Welcome to the speech uncensored podcast. I am Lee Ann Porter a medical speech and language pathologist interested in learning more about our vast scope of practice and sharing that information with you. This podcast was created to inspire and nurture speech and language Pathologists at every stage of their practice. I just want to connect you with actionable Intel so that your practice can flourish because knowing best practice and doing best practice can beTwo very separate things. So let's connect those dots today's episode is bringing the realness on assessing functional needs in the adult neurological population the ultra fabulous Sarah bar from honeycomb speech therapy is back for her third appearance on the speech uncensored podcast. I have thoroughly enjoyed getting to know Sarah and her work better and let me tell you Sarah has a heart for connecting and equipping slps with actionable best practice materials. That suit a variety of settings like acute outpatient home hell's all those things. So if this is an area that you want to improve on then reach out to her she wants to come alongside you and equip you to use the tools that she's pulled from the literature so that you can do your job with ease. Okay, so that's like enough for me. Let's let's get into the material with Sarah. Well, welcome back to the podcast Sarah. Thank you so much Lee and it's so nice to be here again. I've had such a fun time recording with you. And I think today is really going to round out the discussions that we've had so far. Yes, I'm really excited. I loved how we started with making meaningful Aphasia therapy and then moving on to functional cognitive therapy. And now we're going to be looking at discovering functional needs through assessment and dynamic assessment period It's so I'm here for it. I'm ready Sarah take it away first in case this is ever if this is the first time people are meeting you go ahead and introduce yourself. Tell everybody a little bit about yourself. Perfect. Okay, so, my name is Sara bar. I am a clinical SLP. I've been working for the cash. I'm just starting my 12th year and I have been able to work across all the settings acute care Inpatient Rehab Outpatient Therapy Home and Community and two years ago. I started my own private practice which allowed me to also work on my website and blog called honeycomb speech therapy.com. And that is a place where I blog and have therapy materials for slps and the focus of functional therapy and how we can do more meaningful and relevant therapy for adult rehab I know in my first five years or so. Of practice. I was really heavily focused on just you know, doing worksheet therapy and playing games and cards and all of that stuff and really just kind of felt this Gap in what I was doing in like I was not really fully using the time I had with patients to their best benefit and so it started me on a really twisty turny journey toward person-centered care. I really didn't even know what that term meant, but I did know that People responded best to functional therapy and so I learned everything I learned from the whole process from assessment to therapy to home programs in a really disorganized way. And so now I find it so fun to be able to talk about functional person centered therapy and present it in a more organized way for people so that they can really take away these practical tips and tricks and know what they can do and the settings there and that will really work to get them. Up to meet functional needs for patients. Well Sarah, I am a hundred percent indebted to you for doing all the hard work cleaning it up and packaging it up so pretty so that I can benefit from it and hopefully everybody else is listening in tuning in. You're the best. I love it. Oh, thank you so much. It really is my pleasure. And I really just have so much fun doing this stuff. So so I thought today, you know, my first couple episodes with you. I was able to talk about the actual therapy. Time and how we're using evidence-based interventions to meet those functional needs but then I like to start with that because it really gets people thinking about how therapy can look different and then unnatural next question is like well, okay, where do I start Ben and I think that's the perfect question because people are recognizing. Yeah. So if you want to do that more functional person-centered approach to therapy your assessment is going to look a little bit different than maybe what we Traditionally done because I really believe that that assessment and goal-setting sets you up for a really easy transition to doing functional therapy. And if you don't use the best therapy techniques or in your assessment, then it's going to be really hard to think of how you can meet functional needs in therapy. So what we're going to do today is we're just going to talk about an article that I sent. I'll put that in the link. I'll give you the link for that so you can put it in your show notes. Yes, thank you. And so we'll send our first little chunk of time talking about the article so we can think about what best practices are for assessing the neuro population and then following that I really wanted to go through in-depth and give you guys some specific examples of like Real tools that I use in my assessment and what's really working for me. And so we'll talk about three different things. Awesome. Okay, let's go. I'm sad I got my paper and my pain I'm ready. Okay, the article that I wanted to talk about today is an article from a ncds and I think the last podcast episode I botched what that stood for. So I have it today, so it broke go back to me about the same place. Intense learn from my errors. Exactly. So anyone else is listening and CD s stands for the Academy of neurologic communication disorders and Sciences and they have put out some really cool reviews of different topics. And I've found a lot of their articles helpful. So this article is actually from 2005 and so the information in here has even progressed further from what's listed in the article today, but it's a really good starting point and really The ending how you know that these recommendations have