Push-in versus Pull-in, Scheduling, Student Buy-In and Related Service in Middle School!

The Missing Link for SLPs Podcast Full Transcript Mattie Murrey-Tegels 00:06 Now, this next guest, if I'd known she lived in Seattle, I would have rang her up because she looks so interesting, and I was just out in Seattle. So, it pays for me to look ahead, right? I want to introduce you to Bridget Karp. She is a licensed SLP that works in the schools. She was originally from California, near San Francisco. And now, you got it, lives in Seattle, Washington. Actually, in Seattle, the Bitter Lake neighborhood. She went to the University of Washington, Seattle, for her undergraduate degree in Speech and Hearing Sciences. She'd always wanted to move back to the area, and she recently bought a house in Seattle, and as a proud new homeowner. So, yes, SLPs can do this! She attended Yeshiva University in New York City for her graduate program, and lived near the Empire State Building for two years. When she's not doing SLP stuff, like work and Instagram and all those things, she's most likely watching cooking or baking competition shows – and this is a perfect time of year to do it, right around Christmas time, right? She loves going for walks, listening to music, taking naps, or playing Pokémon GO with her partner. She loves connecting with other SLPs via Instagram, as well as she just loves being an SLP. And in reading her bio, she has done a little bit of everything. She started her medical journey in a medical SLP based graduate program. After graduating, she moved back to California from New York City to work in schools through an agency. So, we're going to ask some questions there. From there, she worked both in person and virtually for public schools, mostly in middle school, but also in high school and grades three through five. She then went on to work in early intervention in Seattle for six months, and transitioned back to an agency and worked at a public school for autistic students ages nine to 21. She's worked in a variety of programs with a wide array of students in all of these settings, and she's also worked with a variety of students with a variety of disorders and diagnoses. She is currently working in the public middle school with a variety of programs and students – autistic students, medically fragile students, resource, general education, and most of the students on her caseload receive SLP services for expressive and receptive language, arctic, AAC, pragmatics, social language and fluency. Katie Widestrom-Landgraf 02:38 Welcome back, everyone, to A Day in the Life of a School Based SLP. I am your host, Katie Widestrom-Landgraf, and I have a lovely school based SLP here with me, Bridget Karp. Hello, Bridget. Bridget Karp 02:52 Hello, thank you for having me on the podcast. Katie Widestrom-Landgraf 02:55 We are really, really excited for you to be joining us, and we can't wait to learn all about a day in your life. So, Bridget, let's get started. I'm so curious to learn about your own journey. How did you become a school based SLP? Bridget Karp 03:15 When I graduated from Yeshiva University graduate program, I worked for an agency that placed me at a school. I was actually placed at two schools, a high school and a middle school. So, that's where my journey in the schools began. I really enjoyed it. And then I decided to move to Seattle. I dabbled in early intervention, and I also dabbled in private school, but I found my way back to the public schools and I currently work at a middle school. Katie Widestrom-Landgraf 03:55 Okay. So, I would love to hear more about working with middle school students. But I think it's interesting to know that you're telling us basically you sort of ran the gamut from like early intervention, three-ish – Bridget Karp 04:09 Mhm. Katie Widestrom-Landgraf 04:11 – all the way through high school and beyond, like through 21. Bridget Karp 04:15 Yeah. So, in early intervention, it's ages zero – I think my youngest client was 16 months – to three years old. And then I've worked with elementary, middle, high school, and at the private school I was at, we had a program for students up to 22 years old. So, I have run the gamut, but I've loved working with middle school kids. So, hopefully I'll be in that setting for some time. Katie Widestrom-Landgraf 04:43 So, middle school is your love. So, let's talk about what you love about middle school. Can you walk us through your typical day in your middle school? Bridget Karp 04:54 Sure. So, a typical day for me usually starts around 7:30. The students haven't started school yet, but that's my time to session prep, answer any emails, sort of the business side of things. And then I have my first session at 8:00 o'clock. And I do a mix of individual sessions and group sessions in my office space or classroom, and then I also do some push-in services. So, I might start with an individual session at 8:00 o'clock, it could be articulation, or fluency. And then I will push-into – one of our special education programs at my school we have, I believe it’s five different programs that we run at our