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Therapy in a time of covid

7/3/2020

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Wow, it has actually been almost two months since I last posted. My apologies! As everyone knows, it has been a busy time navigating the new "normal" of living and working during a pandemic. It has been quite a learning curve, at first figuring out tele-therapy and now all of the new safety measures as we begin to slowly reopen for in-person sessions. Luckily for me, one of the other SLPs at Grow wrote this blog post that summed up our thoughts on the matter quite nicely! We have been fortunate to be able to use the self-regulation and "flexible thinking" tools we so often teach to our kids as we go through this transition time of learning so many new things! So, without further ado, I'll let Ashley take it away:

As for so many people and businesses during this uncertain time, things have not been running “business as usual” for Grow over the last few months. Amanda, Catherine, and I have been doing our best to adapt, and learn new skills in order to be better prepared to support our clients and families during this era of social distancing. We are so fortunate to be working together as a team (Zoom team-building, anyone?), and consider ourselves blessed to be able to work with all of our amazing clients and their families right now! Therapy has looked different over the last few months (zoom, vooks, boom cards, oh my!), but the underlying goal of connecting with our clients in meaningful, and growth-centred ways has remained the same. No matter the platform, helping our clients reach their potential has always been our top priority.Being apart from our clients only reinforced for us how important human connection is, and that though we weren't able to be together in-person with all of our clients for some time, we found new and creative ways to connect in other means. As we SLPs like to say, it's physical distancing, but we can still maintain social closeness! I wanted to take some time to share what I have learned with you.
  
   
Here’s a look at a few of the new activities we discovered during the era of teletherapy (for more online resources, check out Amanda's blog post here):  
  • Vooks – Amanda has written about this before, but it begs another mention! Looks is a service that provides subscribers with an interactive book reading experience! It allows readers to watch their favorite books online in a short film format with text and audio playing simultaneously. We have really enjoyed using Vooks, because not only is it important to target literacy and language skills, but it has also allowed us to continue to engage in shared reading activities with our clients, despite not always having physical books on hand.  (My favourite book has been Unicorn and Horse) 
  • Animated short films - another favourite of ours! One thing I love about animated short films is their ability to convey so much emotion through the non-verbal communication of the characters. We have discovered these are great tools for helping children learn the connection between emotions and events that happen to us, as well as how emotions are shown on our face and in our bodies. On top of that, they are also super engaging, and entertaining for kids and adults alike! My favourite so far has been Snack Attack, but we also love Soar, Coin Operated, and Hair Love. 
  • Zoom backgrounds - In my opinion, this is the best discovery I have made for therapy during this time. I love zoom backgrounds, and my clients love it too! The possibilities are endless, and there are so many different goals we can target using backgrounds and props. I love being able to go on adventures with my clients and see the joy on their faces when they discover they can create stories with me on the fly. ​

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Here’s a look at a session I put together targeting three-word utterances with a child, while we were on a pirate ship
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And another behind the scenes shot of an ice-cream shop story that all three of us have been using over the last few months

