation for children with autism spectrum disorder involves communication devices. Both low and high-tech devices help a child communicate.

Learn more at: https://cbstherapy.com/accommodations-for-students-with-autism-spectrum-disorder/

The expectation for kids to start writing is getting earlier and earlier all of the time. However, the youngest children don’t have the physical development needed to use the small muscles in their fingers and hands to hold and control a pencil.

1. Strengthen Big Muscles First:
For a person to write successfully, they need to be able to stabilize their upper arm. If the movement comes from their shoulder joint when they write, they will get tired out quickly. Use play to strengthen the upper body. Wheelbarrow walking, crawling, and animal walks all work well for this.

2. Get vertical:
Tape a piece of paper to a wall or find an easel with a chalkboard or blackboard. Let the child color to their heart’s content. Kids enjoy the novelty of this activity, and it allows for practice with grasp and getting the wrist into the correct position for writing. If this feels tricky, tape a sheet of paper to the wall and let them place stickers on it for a similar effect.

3. Draw:
Creating simple drawings is a great way to work on visual-motor integrations skills. Sometimes referred to as hand-eye coordination, visual-motor integration involves using coordinated movements to make marks with intention. Start with easy drawings and work your way up. An excellent progression could be drawing a smiley face, then a person, then a teddy bear. First, demonstrate how to make it so that your child can copy you. For ideas and inspiration, check YouTube or your local library for drawing guides.

4. Letter Recognition:
Letter recognition is a part of learning to write. Point out letters in books, on signs, blocks, and in their name. Focus on capital letters, to begin with since those are the first letters they will most likely learn to write. Alphabet magnets are a popular exploration item.

5. Write… But Not On Paper:
Practice creating letters in new and different ways! Try rolling out play-doh letters, making letters with sticks, lines and curves cut out of paper, Legos, and anything else you have handy. You can make a sensory tray with a box lid and fill it with rice or salt to trace letters.

6. Kid-Size Tools:
When the concepts and skills are coming together, and your child is ready to start writing letters, use child-sized writing utensils. This promotes the development of a mature grasp. Start with bits of chalk and broken crayons. For older kids, try golf pencils.

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Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders of childhood. The CDC estimates that between 3 and 7% of school-aged children have ADHD. Characterized by inattention, impulsivity and/or hyperactivity, ADHD impacts many areas of a child’s life. This includes social participation with peers and relationships with adults, academics, executive functioning skills like organization and time management, and more. Pediatricians may recommend medication and/or a variety of non-pharmaceutical interventions.

Nonpharmacological Interventions

1. Behavior modification: This intervention involves using behavioral strategies in everyday routines to provide structure, reward positive behavior, and communicate expectations.

2. Cognitive Behavioral Therapy: Also known as CBT, cognitive behavioral therapy involves self-management that results in behavior modification. The process involves identifying and challenging problematic thoughts and behaviors and replacing them with practical actions.

3. Environmental Modifications: Children with ADHD are more likely than their peers to be overresponsive to sensory input; thus, the classroom can be more difficult for them to navigate.

4. Sensory Integration: Sensory integration is a specific intervention approach used by occupational therapists. This sensory-rich therapy allows children to process and integrate different kinds of sensory input in a controlled environment.

5. Activity Modifications: For the child with ADHD, a multi-step activity can become overwhelming and result in behaviors or withdrawal. Breaking down large tasks into manageable chunks can allow the child to experience success. Reduce the size of homework or the amount of written material on handouts.

6. Social Skills Training: Social skills training provides children with ADHD the opportunity to learn and practice social skills. Several professionals use this intervention, and intervention may include education, use of social protocols, modeling, role-playing, practice in the community, and more.

7. Team Collaboration: When a child’s disability impacts their participation at school, the child’s team may adopt an IEP or 504 plan. Children benefit from interdisciplinary collaboration, and the team may consist of the parents or caregivers, the child’s physician, special education teacher, regular education teacher, social worker, counselor, or occupational therapist.

