Using Lessons Learned Abroad to Shape my Teletherapy Practice

Last summer, I had the opportunity to spend 6 weeks in Quito, Ecuador, participating in a graduate program for Speech-Language Pathologists and graduate students that focused on cultural and linguistic diversity in the field of speech-language pathology.  Before we left and throughout our stay, we completed journal entries and responded to discussion prompts.  I hadn’t looked at those journals, that is, until now. A year later, I find myself in unprecedented territory, sitting in my “new” home office, trying to figure out exactly how to reach my students and their families during our time when many people’s lives and worlds have been flipped upside down.  Now, more than ever, I need to reflect on the lessons learned in Quito.

Working in a school setting, it seems that my evidence-based triangle had become more lopsided over time than I would like to admit.  I definitely put a lot of emphasis on clinical expertise.  I try to stay up-to-date on the latest evidence, but what about my client’s perspectives and their cultural values?  It seems the brick walls of my school had created an environment where the majority of us had the same values surrounding education and communication.  Within the gates of my school, it was really easy to forget about the cultural differences that existed outside.  Guess what.  Now those brick walls are gone.  We are providing services in places and spaces that may be completely unfamiliar and feel quite uncomfortable.  And that is why I am going to share the lessons I learned in Quito so that maybe we can apply them here, to help us reestablish a balanced triangle that puts just as much emphasis on the client’s perspectives as it does on our expertise.

It’s About More than the Printouts

A few weeks into our stay, we were prompted to reflect on how our training was being challenged in Ecuador.  

“When working with one of the students yesterday at Centro Jovenes, I felt as though the student would benefit greatly from the use of visual aids.  Specifically, had we had access to the plethora of resources that I use in my practice, I would have loved to introduce her to a high-tech communication device. However, because we didn’t have access to those things, I was left scribbling on pieces of paper…I am constantly surprised how well this works and am reminded that the resources are not the most important part of the therapy process.  I have caught myself on several occasions thinking, ‘Oh, I need to go print that off,’ or ‘Oh, I need to hop on my computer’ and then later realizing that that was not actually the case.  A pen and paper can really go a long way, and using a pen and paper is going to be much more sustainable in the long run if the program chooses to use similar resources/visual aids in the future.”  

Don’t get me wrong, there are tons of great resources out there that can make our jobs a lot easier, but guess what.  Now that your students are at home, it is going to be a lot harder to get them those resources.  Those Chromebooks and iPads that they got to use at school may no longer be available.  Parents might not be able to print an activity off or show their child a video.  This is the time to get creative and remember that it isn’t the materials that make our students successful.  This morning, I was brainstorming ways to get one of my students to work on his goals from home when it dawned on me that I could make some good-ol’-fashioned phone calls.  It is almost comical how novel that idea felt.

Stepping Back

Throughout our stay, we got to work with a local SLP, who taught us Spanish vocabulary used in the field, shared her experiences, and walked us through case studies.  We reflected on our experiences with her. 

One of the ideas that I have been thinking about is using more common gestures instead of ASL signs.  Clearly, like everything we do, this idea would really depend on the individual, but I loved the idea of teaching and targeting universal gestures rather than focusing on language/culture specific signs.  Although I was trained to use ASL and manually-coded English to augment and replace spoken language, I love the idea of using these gestures so that students can be understood by a more general population, especially when working with students who may only end up acquiring a handful of signs.  Not being able to be understood by their peers and the general public is a common argument that I hear from parents for not pursuing augmentative and alternative communication.  Until I stepped out of my routine, culture, and environment, I was not able to see such a seemingly simple and obvious solution to a problem that I have encountered for years.  It just makes so much sense that it almost feels silly to write about it here, but it is something that I will take away from Ecuador.  It is also a very good reminder of the value of stepping back and listening to other’s ideas and perspectives, especially the ideas and perspectives of individuals who live in different places and have had very different experiences in the field of speech-language pathology.”  

We are currently faced with a unique opportunity to provide educational services in the home.  Now is the time to really think about what is going to work for our students in an unconventional setting.  My advice would be to take this opportunity to step back and listen before we start sharing our expertise.

I hope that my experiences abroad will help all of us who are sitting at home today, trying to figure out our new roles as teletherapists, packet printers, and Google Classroom teachers.  Remember that just because the brickwalls of our classrooms have been taken down does not mean that you are not a speech-language pathologist and just because you don’t have the same resources doesn’t mean you can’t do therapy.  This experience is going to change our perspectives.  I hope to walk away with a better understanding of my students and their families and a more balanced triangle.