As we hope you can see, t
eletherapy (though admittedly daunting and scary at first) has been a new and exciting change for us. It has allowed us to expand the repertoire of activities in our toolbox while continuing to develop our skill-set as child-centered therapists. The shift to teletherapy has been an adventure into flexible and forward thinking, which is something I often teach my clients but have learned I needed a reminder of as well. It hasn’t always been easy, because sometimes technology doesn't work how I want it to, but it has been such a great growth opportunity for me! This experience has showed us at Grow that we are much stronger, and more resilient than we once thought, and that anything is possible when we work together. We hope you at home have been able to see the silver linings during this uncertain time as well.   
*** 
If your child is seeing one of us for teletherapy, you may be wondering how much longer until we can get together at the clinic for in-person sessions now that restrictions are being lifted across BC. We are thrilled to announce our clinic is reopened, and we are now seeing some patients for in-person appointments again! As per our College’s guidelines, we are still continuing teletherapy for many families if it is working and we feel goals are still being met. But, if teletherapy hasn’t been a viable option or is becoming difficult, we are now able to bring some families into the clinic. However, things may look differently than they did before! We have put some new policies in place to ensure everyone remains as safe as possible. Some of these policies include:  
  • Family must complete a covid-19 screening checklist before each appointment  
  • If you, or your child is exhibiting any signs/symptoms, we ask that you stay home, and talk to us about either rescheduling, or completing your session via teletherapy that day.  
  • Children will be required to wash their hands before and after each session  
  • We will now be offering shorter, 45-minute sessions to allow for increased cleaning/sanitizing procedures completed after each session.  
  • Reduced capacity of individuals in the clinic at one time (I.e., only clients with appointments are allowed in the building for right now; waiting room is closed; families are asked to wait outside until session is completed, unless an alternative has been discussed ahead of time with your therapist).   
If you are interested in receiving in-person appointments at the clinic again, please talk to your therapist, or contact Amanda directly to set up an appointment. We are committed to making an individual plan for each child and family so that they feel supported and safe. 

We are so happy to take everything we learned during the time of teletherapy, and continue to apply it in our sessions with our clients. If you have any questions about the resources you read in this post, or would like more information on our Covid-19 health and safety measures, please contact Amanda directly. 
​

And, as always, happy talking! 
​
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Books to practice social thinking

3/30/2020

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 You don't have to know me well to know that I love to read. And it's hard for me not to bring that into my sessions with kids! I use books for most of my lessons, either as a jumping off point, the main focus, or related activity. 

Since one of the best ways to pass the time at home right now is reading, I thought I'd put up a list of some of my favourite books. But I have So. Many. So I'm hoping to do a few lists. Today I'll be listing some of my favorite books to work on social thinking - whether it be problem solving, perspective taking, compromise, identifying emotions, etc. There are some great books that are created specifically for Social Thinking curriculums (like these), but I love using story books in addition to a more curriculum focused book. Really, almost any book can be used for social thinking in some way, but here are some of my favourites (in no particular order except roughly younger to older readers):
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Horse Meets Dog by Elliott Kalan and Tim Miller
This is a delightfully hilarious story about a dog and a horse meeting for the first time. Dog things the horse is a huge, oddly shaped dog. Horse thinks the dog is some delusional, tiny baby horse. They can't figure out why the other doesn't like the same things they like. This book is short, full of laughs, and also a great one for discussing perspective taking and compromise!

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​The Monster Next-door by David Soman
This is a very cutely illustrated book about a boy and a monster who become friends...until one of them plays their music too loud! Then, all bets are off. The boy starts listing off all the things the monster did to slight him (really and imagined) and ends up in a broiling rage. However, after finding himself in the monster's house, he realizes that maybe he was a bit too harsh. This is a great book for looking at perspective taking, friendship, and emotional regulation.

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Giraffes Can't Dance by Giles Andreae and Guy Parker-Rees
This is a lovely book about overcoming preconceived notions about what you're capable of! If your child has ever said "I can't..." then this is the book for you. (It's available on Vooks free right now too!) Giraffe thinks he can't dance, so he is humiliated at the annual jungle dance...that is until a helpful friend gives him some support. Sometimes all you need to succeed is to be flexible and think about things in a different way!

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Z is for Moose by Kelly Bingham
One of my favourite books for targeting emotions. Poor Moose his having trouble waiting his turn in the alphabet, so he tries to take Duck's turn and gets in trouble. When he finally (finally! waiting is so hard!) gets to M, he finds out that his turn was given to someone else. He hits the red zone immediately and scares the owl and smashes a pie and knocks over a queen! However, he's able to calm down by the end and gets the reward he deserves. 

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Unicorn and Horse by David Miles
Another one available on Vooks right now. This is a great book about friendship, as well as dealing with feelings of jealousy. Sometimes it's hard to take another's perspective if we think they're too perfect!