been around for over a decade now and I think our clinical practice still needs to catch up to this. So it's it's called non standardized assessment approaches for individuals with traumatic brain injury and I should say that this group of authors also put out another companion report about standardized assessment approaches. And that's a good article to check out also good. Yeah. That other article do they name specific assessments and talk about like their pluses and minuses like what they're good for, you know have caution in these areas that kind of a thing. Yeah. It did that in the non-standardized areas. I'm wondering if they copied that formula for their standardized paper. They did do that it they because the basis or how they started this article was doing a big survey to other slps and so they took the information what are slps using and then they kind of Went further down that route. So yes, it would be worth checking out. Okay, good. Yeah. So, um, so just to clarify then so when we're thinking about our assessment process, I'll tell you kind of how I how I started my career. We would really heavily focused on the apparent level testing. And so whether that meant doing the Montreal cognitive assessment or the Western Aphasia battery or the scan An or the favors, I mean, there's all these different standardized tests that we can do and what kind of became the culture at the places that I worked was get those test scores and even I have memories of working an Inpatient Rehab and patients would be there for less than a week and we would send three of those days giving them battery after battery of every different standardized tests. And what were missing here then is what the best practices are telling us. It's not telling us don't do the standardized test. Definitely there is a place for standardized tests. And I just want to clarify. I'm not staying, you know, toss the standardized test. Those are useless. They do have a place but they really aren't everything and too often. That's the only thing we're focused on getting and it really makes us miss a lot of valuable information. And so this article is talking about the non-standardized. As portion of your assessment and that really that is a best practice in something that is recommended for the brain injury population. If you look at the literature for Aphasia doing non standardized assessment for Aphasia is recommended basically, even in in the Pediatric populations, like the autism population all of the standards for the patients that we treat and Speech Pathology. Man that we also focus on non standardized assessment. And so we're going to break it down. We're going to look at this article and say okay. What are we even meaning when we say non standardized assessment. It certainly doesn't mean like willy nilly just have conversation with somebody and see what you can glean from that and I want to stress that that when I do the non-standardized portion of the test, there's still an organization to what is being done. There's an efficiency. You know what you're looking for. Or it's not just this completely disorganized like well, yeah, then we chatted for about 20 minutes. And this is what I noticed. So, I hope that's reassuring to people because some people I think just want to have more of that structure for an assessment and I've definitely found for myself that there's some great tools out there that we can use that would be classified under non standardized assessment. Okay. So when we're looking at this article, first of all, let's review. Why are they telling us we need to do non-standardized assessment? Why can we not just do the you know, the Western Aphasia battery or the scan and just use those scores alone? Well, it's being that when they've done these systematic reviews about how testing results match up to how someone's actually functioning in there. Everyday life the testing results from standardized testing aren't telling you some really important things. They are not really telling you how things like conversation or functioning with a communication partner is going there is the studies have ample amount of Studies have shown that There's a gap between how someone tests and how their real-world functioning is going. And even since this article has been published. There's been more and more testing to show that when we are only marking the impairment for somebody like, oh they have moderate memory impairments that that does not correlate with somebody's activity and participation so we can't assume. Oh, hey they got you they did moderately poor. And this memory tasks, what does that really tell you about how they're able to make their grocery list at home or remember how to call their kids? And on the flip side of that they talked about how certain people might test within functional limits on our assessments and perform and be judged to be have intact skills in the clinical setting but they're noted to be impaired in the home setting and the patient's telling you these things the family members are telling you these things like this is what's going wrong at home and you're like, but my standardized assessment says you're fine. Call your OB V. I don't know what to do with you now, you know, and that's where these types of non standardized assessments. Dynamic assessments really come into play totally totally. Yeah and I think on some level if you think about all the different patients you've seen like when I when I read this I'm like, yeah that actually does make sense. Like I've seen people with dementia who will have severe impairments on impairment level testing, but then I'm observe them in their home and they can be used for coffee maker and feed their pet those routine things are actually still going. Okay, and then I've seen patients post concussion. Who will do really well on standardized testing, but then just be crying and devastated. My life's falling apart. I can't even respond to my emails, you know, so that's just kind of an example of there really isn't discrepancy between how the impairment level testing is and how someone's real life is going and you don't know unless you do some of these