school. So, I will push-into a class called Life Skills, and I will support students with their speech goals in the English Language Arts and Literacy classroom. And then I'll come back, I'll do a group session. Again, a lot of my sessions are articulation, fluency, or language. So, social language, but also expressive and receptive language. Another class I push-into, it's called the Highly Structured Program. So, this program has all autistic students, and they receive a high level of support, but it's also a very structured program, hence the name. So, they have different tasks that they complete throughout their day. So, I will push-in, and they may be doing jobs. So, they may be sorting things for the laundry, they have a kitchen, so sometimes they'll load or unload the dishwasher. So, tasks that we do at home every day is sort of what that program looks like. We also have a medically fragile program at our school. So, as the name implies, these students may have cerebral palsy, or different conditions where they might be limited in their mobility. So, I will go in there – and many of these students use AAC. So, I will help them with their device. So, I'll model language, I’ll model utterances that they can use. So, that's what a lot of my time is spent there doing. We also have resource classes. So, these students, they attend general education classes, but then they have a few periods of the resource class, which is extra support for their work that they do in general education. So, I'm in and around school quite a bit in different classrooms and pulling students. So, it's a busy day, always, but I find it enjoyable and rewarding. Katie Widestrom-Landgraf 07:59 That's wonderful. So, when you're talking about kind of all the different things that you do in a day, do you have a preference for push-in versus pull-out? Or do you find that there are some unique experiences with each? Could you talk a little bit more about maybe some of the benefits or some of the challenges in a push-in versus a pull-out setting as you've experienced them? Bridget Karp 08:25 Yeah, sure. So, for the pull-out sessions, these are normally for students that are in general education or in resource. And with those students, I may be working on articulation or fluency. And those, I have found to be better suited for either individual or small group pull-out sessions so we can really focus on either the articulation goal or learning different fluency strategies. Oftentimes, these students, they're in a general education setting, so they may be the only student, or one of a handful of students, in a classroom of 30 students receiving speech. The challenge with that is in middle school, at least at the middle school I am at, the students have a different teacher for each period. So, they are going to different classrooms throughout the day. So, finding a balance of pulling students from a class that they're not going to fall so far behind in, but also so the students are enjoying their school day, and maybe getting to go to PE or their favorite elective, can be a challenge, and just collaborating that with teachers can be tricky as well, but we're figuring out a system as we go. As far as the push-in model, I generally use that model for my students in our special education programs. And what's nice about that is a lot of them have speech as a related service, meaning that they don't have separate speech and language goals, but they have goals that can use my support as an SLP. So, they may have a vocabulary goal, or they may have a formulating sentences goal – something in the area of expressive or receptive language. So, what's nice about going into those classrooms is I can see what the students are doing. Maybe they're reading a book and answering a worksheet of questions. That's where I come in and support them. Maybe they're having trouble with the reading, or maybe they're having trouble understanding the question. So, that's where I provide support. So, that's kind of the benefits and the negatives of those different models. It can be tricky for the push-in model. I usually let my teachers know in advance that I'm coming. But sometimes, for example, today we had a negative student encounter between two students, so we had to evacuate the classroom. So, there are instances where that model backfires. But for the most part, it does seem to be a good way to provide those services to those students. Katie Widestrom-Landgraf 11:18 Wow, that's really helpful. And when I think about our listeners, they may not be as familiar with concepts like related service. And so, just to kind of clarify, when we talk about related services, think about it as capital R, capital S. This is under federal law, IDEA, and related services are those services that are necessary for a student to make progress on the IEP goals and objectives. And so, when Bridget's talking about, “I don't have a separate goal or objectives”, it's not that there isn't still communication relevant areas that are being worked on. Absolutely, a kind of – what we do cross walks into that. But your services are related to a primary