Thursday, October 8, 2015

Pulling Your Team Together

Whether you are the parent of a child with special needs or a professional (teacher, SLP, OT, PT, ATP, etc) working with children with special needs, you have likely disagreed with someone at some point over something related to goals and priorities and implementation. Maybe you’re annoyed that the classroom teacher is spending so much time on tracing when you think the child should be keyboarding, or you feel that the time devoted to learning to jump would be better used practicing ascending and descending stairs. Or maybe you feel like the school team is working like a well-oiled machine, but the family isn’t doing any carryover. The conflicts are fairly common, especially when a child is complicated and may have a large amount of team members jostling to direct their area of expertise.

We’ve been through this with Maya’s team over the years, many times. There are a large number of things that I let go (for example, I’m rarely involved with PT, as it’s just not my priority, and it’s the area in which I am least informed about goals and methodologies). I’m semi-involved in OT, mainly because I want her to have the skills needed to write (in whatever form that takes) and I check in periodically to ensure that the occupational therapist is remembering that that is our goal. But communication . . . well, I’m all over that one.

When there are family vs. professional (or professional vs. professional, or family vs. family) conflicts related to AAC choices, AAC implementation, the balance between AAC and other speech services . . . well, it can feel pretty emotional. Fostering an individual’s ability to communicate autonomously, to say exactly what they want to say, to whom they want to say it, whenever and wherever they happen to be----that’s as high stakes as it gets. If one member of a team feels that they have a plan for how to support the child in using AAC and another team member disagrees, or isn’t interested in trying, it feels like a very real threat to the child’s ability to become a communicator (and, truly, it often is a real threat).

Things get emotional. You-have-to and This-isn’t-how-we-do-it declarations are made. Heels are dug in. Invisible lines are drawn. People are defensive. The team is not a team, but loose collection of different people with different agendas who are teetering on the edge of not trusting or respecting each other.

No one wins.

I've been there, as a parent and as a teacher, and I imagine that in a few years I will be there as an SLP, too.  And for the past several years I’ve been in the slightly awkward position of being the AAC expert on Maya’s team, as well as her mom. As you may imagine, it has been uncomfortable to introduce myself to the new SLP each year . . . I have to walk in, teach them about Maya’s system, explain my goals (total communication goals, AAC goals, and speech goals), and give them a rundown of some AAC best practices. Sometimes I have to spend time gently informing them about motor planning, and why I won’t allow them to program or re-arrange vocabulary, and why topic boards aren’t really appropriate or a best practice. So basically Even though you are a professional and I’m the mom, I know more than you do about AAC, and I’m going to tell you how you need to use it, and actually some of the stuff you thought you were doing correctly aren’t really best practices anymore. Oh and hey, nice to meet you!


And then I do it with the teacher and para, too.

I’ve been pretty fortunate to have team members who listen, learn, and work together---and I’m sure that part of this is luck, but part of it is also the approach. As someone who has been a teacher and a parent, I can see that there is one underlying key to getting everyone to come together: investment. The team leader (in the example above that's me, since I was the person calling the meeting) has to get each member of the team invested in the matter at hand. It’s a central concept of leadership, I think: if people feel empowered, motivated, and valued they become excited to dive in and give it a go.  (Whereas if people feel uninformed, un-confident, and like demands are being placed on them, they become defensive and may be “forced” to comply, but their participation will be subpar, phoned in, and will likely fade quickly.) 

And so, here’s my approach. (Note: In this approach you have to presume competence and good intentions of the people on the team. Extra note: If you suspect your team member may not be competent or have the best intentions, put on a fake smile and try anyway.  If needed, when this fails you can move up the chain of command knowing you did your best----but they may end up surprising you.)

Step 1: What is happening here is amazing!!!!! In this step, you share what you are implementing and how it's working. Bonus points for having video clips of AAC use or AAC modeling in action, or work samples, or anything concrete that can catch the team member's eye and pique their interest. Some examples:
  • We are building a foundation of language by modeling without any expectation of him to use it in return, which will lead to his ability to share his thoughts when he is ready and able.
  • We are encouraging her to love and interact with the talker, which will sometimes be purposeful communication and will sometimes be noisy exploration, and this will lead to a greater knowledge and mastery of the vocabulary in the device.
  • We are responding to everything he taps as if it is purposeful and meaningful, which will lead to the understanding that we respect his use of this device as truly communicative and not “just playing.”
  • We are choosing to focus primarily on core vocabulary because it is highly useful and flexible, and using smaller amounts of fringe vocabulary right now while he is learning, which will lead to her ability to communicate about many things throughout the day, rather than just during circle time.
  • We are responding to “misuse” of the device the way that we would respond to “misuse” of speech, by using phrases like “right now isn’t a time for talking” or “we can talk about that topic during free time, but right now it’s time to discuss this story.”
  • We are attempting to increase her utterance length by recasting and expanding upon her statements throughout the day, which will help her to share more of her thoughts with all of us.

Step 2: You are uniquely poised to play a role in this amazingness, and it’s easy to see that you are going to do an amazing job being an amazing member of this amazing team! Some examples:
  • I can see how much you are invested in the success of your students, and I know that he really looks up to you!
  • Since he spends the bulk of his time in your classroom, the support that you can provide for him will have a huge impact.
  • As an SLP, you play such an important role in improving her communication, and analyzing the areas of language that we can target next!
  • During your sessions she will be able to really target and practice new skills in a way that she won’t be able to do in the larger classroom.
  • I’m only her teacher, and I am so excited to hear the new thoughts she will be able to share with this device----I can’t even imagine how exciting that must be to you, her parent.