non standardized test methods. Yeah, just love the freedom that this article gives to us, too. Gives us permission to try some of these real life things in context and know that this is still a valid way to assess somebody this is supported by the literature in our field. So the article goes through a few different definitions of standardized testing and the one that I use a lot is just called Dynamic testing and what that means is you're going to observe them do a task. So for example, I'm going to think about somebody in a hospital setting and I might have them during my assessment. I might say hey have you been able to use your TV remote in the hospital? I've worked at is kind of part of the call light turning the TV on and off and so then if they say, oh, yeah. Yeah, that's been fine. Then I might say, okay great. Why don't you show me how you do that? And so then I'll watch them do it. And if I notice any let's just giving me the contextual situation to notice while might be going on. Do they know where to look are they confused and pressing the wrong buttons? Do I had to are they kind of losing attention partway through your kind of gathering all of that information that you don't know by just get asking the question alone or by doing impairment impairment level testing alone. And then the other part of the dynamic testing, is that right in that moment. You can try a strategy and see if it improves their performance. So I always now have like sticky. Notes in it or like painters tape in my in my pockets because I like to use them to just cover things up or simplify simplifies at ask someone's doing so if I saw somebody pull out their call light and then they were really confused about wow. There's you know, 15 buttons on here. I don't know which one to use for my TV. Maybe I did cover up the other buttons with a sticky note and say okay. Let's try that again. Can you can you turn your TV on for? And then boom if it works then that's all been part of that Dynamic assessment and the information I have is a they weren't really able to consistently participate in the activity of turning on and off their TV and be they're going to benefit from some environmental modifications and there. I have a goal that I could use in therapy. So that's kind of in a nutshell the what the dynamic assessment process means to me. Me something else that I thought was kind of neat in the article. Was it really made a point to talk about our our need to have awareness of what the purpose is for the assessment that if you know many times if you're you know on the front line like acute care you are purpose might be the actual Diagnostics. You're evaluating somebody for the first time and you're really figuring out what's going on. But if Seen somebody even at the next phase in patient rehab or the home setting you may be your purpose might differ a little bit and you might not be so focused on all of that. Testing might be more focused on. Okay, what are going to be the safe discharge recommendations or you know, what? What do you still need to improve upon to get back to work or that sort of thing and I and I wanted to share just an example from my own life. Life my own clinical practice a to show why this having this purpose in mind really matters. And so this is somebody I saw within the past year and this gentleman was diagnosed with moderate dementia. His family had noticed him declining as he lived in independent living and they so they brought him to a neuropsychologist. So the neuropsychologist completed day long Battery of tests and diagnose him with moderate to severe. I think he was in the moderate to severe range and the neuropsychologist report said he recommended speech therapy as this gentleman then transitioned to Assisted Living to help him with setting up his home environment for better functioning improving word finding for family members that sort of thing. It was a great report from the just I thought because you know, they don't always include those things and it was just sad on hmm. Well this report first went to a large rehab system and what what the speech pathologist was unable to do is to recognize the different purpose that this assessment was supposed to serve and so instead the initial speech pathologist that saw this patient just repeated all of the standardized. That the neuropsychologists had done. And in fact, it didn't even invite the family members into the room with the patient. And so the report just included all of the same information that the neuropsychologist report included and it didn't include any functional information about you know, could he use his phone to call somebody or did he have to manage any of his ADL still? We didn't know the family wasn't super happy about that and you No, we can kind of see why because it seemed like a duplication of services in that in that case. And from there the patient got referred to me in my private practice. And so what I did then instead of repeating all of that standardized testing because that wasn't the purpose the purpose wasn't to see where he was, you know impairment wise that that information was available to us already. The purpose was to see what kind of strategies and supports may be beneficial. To him and his home and so I did more of that Dynamic assessment. We looked at the pictures he had in his home of all of his grandkids and I saw how many names he could come up with easily. And then I added a little label below the photos in Saw. Yep, readings and tacked in that helped him get the, you know, get all of the names in a minute. And so we went through all of his different ADL areas like we looked at how he was maintained. Meaning feeding his pet and making his coffee in the morning and finding activities within his facility and it was a contextual evaluation and we use that Dynamic approach where if something didn't go well I could use the time to try a strategy and that was giving me really specific ideas of the goals. I was going to set and how I was going to use my therapy time going forward. So I hope I just think to give a specific example of how the Purposes have looked for me. And so in that article when they talk about the different purposes. I hope that that gives you an idea of one way that I've applied doing doing things differently because the purpose is different. 