disability, and are intended to support progress on the IEP goals and objectives. So, just as a point of clarification, if folks haven't heard of related service. I think it's good to just kind of clarify that. So, thank you for talking about that too, because I think that is sort of a new thing. So, not only are we primary providers, meaning we may be case managers writing IEPs, and speech or language disorders or disabilities, our primary areas, students may also receive related services. I know in the state of Minnesota, we also have secondary disability, which is a different thing. So, we have primary, secondary and related service, and we can wear all of those hats. Bridget Karp 12:50 Oh, boy! Katie Widestrom-Landgraf 12:52 I know! Yeah. So, middle school is an interesting age group, right? They're not little people, and they're not yet, maybe, developing some of those more advanced reasoning skills. Can you speak a little bit about what you enjoy, specifically, with that middle age range? Bridget Karp 13:16 Yeah. I think what I enjoy seeing is them sort of figuring themselves out and learning who they are as people. I have some students that are very witty and sarcastic. And then I have other students that are very outgoing. I have students that are shy, but around certain people, they really light up a room. So, I think that's what I enjoy seeing. It's that sort of in between period. And I think what's cool about it too, is I'm able to support these students in a very critical time, I think. It's very different than what they're used to in elementary school. And I know high school, since I've worked in that setting as well, is very different from the middle school experience as well. It's a big jump from fifth to sixth grade. So, just kind of helping them transition into the middle school experience. And really seeing them develop and kind of come to life, if you will. I think it's the most enjoyable part, for me. Katie Widestrom-Landgraf 14:20 That does sound really cool. So, this is kind of related to that. When you think about where you're working at right now, what is your favorite part? And maybe there isn't just one part. Bridget Karp 14:33 Yeah. Katie Widestrom-Landgraf 14:33 What are some things that jump out for you? Bridget Karp 14:35 I mean, broadly speaking, I do love to work directly with the students. So, providing therapy would be my favorite thing. I don't know if I have a specific area in the field of speech and language that I enjoy helping students with. I really do like articulation. I have students that are working on R’s and L’s, which is fairly common, but I also have some students with more severe articulation needs, so they're working on their K’s, and their G's, and those sorts of beginning sounds, or what we think of beginning sounds. I also like working on AAC. I've really gone into AAC and learning more about it, and have become more comfortable with it in the past couple of years. So, it's great to see when a student really engages with their device for the first time and communicates something new, or just communicates in a way we haven't seen yet. I'd say the one area I'm still learning about, and still learning how to provide effective but also fun therapy, is fluency. Just providing those strategies, having the students practice those strategies. But it's sort of a fun challenge to learn about that area, and more about it, and provide those services as well. Katie Widestrom-Landgraf 15:57 What I so appreciate is when you talk about the things that you're also learning about. As speech language pathologists, we do cover a lot of different needs. And we may not always have a half a dozen students that have a fluency disorder, for example. And so, I think that is a really great part of our job, is that we also have the opportunity to learn new treatment approaches, and new ways to intervene effectively for our students. So, thank you for speaking to that as well. Bridget Karp 16:33 Yeah, sure. Katie Widestrom-Landgraf 16:34 Yeah. So, I do have to ask you, of course, we talk about the things we love best, and we're also going to talk about some challenges – there's got to be a few, right? So, what would you say are some challenges, Bridgette? Bridget Karp 16:46 I would say the number one challenge, at the middle school at least that I have found, is scheduling. Like I mentioned, the kids have rotating classes, and the academic requirements increase at the middle school level. There's a lot more homework, just the content itself becomes more challenging to learn. So, scheduling in itself, I would say is the most difficult part, and sticking to a schedule once you set it. Currently, I'm sort of working on a week by week basis of a schedule. So, some teachers love that. Other teachers just want it to be the same week to week. So, just explaining that too, I think is a challenge. Some teachers know that I'm the SLP, but that's sort of where their knowledge ends. Some of them know, “Oh, you help kids with their speech sounds”. The staff in general, our general education staff, just letting them know, “Here's what an SLP does. Here