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In this episode, Zach talks with Danielle Pugliese, a speech-language pathologist who spent her clinical fellow year with All About Kids. They discuss the difference between a specific dialect and a problem, how effort best measures success during a pandemic, and why agencies are not as bad as they seem. Danielle also explains strategies for intervention and the reason she’s billing in bed.


Education Goes Beyond the Classroom

  • Leaving your comfort zone can change your perspective
  • How you speak is often tied to geography
    • (4:45) “A lot of people pointed me out right away and were just like ‘oh, you’re from New York.’”- Danielle
    • (6:00) “I went to school down in Richmond, Virginia, so it was definitely more of a southern language. Everyone says ‘y’all.’ I’d never heard anyone say ‘y’all’ before except on TV western movies.”- Zach
  • It’s important to understand the distinction between a difference and a problem
    • (6:31) “A lot of my friends if they’re drunk and they’re really just saying whatever, they get into their southern drawl big time, and I can’t understand half of what they’re saying. But it’s still the right words. Their accent, I’m not used to it.”- Zach
    • (7:19) “We do have to keep in mind, there’s an African-American dialect. So sometimes, you know, when I see those students, they speak a certain way at home with Mom and Dad, and that’s fine. There’s nothing wrong with that. So I think it’s important to just keep in mind you’re not trying to change that about them. “- Danielle
  • Research leads to an informed strategy
    • (9:32) “I think it all goes back to just doing that full assessment in the beginning. Really know what you’re working with. You know, are they doing it all the time? Is it only on that certain word because that’s just how they say ‘dog’ versus ‘dog?’ It really depends on the case.”- Danielle

Phonology vs. Articulation

  • Articulation deals with structural issues
    • (11:56) “Their tongue is not moving in the right spot for a sound. They have some kind of palette issue, a cleft palette type issue. Dental issues, stuff like that where it’s just a single sound. It’s no pattern at all. It’s just a single sound they have trouble saying just due to articulators in the mouth not moving in the right direction.”- Danielle
  • Phonological problems are pattern based and require process-specific solutions
    • (12:38) “Just telling them to move their tongue in a certain way is not really going to change anything. You’ve really got to increase their awareness too that they’re doing it.”- Danielle
    • (13:19) On the Minimal Pairs strategy- “It kind of just tricks their mind into just understanding better what they’re doing because a lot of the time the kids just have no idea that they’re simplifying their speech with that sound.”- Danielle
    • (13:39) “The population I work with, preschool-level, the visuals are big. Looking at my mouth. Looking at themselves in a mirror is very helpful.”- Danielle
  • Effective intervention requires an appropriate diagnosis
    • (13:49) “That’s a big mistake that I made when I first started was kind of approaching everybody with that articulation approach. And then I did a lot of research. I’m always looking to learn new things. I noticed you just need to pick a phonological approach if it’s pattern-based because it’s not always going to work to just tell them ‘do this.’”Danielle
  • There is not an overarching treatment in speech therapy

Pandemic-related Changes are Everywhere

  • Logistical modifications, such as platform-choice and scheduling, have been a mixed bag
    • (17:02) “It was like starting all over again with filling the gaps of the schedule and getting everybody set-up.”- Danielle
  • The approach to teletherapy is both situation and age-based
    • (17:27) “Kids aren’t meant to stare at a screen for 30 minutes. So we can’t be too hard on them, but they do need a little more incentive to stay focused with me on the computer versus in person. So, finding things that keep them busy, and also work on goals, has been stressful.”- Danielle
    • (18:49) “I imagine it’s hard to plop a baby in front of the computer and be like ‘take it from here.’”- Zach
  • An online model can create discipline problems
    • (17:45) “I do see a lot of the kids in school, so I didn’t know the parent. I don’t see them around the kid. The kids are acting very different with Mom, or Dad, at home on the video chat. So they’re definitely acting up.”- Danielle
  • Increased parent involvement has been a huge benefit of the current environment
    • (18:29) “We use a parent coaching style with the little ones. Most of when they’re little like that and they’re not communicating from an early age, we’re telling Mom and Dad what to do. Strategies that are going to help them. Incorporating visuals into their house.”- Danielle
    • (19:18) “It’s nice to get on with them and have time because usually if we’re working with that population, we come in the house and we go right with the little one. We have the last few minutes to chat with Mom, but this is like a whole 45 minutes with the little one and the Mom.”- Danielle