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So join me Michelle and Marisha my other podcast host as we balance excellent ceu opportunities with some sweet vacate. I'm on a very large boat. Be sure to visit speech therapy PD.com / cruise to learn more and sign up. I'll see you there. Yeah, that makes a lot of sense. I mean obviously we don't want to be someone who's just going to duplicate Services. We want to know what are the actionable ways we can meet this patient's needs and their own personal goals and aligning that with what we've been taught and what we think our job is and helping them is pretty crucial bridge to cross I think about that. I think you I feel like you're pretty lucky and that you're able to go with the patient their family into their home and really Like see the whole nine yards and really get functional and I think about applying that for me and outpatient setting I just have to go based on report and sometimes just the patient's report and they might not be giving me the most accurate information for a variety of factors. So, yeah, so yeah, I and I worked in I've done like, you know outpatient or Inpatient Rehab for probably eight years or so, so I definitely feel the pressure. Pain that you have and I will acknowledge like oh, yeah going right into someone's home or Community is you know, you could just so readily see what the needs are. Whereas you always have that feeling of like am I really getting the full picture here when they're coming into your space? And so yeah, this is just kind of off a script for me, but I'll give you guys just a few tips and tricks that have worked for me. So one is I as anytime Possible. I assigned for homework for them to bring in their own stuff into my speech therapy room. And so I've had people bring in their TV remotes to my outpatient therapy room and we modify it so that they can sequence the buttons better that might mean, you know covering up the other buttons or putting a label on like on and off whatever is going to work for that patient or any time possible. I try to get out of my quiet. Each therapy room and go to just more realistic setting to practice things. So when I was doing Outpatient Therapy, I was in a kind of a larger hospital. So we had the opportunity to go in like noisy therapy gym or the cafeteria or a Starbucks and just practice some of the techniques we were working on in a noisier environment people often times will have some form of a smartphone knees. Days, and they have pictures on them. And so rather than using my phone prompts or picture cards. I always try to see if they have pictures on their phone that we can use as a conversation starter. It's just something that's built into today's world for the most part and that's just one way that has helped me be a little bit more functional and then the other is your mind blown right now. We are sorry. I know I'm I mean over like our You like my mind's exploding like sir. This is so good. So I'm like cracking her up on the side for the focus here and then you know, just the last tip I have off the tip of my head here is anytime so you have the patient you're feeling like you're getting this unreliable history. You just don't know use your therapy time with the patient to call staff member or the family member on speakerphone and that's something yeah, you have to adjust. You're the way you're talking a little bit because you can't maybe directly ask the family member, you know, you have to kind of ask it in a sensitive way, but I find that you can do that pretty easily like hey, Tommy and I are sitting here. He says his school work has been going awesome since he's been back to school. He hasn't had any memory challenges with turning his homework in on time. Is that what you've been noticing? Also? I always like to hear it from two people, you know, and so you You have that discussion that way and I just get out my phone all the time to call doctors with patients or family members or whoever so that just to maintain productivity and efficiency. You're getting that stuff done during your session. And that is a valuable part of your session to make sure you're getting the correct information. Yeah. Alright. Yeah. Thank you Sarah like these things are you know, I like to think of them as like those obvious like Common Sense things, but literally I hadn't thought. About some of those things so thank you. Yes, I know simple is good. And I'm that's the sort of stuff that I like to sew. Okay. So what I want to do now is use the article to talk about three things that I do during my assessment process to help discover functional needs and remember I'm a clinical SLP like you guys so doing this efficiently and easily is Paramount for me just like you guys so the first First thing that I do when I need a patient is I do what I call a functional needs interview. And so this is the very first thing that I do I'm not diving into standardized testing, but I actually have a new packet on my website honeycomb speech therapy called discovering functional needs and I've really shaped out what these interviews look like across a variety of settings. So I'm going to give you guys an example. I have a new patient. Day that I'm going to go see and this is a brain injury patient who this is what I know about her. She she wants to get back to work within the next month and she's that she went through hospitalization Inpatient Rehab home health. And so now I'm coming into the scene. And so the things that I'm going to do with her right away is I'm going to be talking about what does her job look like and I have a functional needs interview that I've set up in this is really an efficient way for me to gather information about the skills that she needs to do for her job. So I'm going to ask about meetings emails customer service managing inventory or numbers. I've heard from one report. That kind of numbers was a tricky thing for her and so we'll talk about exactly what she needs to do for