are the challenges we're facing. How can we work together to handle any issues that come up, such as scheduling?” So, I would say that's the number one challenge. And when working with students, sometimes the buy-in to therapy can be challenging. So, building that rapport is very important. I've had students who will ask me, “How long is this session?” And then every five minutes, “How much more? How long?” So, the buy-in aspect can be tricky. But to combat that, I usually will try to learn what the student’s interests are, or I'll find a way to bring in a fun activity like a game or a video into therapy that's going to target their goals but also be motivating for them to participate in the session. Katie Widestrom-Landgraf 18:45 I think it's important to talk about cultivating buy-in. I do think that it does get more challenging in the secondary setting, whether that's middle or that's high school. And I appreciate that you speak to that, and some ways that you might be able to kind of help kids buy into understanding the big why, why they're there, why you're spending time together. And what's interesting, is when kids do get it, I think then they're bought in for good. They keep coming back, which is also awesome. When you were talking about scheduling, I have yet to meet a school based SLP that's like “My favorite thing – scheduling!”. Nobody says that! It is crazy intense, like the things you have to consider. And like you said, when kids are switching classes, and changing teachers, and their increased academic requirements, and they may be doing something some days but not other days, and all of that gets dumped into our scheduling soup. I've not been able to write a schedule in anything but pencil. And so, when you talked about a week to week schedule, that really resonated with me as well. I think that our schedules require flexibility for sure! Bridget Karp Yes. Katie Widestrom-Landgraf Yes. So, can you talk a little bit about how you manage your own workload? I know that there are more tasks than there are hours of a day for what we do. So, how are some things – or what are some things that you do, and how might you manage your own workload? Bridget Karp 20:29 Yeah. So, when I'm creating my schedule, I'm obviously scheduling in those therapy or treatment hours, but I also make sure to schedule in prep time. So, that is my time to catch up on any emails, write up reports – so, assessment reports, write into IEPs, anything logistical or paperwork or more business, those are my times where I have scheduled – I just labeled them prep. And I know, for me, okay, this is my time in my schedule where I'm going to work on next week’s schedule, or I'm going to lesson prep for tomorrow, whatever it may be. So, I think that's the best way to manage all of the tasks. So, treatment, IEPs, anything else, is to put in those blocks of time, and make it known on other people's schedules as well. I think an important thing to remember to manage workload, is to not overload yourself. So, if you get asked to a lot of meetings, I think all SLPs, or many SLPs, have a tendency to just say yes to everything because we're in a helping profession. So, if you have five assessment reports you need to write up, but you're being asked to come to all these meetings, I think it's important to say, “Thanks for inviting me or thanks for thinking of me for this meeting, but I can't attend to it right now”. So, I think setting those boundaries and scheduling in the time for more administrative tasks is the best way to manage that workload. Katie Widestrom-Landgraf 22:09 So, I just want to say back to you something that I think bears repeating. When you said be really cautious not to overload yourself, we work in a helping profession, and the boundaries and holding that non-student contact time sacred, is what will ultimately, I think, allow you to stay in this setting – Bridget Karp 22:33 Yes. Katie Widestrom-Landgraf 22:33 – versus not. I really appreciate that you said that because I think it is easy for us to do just one more thing, to add that meeting, right? Bridget Karp 22:45 Yes. Katie Widestrom-Landgraf 22:43 Or I'll move this around so I can do your thing. And that's the disadvantage of building a schedule in pencil, I suppose! So, I loved it when you said, “And let other people know that this is a time that I'm not able to be available, or this is a time I'm not able to do something”. I think that's really important. Thank you, Bridget. When you think about workload, do you have demands outside of your school day? Or do you feel like you've been able to structure your time in such a way that you can have boundaries around work time, and home time? Bridget Karp 23:22 For me personally, I feel like I have found that balance, and I do have a boundary of I will not be doing work at home. Once my contract day is done, I stick to it. There will always be tasks to do. The To Do List is never ending. But for me, once my contract hours are up, that is my time to do whatever I need to do. Like for myself, I know I need that time just to decompress and not think about work. But for some