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Rosie Revere, Engineer by Andrea Beaty
This is a great book for talking about perseverance. This book celebrates failures as a part of the process. Often the kids I work with see their difficulties as failures, so when we read this book, we talk about how we can incorporate all of the parts of who we are into ourselves and keep on trying! You can see astronauts on the ISS reading this book here!

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Narwhal and Jelly by Ben Clanton
These books are a hilarious account of two unlikely friends. The stories revolve around a jellyfish and narwhal who are best friends. But just because they're friends doesn't mean they don't have their arguments! This is a great book for looking at themes of friendship, social problem solving, being flexible, perspective taking, and using your imagination. This book is great for reluctant readers.

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Ape and Armadillo Take Over the World by James Sturm
Another cute comic book about two unlikely friends, this one delves much more into the conflicts that can arise during a play date. We can see what happens when one player wants to dominate all of the play (and also the world). It makes the other player have some big feelings. But don't worry! The book has a happy ending with ice cream! 

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Bird and Squirrel by James Burks
Yet another story of two unlikely friends and all of the bumps in their friendship. These books are hilarious and pretty easy reads for reluctant readers. I also find them great for targeting expected/unexpected behaviours (bird is almost always doing something unexpected!), perspective taking, and flexible thinking.

I'm curious to hear some of your favorite books! This is just a sampling of mine, and I love to expand my library regularly, so feel free to comment with some recommendations!

​Happy Reading!
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Book of the week: Valentine Mice

2/12/2020

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(You might have noticed that the title of this post has changed from "Activity" of the week to "Book" of the week. This is because I noticed that I'm most often posting about one book and many accompanying activities. So, each week I'll post my literacy-based activities under "book" of the week. 
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This week is all about Valentines Day! I've been using this cute little book for lots of my younger kids this week. I like it because it has great pictures with a lot of action, but few words. That way I can get the kids to make more inferences and think a little bit more about what's happening in the story.

This story is about a family of mice that make and deliver Valentines to all of their neighbours. Like all of the other books I do, this one lends itself to lots of different levelled activities. My kids who are just learning how to put words together can practice describing the pictures:




"He is falling," for example.




​For kids using more complex language, I use this book for inferencing questions as I mentioned above. It also lends itself well to a few vocabulary words, such as "deliver," "anxious," and "relieved."

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The mouse is UNDER the slide
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There are so many great activities that can accompany this book. For one kiddo learning location prepositions, we played a hide and find game. 

I mentioned there were lots of good opportunities for inferencing and predicting in this book because of the limited words. Some questions I might ask are:
  • What holiday do you think this book is about? (I always do a cover-prediction, where I ask the kids questions before we've even opened the book. Depending on their attention span, I may also ask them to predict what might happen in the book.)
  • How do the mice feel about delivering Valentines?
  • How will their friends feel when they receive the Valentines?
  • How do you think these mice know each other? (ie: family, friends, classmates?)
  • What is the parent thinking when the little mouse falls off the sled? (I sometimes use a thought bubble sticky note to practice these questions)
  • It's winter, so what do you think the pond is like? What will it be like to cross it?
  • How do you know the mother mouse realized the little mouse is missing?
  • What are they feeling when they find the little mouse buried in snow?
  • What could they do to help him?
  • How do they feel once they get him out?

You can see, there are a lot of questions about feelings here! Valentines Day is also a time when I focus on feelings with my kids. The Story Grammar Marker from MindWing Concepts uses a heart shaped icon to indicate feelings in a story, so it gels in nicely with Valentines Day. We start in the context of the book, discussing how the family feels when they're delivering Valentines, when they realized one of the mice is lost, and when they find him again. Then we do an art project thinking about all of their own feelings. This is a great jumping off point for the Zones of Regulation as well. In the art project below, we just used pink hearts, but you could easily use hearts to correspond to the Zones. 