work and we'll use that Dynamic assessment where I will have her. Practice some of that stuff like oh, okay. So maybe she'll tell me. Yeah when I answer when I call somebody on the phone, I need to be giving them five digit codes for the supplies that we need. And so we'll kind of simulate that in practice and then I'll be able to know. Okay, where is the break down? Why are you having difficulty with us the article that we're talking about explains why it's so important to kind of role play and do some of this content. Textual observation because even with the case of someone needed to report numbers over the phone if they say that's been difficult you need to know. Okay, is it is it a physical thing that could be fixed? Like I've had people who just simply needed their phone microphone closer to their mouths. So somebody could understand them or is it that they are, you know saying the wrong numbers. Is that something we need to This is that the reading the wrong numbers wrong and having them written out and words would work better than the actual numbers. I mean, there's like a lot of different ways and you won't really have an idea of how to start or what to start unless you practice that a little bit in therapy and just kind of give it your best guess. Okay, so the the functional needs interview is what I start with when I work with patients and that like I mentioned it's basically a checklist where you can efficiently go through what someone may need to be able to do and what's important to them and that gives you your need from there. Then you'll be able to apply an intervention to that need. So then the second part of the second tip I wanted to share with you guys is how I am. Ask these questions to patients and motivational interviewing is a technique that has been developed for many different fields. Not just speech therapy, but it has been applied to our field as a good fit for person centered care and just for helping discover patient needs because it's evidence-based for helping patients recognize the change that they want to make. So we all know those patients who really aren't interested in speech therapy, and we know that if we are just trying to be persuasive or putting it on someone it's really probably not going to end up going anywhere. Great. Yeah. Yeah, and I think when I first started doing speech therapy because you're working with the neurologically impaired population. You kind of have that idea where you have to be a little bit blunt and in your face like Actually, no you didn't do well on this you missed three of these questions and I can tell your memory is not working how it needs to do like we would say statements more like that. And I've really tried to change since I learned about motivational interviewing and I really wanted to just go through and tell you guys a little bit about what motivational interviewing and Tails. Okay. So this is basically built on freezing your statements in Four main areas and when you say these statements the idea behind them is always expressing empathy developing discrepancy. So if the patient like says they want to change something like oh, yeah. I wish that I was doing a better job not losing my tools at home, but then they say, oh, yeah, but I don't want to try any of that stuff. You said you're kind of just developing the discrepancy. So you say oh, yeah, so you would like To be functioning better at home. But this this technique that I mentioned isn't seemed like a good fit for you. But ultimately you do want to be functioning better and making statements like that. It helps them realize and internalize what they want to change instead of using like, well listen, you said you wanted to change this is the way we're going to do it. Okay. And so and anytime you have resistance, they just say roll roll with resistance and so without into in your face or trying to convince them one way or the other you're just kind of rolling with resistance and I like that they say you can you can do this by using open-ended questions. And so today when I meet my new evaluation one of the first things that I'm going to ask her is, what is the most important for you to know today? And the reason I'm choosing that is because when I was scheduling the Made with her today, I could tell there was a lot of frustration and anxiety about her plan for going back to work. And so I want to make sure today as I'm established in my role with her that that's like the first question she hears from you as you know, okay, what is most important for you to know today? Another way you can use motivational interviewing is to use affirmations. And so you're just affirming and helping that person. I feel heard and so I might say you are a really hard worker and it's important for you to show your boss that you want to get back to work and just kind of recognize why there's some anxiety in her about about this work topic that we'll be discussing today and it really is amazing how you know, this is just a general life too. But when people feel heard and validated then they open up more. Our and give you more information and so as you go through and use these techniques you will be surprised to sound so simple when I'm talking about but this is using this style of talking patients. Just go to the next level and kind of give you that next need to so I really love I love this technique Reflections is another Technique we can use in the statements that we're making and so your if they're talking about something you're just stuck like kind of reflecting back like it sounds like you want to be doing more social outings, but you don't feel as confident as you used to you just kind of give you that information and reflecting back the emotions that you're recognizing and then the last kind of technique that they promote in motivational interviewing is called summarizing and so, you know if the patient It kind of just goes into this whole deep-dive of emotions and not sure what they're wanting or they're upset about something. You kind of helped bring it back by giving it a central summary and a focus and so you have you been talking about you want to get back to work and