people, working at home, that's where they get their good work done. So, I think it just depends on the person when you're thinking about workload or work life balance, if you will. Katie Widestrom-Landgraf 24:09 So, what I'm hearing you say is that that may look different for different people, but having it be intentional is the key. Bridget Karp 24:17 Yes. Mhm. Katie Widestrom-Landgraf 24:17 But that is so helpful, I think, to just kind of give people a sampling of all the different ways working in a school can look. And yet what's interesting too, is we have some complete similarities in experience. And so, things like building a schedule, the types of students we see, some of those things become themes as I've been having these conversations, and that's just really cool to hear. Bridget Karp 24:46 Yeah. Katie Widestrom-Landgraf 24:48 Yeah. So, when you're thinking about maybe that future SLP, this person has not yet decided what setting they are working in, if you had one piece of advice for people looking at working in the schools – and maybe they're a new grad, but maybe they are someone who's like mid-career, and they're wondering, “Gosh, should I consider a change?” What would be a piece of advice you might give to those individuals considering working in the schools? Bridget Karp 25:22 Yes, definitely. And I think this goes for people that are new to the profession, maybe people that are looking for a change, and people within this setting – I think my number one piece of advice would be to take care of you and really think about what's important to you. Are you someone that really values that time outside of work to take care of yourself? So, if that's exercise, or rest, whatever that looks like, is that something you really value? Or are you someone that gravitates towards working? And that's sort of your – what fills your cup, essentially. So, I think just being mindful of kind of what you want your work life balance to look like is really important. So, whether that's a new SLP, I think a benefit of the schools is the breaks, and just what the day looks like. For me, I start at 7:30. So, it's a pretty – a fairly early start, but I end at 3:15. So, I think that would be my number one piece of advice though, is really think about what's best for you. Katie Widestrom-Landgraf 26:39 I think that's great. Okay, so I know we're running short on time, but my favorite question to ask people, Bridgette, what is your big “why”? What keeps you coming back day after day, year after year? I'm headed to the middle school tomorrow. What keeps you coming back? Bridget Karp 27:01 I think just the progress that the students make. And honestly, I have some students that make me laugh, and that's the highlight of my day, whether it's a funny joke they tell, or just something unexpected that they share about. I think it's just those little moments that I really connect with the student that bring me back, and just seeing them progress and really make strides in their goals is what drives me to come back each day. Katie Widestrom-Landgraf 27:30 That’s fabulous. Bridget, I have so enjoyed our conversation, and thank you so much for sharing your time and your insights. Is there anything that we’ve forgotten, something that maybe you were thinking about before we started our conversation, and then we didn't circle back? Is there anything that comes to mind for that you just think our people need to know, our listeners need to know? Bridget Karp 27:56 I think for anyone in any setting, another piece of advice would be to take your lunch break. Don't work during your lunch break. I know it's tempting, I know I have in the past, but that time is for you. So, no matter what setting you're in, make sure to take your lunch break. That time is for you. And I think that really helps with managing caseload, preventing burnout, and just taking care of yourself. Katie Widestrom-Landgraf 28:23 That's fabulous. I think that's a great piece of advice to just remind all of us. Lunch is lunch. Keep it for yourself. Bridget Karp 28:34 Exactly. Bridget Karp 28:35 Okay. Oh, Bridget, thank you so much. Bridget Karp 28:39 Thank you. Katie Widestrom-Landgraf 28:41 Yes, this has been so great. Mattie Murrey-Tegels 28:47 Well, I hope you enjoyed that as much as I did. I love every minute listening to these podcasts. I sit there with my headphones on following the whole entire conversation. And I know I'm a medical based SLP, but I must admit I am tempted to at least go peek open the door of a school based SLP and just see what that setting is about. That's what this podcast is all about. It's about being curious about what we do as SLPs. So, please, Like, Share, Follow, Subscribe, do all of those things, and come check out our website at freshslp.com. Sign up for our newsletter. You will be able to see those when they come through when we have our new episodes come through, and read through and see if there’s something that you want to listen to. Follow us on Instagram @freshslp.com. We've got all sorts of fun things happening there as well. And until our next episode, cheers, and keep on smiling!