Step 3: Don’t worry if this seems new-there are a lot of different ways that I can support you and we can work together to keep up the amazingness!  Some examples:

  • Let me show you a few things that are working for us. We’re really excited about them! 
  • I know that you have a lot on your plate. Let’s figure out how we can ensure that this is easy for you to implement (and doesn’t create much extra work)
  • Let’s identify a who/when/where/how for starting implementation (in a discreet way)
  • Let’s agree on a bottom line for these first two weeks, and then we can check in. 
  • Let’s figure out how I can support you. Some ideas include:

        -report what we talked about at home/school
-create a target word list
-create print supports
-provide you with some research articles about AAC
-send home worksheets for you to complete together
-provide you with links to videos of modeling, or video myself modeling with this 
                         -come to school to guest model for part of a day, or invite you to our speech session 
                           so that you can see modeling
                          -refer you to some online groups/websites that have great AAC resources and 
                          -help you to troubleshoot

Step 4: I welcome your input as a valued team member! Make sure that you give the team member a chance to respond, and really listen to what they say. Take notes. Examples: 
  • What do you think about this?
  • What do you see as being the biggest potential challenges? 
  • After a few days of trying, let me know what you think, I’m looking forward to hearingyour input.

Step 5: Catch new team member being amazing, shout out the amazingness!  EVEN if the team member isn’t doing things perfectly, don’t criticize yet!!! For example, if the history tracker shows that the talker was only used at lunch, you praise that use at lunch, and don’t mention the silence elsewhere. They are dipping their toe in the water . . . you need to build them up, reinforce that the water isn’t scary and that they are ready------you don’t need to yell at them to jump in the pool. You want to give a few rounds of praise before gently pushing for more. Examples:
  • I was thrilled to see the modeling that happened at lunch yesterday! Keep up the great work!
  • (Child) said that you used the talker to talk about stickers, and he was really excited. His favorite stickers have green bugs on them---maybe that’s something you could talk about today!
  • I can see that the talker is being used every morning during circle time---great job being consistent!

Once you’ve got people on board and feeling good, now you’re ready to pick a new goal. Then you go back to step 1/2 , telling everyone that they are great and amazing, and that they’re ready to up their game a little bit J
Now . . . is this a magic approach? Will it work smoothly, without any resistance? Probably not. So here are some ways that you could address resistance:

Some possible things to say if a new team member is resistant:
  • Tell me about what you think the biggest challenges would be here.
  • I can see how that could be challenging. (That period is important! Acknowledge that it’s challenging as a full sentence and wait before rushing in to tell them why it’s not challenging).
  • When I was new to this approach it seemed strange to me, but as I learned more I saw how amazing it is---you’ll see J
  • I hear your concerns. Would it help if I could provide additional resources or references about this approach?
  • Maybe we could have a trial period and then re-evaluate what’s working and what needs to be tweaked?

And a possible thing-to-say if they become obstinate:
  • I know that this approach is new to you, and that it may not be your preferred course of action, but I also know that we are both working toward the same goal: helping my child communicate as independently as possible. It seems like we each have a preferred way of working toward that goal, and I think that we need to find a way to merge our approaches so that we can better support Johnny together.

And if there’s just no getting through and the meeting time is done and you’re nearly in tears (not that that’s ever happened to me), here are a few possibilities:
  • I’m disappointed that we weren’t able to figure something out today.
  • I am frustrated and scared for my child, and desperate for him to become a better communicator. I feel like he’s not getting the support that he needs to work toward this goal at school, and I was hoping that we would be able to make some small changes today that could pay off in big ways. 
  • I’m going to request a meeting with (principal, superintendent, speech supervisor, district person, etc)---and I hope that maybe having more minds at the table can steer us toward a better resolution. 
  • I’m going to put in a written request for an assistive technology evaluation through the district, so that we can get a specialist in to help both of us come up with a better plan.
  • I’m going to hire an independent assistive tech/AAC specialist/AAC-SLP to come in and consult with the team, and hopefully she will help formulate and action plan.

Calm. Compassionate. Seeking first to understand why team members may be holding back or disagreeing, then to have your proposed path and solutions understood and accepted.

Presuming competence and good intentions from the people that you will likely be stuck working with (for better or for worse) for many months, and trying to unite with them to create a support network for your child. You are not begging or pleading, but also not demanding. You are firm and calm and clear, and inviting and affirming and welcoming.

Will there be times that this doesn’t work? Yes, yes there will. But with those people, nothing would have worked---the yelling and demanding or shaming or threatening wouldn’t have worked, either. I believe that this approach gives everyone the greatest likelihood of building a team . . . and if not, at least you’ve taken the high road of being respectful and professional as you advocate. No one ever regrets taking the high road.

(And that’s when you take the high road right up the chain of command.)

Feel free to share you own tips & tricks in the comments :)


Anonymous said...

This was a timely post for me! I am an SLP working with a teenage boy who is being cyber schooled, diagnosis is autism and cognitive deficits. As he had never been introduced to augmentative systems, I began aided language with him. At our reevaluation meeting recently, mom said she does not want to pursue augmentative systems, as he does speak at home (single words in response to prompts/questions) she said he will use sentences when cued to expand. So I am rewriting goals to suit the family, trying to hit some of his major needs, without aided language. Any suggestions would be greatly appreciated!

Anonymous said...

Wow as a mum with very little time or energy, this sounds absolutely exhausting.
but also some great tips of what to say and how to say it when things are getting tough -