you're not sure if you're open to do it using strategies to get back to work. And so that's kind of where we're at and you just kind of give a nice summary like that. I am my website. I'm actually I have a packet of like a freebie of statements that use that people can use in speech therapy with the motivational interviewing technique. I just kind of typed up like two pages of statements that you can make. I know when I started using motivational interviewing and still today. It's like I'm tired my brains frazzled. I forget just how to say things just right and so I Actually typed up these questions and ways to use the motivational interviewing technique and I'd love to share it with anybody else who would like that and so they'll be able to find that on my website. So Okay. So we've covered then when I do the evaluation, I'm using motivational interviewing techniques. I use a functional needs interview. And then the last thing I wanted to talk about was using what's called person centered outcomes. Sometimes they're just abbreviated as PCOS. And again, I have a list on my website that's free. If you want to see a bunch of different person centered outcomes. What these are is they're a little bit different than like a questionnaire which the article talks a lot about questionnaires. But since this article came out, we've actually Progressed in people are doing more what's called person centered outcomes in their statements that the patient can fill out that they rate a statement from like maybe 0 to 4. And so there's a score associated with all of these statements that are talking about activity and participation. So I have found them very helpful because when you go through these you actually have a score out of 30 points and then you can use that too. Set a goal for in your goal setting and you actually have a quantifiable number that relates to their actual activity and participation. And as I as I became aware of these it's really cool because they're coming out with more and more of these here, but what I started to I took like an entire day like 8 hours like okay. I am going to find these PCOS and what ones can we actually use in therapy because when they started getting developed there's some really Good ones that are so thorough but they might have 50 questions in them. And you know, we know that in the medical setting like we just don't have time to go through that sort of thing. And in addition to the other things we need to accomplish in the evaluation. And so the list that I've compiled on my website, I really said, okay, this is for sure going to take 10 minutes or less and it's got to be free because a lot of them are available for purchase. Purchase but like a shy has a few of them, but they might be a hundred dollars and I really focused in on where are they? Where can we find this in an article that we could then print out in use and that they're highly usable in the medical settings that were in so just some to give you guys an idea of one of those today and if you've got if you're interested in seeing more than check out my website. Okay, so the one that and I didn't print out, I think this one just Amount in 2018. It's called the communicative participation item bank. So they you know, everything has to be abbreviated in our field. So they abbreviate that CPI be and there's a short form and so whenever I see short form, I'm like, yep, that's the one and so this short form is you can find this for free and I'll have the link to this also and it has 10 questions. And you can talk you can talk this through with a patient or they could just fill it out if they're able to like read and answer these and they rate each question as not at all a little quite a bit or very much and then each of those has a point 3 2 1 or 0 points. So they might ask questions like oh, I guess I should first say the communicative participation item Bank was normed on a variety of diagnoses like ALS Ms. Head and neck cancer. So I think it's kind of a cool one because it's not even just talking about like dysarthria. Oh, it's really they tried to make one a little bit more broad for different populations. And so again, it would be highly. Isabel in medical settings because you could use it for a variety of Diagnostics and Sarah who made this one that one you know what I don't have it pulled up. I just printed out the short form. I'll have to let me send you the link to that because I don't have them come first. The author's name is not on the actual form, but I'd love to send you the link to the article to okay. Sure. Yeah, that'd work. So the patient may will go through these questions and it says does your Russian interfere with talking with people, you know, and so then they rate that does it interfere with communicating when you need to say something quickly or communicating when you're out in your community errands or appointments. How about asking questions in a conversation? How about having a long time verse ation with someone, you know about a book movie show or sports events. And so that's just kind of giving you guys the flavor. Of how these PCOS work. It's really cool because you not only then get a score when you're done, but you are seeing oh, okay. So you are pretty happy with everything but you are not happy with how you're doing talking with people about sports and having a longer conversation. So it's an efficient way to figure out what that need is sometimes people don't know to say those sort of of things when you just ask them that open-ended question. And so I especially like doing these when people haven't been able to just come up with and give you that information alone. It gives them a little bit more of a focus that they have to respond to. Yeah, and then when I sold this one for example has 30 points total and they so 30 30 points is the best you can score and so I may then set a goal that the patient will And the patient will indicate that they have improved communicative participation by an improved score on the CPI be and their Baseline score is maybe a 20 out of 30. And so then if I would really give that in four weeks and I would want it to be higher than 20 