Learn more: https://cbstherapy.com/nonpharmacological-considerations-for-managing-adhd

Tracking student progress is one of the most crucial components of a child’s journey in special education. Data collection allows us to provide children with the best possible interventions and actively impact their education. Special educators, occupational, physical, speech-language, and behavior therapists all use SMART goals as an efficient way to support intervention planning and data collection.

 SMART is an acronym that stands for specific, measurable, attainable, relevant, and time-bound. The SMART template provides a consistent structure for goal-writing. They are widely recognized in education and help professionals ensure that the goal includes all necessary components.

S: Specific
Educators should write goals with definitive criteria. Break down anything that might be considered vague. ‘Play-group’ could be described more specifically as ‘a teacher-facilitated recess group with five same-age peers.’ If the child has to switch school districts without notice, the new educators should easily distinguish all the goal criteria. Don’t forget to include any adaptive equipment, modifications, or cues that the student will use to meet their target.

M: Measurable
This part of the goal reveals the intended outcome and helps track progress. To improve a goal, add one specific behavior that an educator can measure. For example, “Hakim will initiate three social interactions with peers, as measured by teacher data collection” rather than “Hakim will participate in a play-group.” Be sure to include who will collect the data or if there will be an observation period, retesting, or portfolio collection.

A: Attainable
When a child qualifies for special education or transitions into a program, they undergo a thorough evaluation. The evaluation should contain the child’s present levels of educational performance. Use this information to create goals that are attainable within the term of the IEP. If a child is currently speaking with one-word responses, it is unrealistic to expect them to use an average of six words per sentence within a year. Use their present levels along with your clinical reasoning to determine what is an attainable goal.

R: Relevant
Does the goal fit into the context of the child accessing their education? Does it make sense given the child’s individual learning profile and needs? If it is unclear, try using vocabulary that ties the goal back to the student’s educational needs. If it still doesn’t fit, consider what the team wants to prioritize to ensure that the goal is relevant.

T: Time-bound
The goal should be attainable within the timeframe of the IEP. An IEP is typically valid for one year. However, if a related service gets added to the plan mid-year, the specialist will create goals for a shorter time. To ensure that you are using the correct timeframe, look for the next annual IEP date and write it into the goals.

Learn more: cbstherapy.com

Universal strategies support learning for all students regardless of their disability status. However, systems embedded in the classroom are especially beneficial to students at risk of falling behind or receiving special education or related services. Providing best practices to all of your students is a win-win for general and special education staff and, of course, students.

• Flexible Seating

Many people picture elaborate chairs and spaces when the topic of flexible seating comes up. T-stools, rocking chairs, and swings built into classrooms are excellent but flexible seating doesn’t have to be complex! Allow your students to stand at their table, move to a different space, or lay on their bellies during read-aloud. Movement helps both children and adults focus (hence the popularity of the office sit-stand desk).

• Positive Reinforcement

Positive reinforcement helps create a nurturing classroom environment and is a tool that encourages children to engage in appropriate behaviors. Positive reinforcement also builds up a child’s self-esteem. Give your students a high-five, recognize their hard work, or allow them to earn a fun activity. Use positive reinforcement often and with all of your students.

• Use a Routine

Routines provide structure for a day with academics, social participation, lunch, breaks, and more. A transition is much smoother when a student is expecting it. Let your students know when there will be a change in the routine and remind them throughout the day. Post a schedule of the day where everyone can see it. Use picture images for young children and write the plan out for students who are confident readers.

• Check-in

For student well-being to occur at school, an adult must connect with them. Touching base with them each day can foster a community of positive mental health. You can use the Zones of Regulation or other programs or even teach and provide language for them in the classroom. Make them feel comfortable sharing by using examples from your own life and validating that experiencing different emotions is okay. When appropriate, offer strategies such as deep breathing or movement to help your students feel their best, and feel supported.

• Provide Extra Time

Some children can easily recognize and process sensory information in the world and then quickly recall information and figure out how to respond to a question, for example. For others, it takes longer. Giving extra time to all students offers everyone a chance to participate in the conversation. Especially after asking, “does anybody have questions?” try to pause for five to ten seconds.