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This book can also be used for some articulation practice. There are quite a few consonant clusters to target, such as "sl," "gl," "fl," and more.

Stay tuned for next week (or the week after that, let's be honest!) where I share the next selection of book-related activities.

Thank you for reading and happy speaking!
​Amanda
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January 29th, 2020

1/29/2020

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Well, it turns out it did take me over a week to get out our next Activity of the Week. It has been a busy time at Grow, as we are GROWing! Two new clinicians have been hired this week, so stay tuned for some "Meet the SLP" entries to get to know the new team members better.
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But, finally and without further delay, here is this week's Activity of the Week. To continue on our snow theme, even though all the snow has been long rained away here in Vancouver, we read Snowmen at Night last week. This is a great book for discussing perspective taking and expected/unexpected behaviour in a fun and silly way. With some of my preschool and early elementary kiddos this week, we did the following extension activities with it:
  • Acting out all of the zany things the snowmen did in the book - this is a great way to incorporate some movement into the session after a time of sitting still and reading!
  • Answering some inferencing and perspective taking questions about the book:
    • Do you think what the boy imagines really happens at night?
    • What might actually be happening? What is a different possibility?
    • How would you feel if you saw snowmen heading to the park and playing after dark?
    • How would they feel if they saw you watching them?
    • Why do the snowmen drink "ice cold" cocoa?
  • Following directions to complete our own "snowmen at night" picture
  • Telling our own stories about our snowmen at night. What kinds of silly things did our snowmen do?
  • Making play doh snowmen and using them as figurines to tell stories. For some of my younger kids, we used the play doh snowmen to practice building sentences and using verbs. "The snowman is running, the snowman is jumping, etc"
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I did read this with a few older kids as well and used it as a jumping off point to make a bio poem. After reading that bio poems ("bio" as in biography) can be a good way to increase perspective taking skills in middle schoolers, I've started to incorporate this into some of our narrative language sessions. We first make bio poems about ourselves and then we work through the template with characters in the books we read. Typically I do this with more serious characters, but this week, we made a bio poem about silly snowmen! :) ​

Stay tuned for the next Activity of the Week!

Thanks for reading, 
​Amanda
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The Mitten: Activity of the week

1/19/2020

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The Mitten by Jan Brett
Welcome to our first Activity of the Week! This is where I’ll showcase something I’ve worked on this week. Most of my sessions center around a storybook, as storybooks are an effective way to teach vocabulary, grammar, narrative structure, inferencing, and more. It also keeps my kids engaged! AND, I just love books, so any excuse to read them works for me! 

For those kids that have a bit more trouble sitting through a book, sometimes I will make modifications, such as reading the book while sitting on a platform swing, reading the book one page at a time and acting out whatever action is happening while we read, or giving the kids manipulables or small figurines that go along with the book and letting them play with those while we read. 

A little disclaimer, obviously not ALL clients are right for this activity. Be sure to match your book and activity choice to your client’s interests and abilities. That said, I’ve been able to use kids picture books with a lot of my older clients as well and, to be honest, they have loved it! I think a lot of “big kids” actually miss having picture books read to them (that’s not research-based, just my own experience!). I often tell my older kids, “We’re going to learn older kid skills but with a younger kid book,” and they don’t mind at all. I’m just always sure to extend their learning with another “older kid” activity after. I may pair the picture book with a related article from ReadWorks or may tack on a writing activity on a topic from the book. For my book this week, The Mitten, I often use the Winter Is Coming article, which often segues into a nice discussion about why some of the animals would probably not be wandering around in mid-winter to find the mitten!
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But now, without further ado, my activity this week! Last week we experienced a massive snow-dump here in Vancouver. (Well, massive for Vancouver!) So my book choices have been all snow themed. (Stay tuned in the future for a list of some of my favourite kids’ books organized by theme!) This week we did The Mitten by Jan Brett. This book has so many amazing teaching possibilities, I just love it. Here is a sample session with The Mitten:

First we read the book. With any kid above Kindergarten level, I let them help with some of the reading. Depending on the child’s literacy skills, they may read the whole book, do one page here and there, or at least help with a word or two on each page. This book has some words that are repeated and fairly easy to sound out, like “Baba,” “snow,” “mitten,” and more. Most kids, even those with reading difficulties, can at least get those words and then feel some success in the book reading part.