points. So that's just an example of how you can use this hand tie it into kind of a more functional goal to all right, so okay man, I think I'm kind of wrapping up here. So we talked about then those really three areas that I hit before. I do standardized testing. So I do my functional needs interview, I use motivational interviewing techniques and then I may choose to do a An outcome and then at that point is when I bring in standardized testing that applies or will give me more information and fill out what I need to know to meet those functional needs. Okay? All right. Yeah that really helps kind of seeing that outline and how one Builds on the other to let you know, you know what this assess this standardized assessment in my tool bag would really help kind of flesh out some of the other areas that they were talking about where some of their problems are there concerns. Earns. Yeah, rather than using the standardized assessment to be like I see that you know, you have a memory issue but they're more concerned about something on well-rounded. Yeah. It's really like a flip. So instead of us assessing everything and then telling them what they have problems in your kind of asking what parts of your life have been impacted and then I've had people where I it's obvious that they have memory impairments and oh, yeah, you know, I'm Forgetting my car my car keys. I'm leaving it around the house and different places, but then they express that that's just not a priority for them to work on and so it really is a different mindset to kind of let that go and be okay with okay. Well, if you ever change your mind about that that's something we could work on but let's focus on the things that are important to you. Okay. So for your functional needs interview do you have nothing, like typed out like a guide and outline that you follow or have you just been kind of doing it so much now that you can just yeah go on I do and so this is this new packet on my website is called Discovery and functional needs and so I made these kind of like like a checklist but their spots to write in more information and then it prompts you how to have the patient demonstrate a skill and so like for example if I'm seeing somebody in the hospital I have And a one-page checklist that I go through things that they need to do in that setting. So can you use your call light? Can you use the menu to order food? Can you ask the nurse if you needed something? What would you what would you do right now if you were cold and so I kind of have these one-page checklist that I've made that you ask the patient a question, but then also have them demonstrate and so I have one specifically for patients who are getting back to work. And so today that's that's the one I'm going to be using for for the for the woman because I just know from our phone call that that is her highest priority. Yeah, I've noticed that some patients can do really really well with verbal reasoning skills. I might present a scenario a problem and I'm like, okay tell me some ways that you might try to solve that problem and they can they'll be able to verbalize the steps even and tell me what they would do but I'll get feedback from PT and OT and they're like they Figure out how to get dressed. They can't sequence the steps to put their clothes on right now. That's what we're working on in those disciplines and I'm like, wow, I feel like I gave them some high-level stuff and they knocked it out of the park. Yeah them demonstrate anything for me. I didn't have them show me those skills. So yeah, just thinking about like the classic example of asking patients. Okay. What what what number would you call if there was an emergency right A lot of times I do. In my small kids can say 9-1-1 do I think that they would actually be able to call 9-1-1. I really don't and a lot of times. I mean I have I have done the like those sort of scenarios where you know, there's an alarm going off. What are you going to call or I've oh, I've locked my keys in the car at somebody's house. What are we going to do? You know, I do these pretend scenarios. I just kind of think doing stuff like that. It's fun just to Someone would actually respond but yeah, there is sometimes that discrepancy between giving the answer and then actually doing it. Hmm. Yeah for sure and then so where did you learn and start to become familiar with and learn how to do motivational interviewing techniques? Yeah. I'm trying to think of when I first I feel like a lot of our kind of head researchers mentioned this a tional interviewing technique, but I wasn't really sure what exactly entailed. Dr. Audrey Hollins book about counseling includes that idea of things and then there is a great article specifically for our field for motivational interviewing see if I can click find it here. Yeah, so there's a article called motivational interviewing practical strategies for speech-language Pathologists and audiologists. And that was written by Lou Ann McFarland. And that I thought was a really good article for applying it to our field because the other stuff I had read just kind of was a little bit more broad. Hmm. Okay. Yeah, so like some direct application to how we we with slps. What implemented. Kind of making the case of why it matters so much also, so yeah, it's a very readable article awesome. Okay. Well Sarah, once again, I've spent the last 45 50 minutes just having my mind blown. I'm talking about this stuff really excited about looking up these different areas and the CPI be or the CPI call the CPI bank. Now, I just learned about it as people say it. I don't know. I I've heard anyone let's let's aside What's called the CPI Bank, we're doing it we go usually do things and distort them and confuse people. So that's just me, but I'm really excited. A lot of this is really new information to me and I am really pumped about learning more about it going through those links that you sent me and then putting it into practice and I know it's going to be bumpy and like you said on our last episode, you know, pick one thing and focus on that and then you get comfortable with that you Learn more from it then you can you