Learn more: https://cbstherapy.com

A clinical fellowship provides you with supervised clinical experience in a setting where you can learn and grow your  Speech Language Pathologist skills, under the supervision of a seasoned SLP.

A clinical fellowship is a post-graduate program designed for SLPs who have recently earned their Master’s degree but who have not yet met all the requirements to obtain a Certificate of Clinical Competence (CCC).

Completing a clinical fellowship is a requirement for obtaining a CCC.

Why Pursue a Clinical Fellowship?

First off it is a requirement to obtain your Certificate of Clinical Competence (CCC). Completing a clinical fellowship offers many benefits. There has been an increase in clinical fellowship jobs in RI along with a rise in salaries. The CF provides a new  SLP with the opportunity to apply the knowledge they have accrued during graduate school to the real world situation of providing therapy to a caseload of clients with the support of an experienced mentor providing guidance.

As well, completing a clinical fellowship can improve your chances of passing the Praxis exam. Studies show that SLPs with a clinical fellowship had a higher pass rate than those who did not complete one.

How to Complete a Clinical Fellowship

An SLP must complete supervised clinical hours in order to complete a clinical fellowship (at least 1,260). They must be supervised by an experienced SLP for a minimum of nine months and holds a CCC.

The CF supervisor helps guide the SLP and offers support as they build their clinical skills. This mentorship allows the SLP to effectively provide therapy in a professional setting.

Examining the Value of a Clinical Fellowship

Research studies show that completing a clinical fellowship has a significant impact on an SLP’s long-term career success. CF graduates have more job opportunities, earn more income, and often have a more diverse set of clinical skills.

Completing a clinical fellowship can also lead to job placement and advancement opportunities. Clinics and hospitals desire SLPs with practical experience in a work setting and practical skills.

Once completed, SLP clinical fellowship on the SLPs resume demonstrates that they have acquired extensive clinical experience and technical skills needed to hit the ground running in a new job.

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When it comes to providing quality healthcare, having adequate staffing is crucial. A case in point is speech therapy, which requires specialized training and expertise.
Here, we’ll define speech therapy staffing, explain its importance, and examine its benefits.

Qualifications Required for Speech Therapists

Speech therapists sometimes referred to as speech-language pathologists (SLPs), are required to have a master’s degree in speech-language pathology.

They must also hold certification from the American Speech-Language-Hearing Association (ASHA) and be licensed by the state in which they practice.

Specialization and experience can also play a role in determining qualifications for speech therapists.

Importance of Adequate Speech Therapy Staffing

Having adequate speech therapy staffing can have a significant impact on patient outcomes. Speech therapy can help patients with various conditions, including speech and language disorders, cognitive impairments, and swallowing difficulties.

Without proper staffing, patients may not receive the care they need promptly and effectively. Adequate staffing can also improve healthcare facilities’ overall quality of care, ensuring that patients receive the attention they require.

Benefits of Hiring a Speech Therapy Staffing Agency

One way that healthcare facilities can address these challenges is by working with a speech therapy staffing agency.

These agencies specialize in recruiting and placing speech therapists in various settings, including hospitals, rehabilitation centers, and schools.

Both school speech therapy staffing agencies and outpatient speech therapy staffing agencies can provide access to a pool of qualified candidates and can help reduce recruitment and training costs.

Working with a speech therapy staffing agency can also provide flexibility in staffing, allowing facilities to adjust their staffing levels as needed.

Speech Therapy Staffing Models

Healthcare facilities can use several different staffing models for speech therapy staffing. In-house staffing involves hiring speech therapists directly as employees.

Contract staffing involves working with a staffing agency to provide temporary or permanent staff.

Hybrid staffing involves a combination of in-house and contract staffing. As with any model, there are advantages and disadvantages, and facilities should choose the model that best suits their needs.

Impact of Speech Therapy Staffing on Healthcare Facilities

Adequate speech therapy staffing can have a positive impact on healthcare facilities. 

It can lead to improved patient satisfaction, higher productivity, and better financial performance. 

Providing high-quality speech therapy services can also help facilities stand out from their competitors, attracting more patients and increasing revenue.