Then, I usually prime them with some questions about the narrative elements. I use the Story Grammar Marker format from MindWing for this. Studies have shown that asking children questions about narrative structure can increase their success in including the components in their retell. I also love to use manipulatives to go along with the story. I have a little snow-white mitten myself and I made a few paper animals to go in it. We use some dolls from the dollhouse for Nicki and Baba.


After the retell, with the story fresh (and then re-freshed!) in our minds, I often jump into some inferencing questions. Depending on my client’s goals, this may be a larger part of our session. If the child is working on anything social-learning related, I will really increase the amount of time and discussion we spend on inferences and emotions in books. The Mitten, along with most of Jan Brett’s books, often include some excellent pictures for inferencing. It’s so nice how she includes a little clue about the following page on the current page, so the kids can guess what might happen next.

Here are some questions I may ask about The Mitten:
  • Why did Baba say Nicki would lose his mittens if they were snow white?
  • Does Nicki know he lost a mitten?
  • How do the animals feel about the hedgehog pushing his way in?
  • We can see the Fox is coming next - do you think the animals will let him in the mitten? Why?
  • What is Nicki thinking here? (when he realizes he lost his mitten)
  • What is Baba thinking when Nicki brings home his 2 mittens?

I also love using books to teach vocabulary. I use a vocabulary chart that I found through a presentation by Jennifer Schultz, MA, CCC-SLP called “Building Vocabulary Through Children’s Picture Books” on Northern Speech Services. I will include my vocabulary chart for The Mitten in another post. [Also, if you are interested in using picture books to teach vocabulary, I found this presentation full of great ideas and information!]

To teach the vocabulary in my session, I usually pick 2-4 words from my list that the child didn’t appear too familiar with. We write them on cards, along with a friendly definition. I often use ELL dictionaries to find the definitions as they’re written in plainer English. Then I have the child draw a representation of the word. We may act out the word then, or go through the book and find other places where that word applies. (for example, in The Mitten, if the word is “Burrow,” we might look through and see which other animals burrow.) I’ll often try to find some synonyms for the word. We use the words in sentences. I try to make a few funny and ridiculous sentences as I have found when I get the kids laughing, they remember things better! :) We keep these vocabulary cards in clear plastic pages (I use baseball card pages) in a vocabulary journal. As we amass more words, we sometimes take the cards out for a variety of activities, but that’s a post for another time. ;) 
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The final activity I may do after a book read is a related story. Together with the child, we tell the story, but change a few elements. I wish I had snapped a photo of the latest one I did for The Mitten with a little friend of mine! We created a comic-style story about a fisherman who lost his boot in the water. As the boot drifted down, all sorts of sea critters crammed their way in, until finally a great blue whale squashed in. Suddenly, he blew air out of his spout, sending all the animals in all directions, and the boot right back into the old fisherman’s boat.

It’s rare that I will do all of these activities with one child. When I do, it is obviously over the course of a few sessions. However, I often do cycle through different activities with different kids. For example, in one day this week, I used the book for vocabulary with one child, for a story retell and narrative practice with another, for attention and simple sentence structure with another, and inferencing with another. Lots of birds with one stone — err, I mean book. :) 

I hope you enjoyed this Activity of the Week! Stay tuned for more next week!

Feel free to leave pictures and descriptions of what you have done with this book in the comments!!

Thanks for reading,
Amanda
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    Carla Monteleone & Deborah Carter own and operate Grow Speech and Language Therapy in Vancouver, BC

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