can adjust adjust one more thing and then just keep slowly add more if we try to do a complete 180 we might fall apart. Exactly. No, no need to fall apart. And yeah, I did want to just give one piece of encouragement specifically for this assessment process to and I like to remind people you don't have to know everything you just have to know something and so you really don't have to know every single functional need for somebody you just have to know like one or two. Things that you can start with and then that's going to open the door and lead to the to the next few as therapy goes on. So, you know just take the pressure off like knowing every single possible thing they need to do and just pick a couple to start with. Yeah. Absolutely. That's right because you know, it would overwhelm your patient to if you're like, here are the 10 things we're going to address and they're like, whoa. Yes. No pick the one that matters most of them that you feel like you'd be able to make good gains on because you know, People are encouraged by that success if they make success in one area, they can snowball that other areas. All right, Sarah. This is awesome. You're the best. Thank you. If you want to keep earning CEUs for listening to your favorite podcast, then use my coupon codes suck that's ssup at speech therapy PD.com for $10 off a Year's subscription. You can earn countless hours of podcasts and videos CEUs for only A year through speech therapy PD.com, you know December is coming and you go to get your CEUs in before the end of the year. So sign up now for the lowest price point for audio and video CEUs available on the market. If you're feeling fancy, you can get $10 off the premium subscription which drops it down to $179 for the year and that's access to every single thing all the content that's on speech therapy PD.com and there's some quality stuff on there you guys so Go check it out. And don't miss this deal. Remember coupon code ssup for a Year's worth of CEUs for 79 bucks. Huge thanks to Sarah bar for dropping all that wisdom on us. Once again. She is so incredible such a wealth of information not just information, but actionable information things that you can take and use right away. If you want to learn more check out our show notes at speech on sensor.com for this episode to get links to everything that she's talked about and see more about what Sarah does. All right. So next week, we're going to be hearing from Brooke. Your sin on the topic of respiratory muscle training and I'm just gonna let you guys in on a little secret Brooke is a huge nerd like huge which is why it was such a delight to interview her so that we could no doubt together like it was awesome. It was so much fun. Basically. This podcast is an excuse to nerd out with other nerdy as LPS about nerdy SLP topics, and it's a delight Brooks going to be talking about respiratory. Three muscle training for dysphasia and for cough and how that applies how you can start up a program in your hospital. This is actually kind of a snippet about what she does in her seven and a half hour CEUs seminar that she travels around the country and internationally to provide so we are in for a treat next week as well special announcement exclusive to slps who listen to the live broadcast Brooke is offering a discount. Count to her upcoming webinar titled lab values for the metis LP for more information about Brooks webinar, please visit the show notes for this episode. And before I let you go. I just want to give out one last thing is that the speech and censored podcast is connecting listeners directly with my expert guests during the Live question and answer portion that participants who register for the ceu credit are able to participate in I have loved it being able to answer these questions in real time as people are listening to the podcast for the first time is so awesome. I've just it's it's incredible. I didn't know how much I was going to love it. And I absolutely love it every Monday night at 5 p.m. Pacific 8 p.m. Eastern you can sign on not just to learn but to engage the most cost efficient route in my opinion is to subscribe for the year subscription plan, which $79 when you use my promo code s you pee during registration at speech therapy PD.com this will provide 52 weeks worth of access to high-quality video CEUs and pod courses with the option to engage with myself and my guests every Monday night. So it's pretty awesome. Join us. I want to hear from you and interact with you. Alright, so now I want to give a quick shout-out to the speech uncensored listeners in the Following locales also, please forgive me. If I butcher your city's name. I really like you guys, please don't hate me. Okay, alright koblenz, Germany, Chattanooga, Tennessee Yarmouth, Maine and Wasilla, Alaska now, I want you guys to get out there and nourish your brain so that your practice can flourish. Thanks for listening and I'll see you next week.
Sarah Baar is here to revolutionize your evaluation procedure. If you want to know how to dynamically assess the functional needs of your patients to identify deficits to target in therapy and develop measurable goals for therapy, then Sarah has the inside scoop for you. Sarah will guide you through real-life examples of how to implement a functional needs interview, get the best out of patients with motivational interview techniques, and create measurable goals for therapy via Person-Centered Outcomes questionnaires. Something I’ve been lacking in my practice has been this critical piece of the puzzle. I’ve been relying solely on static, standardized assessments and a few brief open-ended questions along the lines of “so, what’s important for you to achieve in therapy?” Sarah’s recommendations go so far beyond that to really capture a patient’s functional needs/deficits that many standardized assessments can often miss. For example, a patient may test “WFL” on an assessment, but have impairments in the home environment. Nonstandardized, dynamic assessments can fill in the gaps and show us how we can help the patient return to a level of participation in their daily life that is achievable and desirable. 