Success is Measured by Effort

  • Any intervention is better than nothing
    • (20:12) “If we can get through 2 of the 3 things I planned out, I’m happy. Because I told the parents in the beginning, ‘we’re not stressing about this. I don’t want this to be any more stressful than it already is.’”- Danielle
    • (21:57) “It’s different. It’s hard for everybody to adjust. It’s gotten better over time. I’m not beating myself over an amazing session where we got everything done versus, you know what? We touched base today on what we needed to do.”- Danielle
  • Parents understand the challenges of teletherapy
    • (21:38) “No one’s really been so intense and said they’re not happy with how the therapy’s going.”- Danielle
  • Unstructured play still provides an opportunity for improvement

Improvement Starts with an Open Mind

  • Clinical Fellows must strive for positivity and humbleness
    • (23:22) “I think it’s important to just remember, step back and say ‘I don’t know everything yet, and I’m not going to for a while.’”- Danielle
  • You can learn more if you take advantage of a good opportunity

The Agency Route

  • Agencies provide the perfect environment for continual learning and growth
    • (26:54) “It’s a good time to just travel, get around all different schools, make some contacts. You just kind of learn that way. Versus, it’s great to be in a school all day, one school, but you may not get so much of that different variety of kids.”- Danielle
  • Most hardships are temporary
    • (28:08) “The agency work is not for everybody. Sometimes, it’s good for your CF and then you want to move on.”- Danielle
    • (30:17) “Nine months can be long, or it can be short, depending on how you look at it.”- Danielle
  • Professionals must constantly fight for their rights
    • (27:59) “If you can really just put your foot down and have a voice and just say, you know, ‘I’m willing to do the travel. It’s my first year. I know I have to do these certain things.”- Danielle
  • All About Kids is the perfect example of how an agency should operate
  • Flexibility and openness are an important part of a good experience
    • (29:53) “It makes you want to sign with them when they just give you an entire packet of information, they answer any questions, they don’t tell you that you have to come back to get extra info.  Just be honest with the people. The people who are running it should think ‘if I was in this person’s footsteps, would I want to sign with us?’”- Danielle

Effective Recruitment is Personal

  • Hearing a testimony gives you a clear picture of what to expect
    • (31:22) “It’s nice that we’re doing this at least because I think people then can get a really good view for this agency personally. When they hear from someone who’s done it, it’s nice to be able to hear from them that this was exactly what I was expecting, it was a good experience.”- Danielle
  • A phone call speaks volumes about how an organization treats their employees
    • (31:51) “I like just calling someone. I feel like a lot of the times they’ll email you with info and then if you write back saying ‘oh, I have more questions on this, this and this, can we just set up a phone call?’ If they’re kind of hesitant and don’t feel like getting on the phone and explaining anything, I’m like ‘okay, there’s something sketchy here, and it’s not adding up.’”- Danielle
  • Word-of-mouth is one of the primary decisional factors between choices

Hidden Benefits/Drawbacks of the Industry

  • Paperwork can be cumbersome, but it plays a crucial role in each day
    • (34:14) “Every day, you’re basically writing up a daily note and saying exactly what happened and there’s a lot of numbers because you have to take data to know if you’re making progress over time. So it gets repetitive with just ‘this kid produced this sound in 7 out of 10 trials using these cues.”- Danielle
  • Effective writing is an undervalued skill that is essential to success
    • (34:51) “If your writing skills need help, I feel like it’s really good to just kind of do your best to get that together before you get a job because it’s a lot of wording things nicely. Whether you’re trying to write a report that a parent’s going to read and you want to make things sound better. Being able to list positives, and then a few things that the kid needs to work on.”Danielle
  • Making a positive impact is the true reward
    • (36:18) “Especially with the teltetherapy now, I’ve gotten a little snippet into their lives and how what I’m doing is affecting them. And I think that’s a really nice thing in this field is the things you’re teaching that kid, it’s helping them communicate with their parents, their grandparents, sisters, brothers.”- Danielle

Tips for a Future Speech Language Pathologist

  • Ask a professor, or supervisor, about the fine details of billing
    • (39:32) “You have to do it, but you just wish you knew first how to do it.”- Danielle
  • Consider an unconventional schedule when working from home
    • (44:06) “Just trying to spread your day out enough where you’re not working all day, but then enough where you can get some work done.”- Danielle
  • Use your time wisely to ensure a high level of productivity
  • Be dedicated to your job, but always remember your own needs
    • (44:35) “You can start a company called ‘Billing in Bed,’ instead of ‘Breakfast in Bed.’”- Zach
    • (45:08) “I need to learn to clock out and just put my mind somewhere else. A lot of the time I don’t turn off at night, and I’m just thinking about students and what I could do to help them even more.”- Danielle


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