Thinking Outside the “Box”: Exploring the SLP’s Role in Dyslexia

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Intro

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Kate Grandbois: Welcome to SLP Nerdcast, everyone. Today, we are really excited to welcome two guests. We are here with Heather Casca and Kareena Khadi. Welcome, Heather and Kareena. 

Karina Kadhi: Hi. Hi. Good morning. Thank you. And 

Amy Wonkka: Heather and Kareena, [00:02:00] you are here to discuss the SLP's role in dyslexia. But before we get started, can you please tell us a little bit 

Karina Kadhi: about yourselves?

Yeah, sure. Um, so my name is Karina. I'm an SLPA. Um, I have been doing this for about 10 years now, uh, and my first job out of college. So I got my bachelor's degree at the University of Arizona. Um, and my first job out of college was, uh, with Heather. She was my first supervisor. So that's how we met. Um, I've worked in pediatrics ever since, both in a school and a private setting, um, and I just have a real passion for early language development, um, and Heather, when Heather and I cross paths, some of our like niche areas, kind of, um, Lined up and that's how we are, where we, how, why we are, where we are right now.

Um, personally, I have two, two daughters, a six year old and a three year old, um, two, yeah, two girls. And yeah, it's a little bit about myself.[00:03:00] 

Heather Caska: And I'm Heather, I, uh, live here in Arizona, uh, in the Phoenix area, just like a small little, actually, it's not small, it's growing quite a bit, but a suburban Phoenix.

Um, I also have been a speech language pathologist for just about 10 years, um, have worked in private pediatric. Most of my career, I started in a nursing facility and found out quickly that was not for me where I wanted to be. Um, so I, A couple years after I graduated and working in pediatrics, um, I just found a passion for dyslexia.

I first was introduced to it in undergrad, um, through Dr. Tiffany Hogan at the University of Arizona. She was one of my professors and she's incredible. Um, and so. Yeah, I just started doing as much training as I could, extra CEUs. Um, I went and got some training through the Academy of Wharton Gillingham, practitioners and educators on reading intervention.

Um, and then just quickly learned that there was such a need for education in our field, um, and how important our [00:04:00] role is, uh, uh, in dyslexia and especially early identification and, and early intervention. And so again, that's how Karina and I kind of crossed paths. Cause she just loves that early intervention.

I love the reading. Um, and. We just rolled with it. So I decided to, um, start my practice, uh, in the middle of the pandemic. Uh, craziest idea I've had, but, uh, it just been, been amazing ever since. Um, I just knew that I really wanted to go out on my own and be able to educate SLPs and do trainings and workshops, but also provide services for students.

So, um, I also have two kids. I have a son who is also six and a daughter who is three. Um, my son just started first grade. We already started school here in Arizona. My husband and I have been married for about nine years and yeah, that's it. No one 

Kate Grandbois: could see my eyes go wide when you said you've already started school.

We're recording this at the very end of July. Um, we don't start school here in Massachusetts until late August, [00:05:00] September. So, um, it's always fun to hear about how different areas of the country do things. And we already talked about this before we hit the record button, but Amy and I don't know very much about dyslexia.

This is not our area of clinical expertise. So we're very excited to learn from the both of you today. Before we get into the content, I do need to read our learning objectives and our financial and non financial disclosures, which are ASHA required. I'm going to get through those as quickly as possible, and then we'll get onto the good stuff.

Learning objective number one, describe three additional service delivery domains outside of assessment and treatment that are essential when working with students with dyslexia. Learning objective number two, describe three barriers to upstream thinking when discussing prevention and early identification.

And learning objective number three, discuss three ways you can play a role in upstream thinking for early identification of students who are already struggling with early literacy skills. Disclosures. Heather's financial disclosures. Heather received [00:06:00] an honorarium for participating in this course.

Heather is the owner of a private practice called HBC Language and Literacy. Heather is also the co owner of Soar with Words LLC and co manages the Soar with Words educational platform on Teachable. Heather's non financial disclosures. Heather is the current president of the Arizona branch of the International Dyslexia Association.

Heather also co manages the social media accounts for Soar with Words. Karina's financial disclosures. Karina received an honorarium for participating in this course. Karina is also the co owner of Soar with Words LLC and co manages the Soar with Words educational platform on Teachable. Karina's non financial disclosures.

Karina co manages the social media accounts for Soar with Words. Kate, that's me. I am the owner and founder of Grand Blois Therapy and Consulting, LLC, and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12, I serve on the AAC Advisory Group for Massachusetts Advocates for Children, and I'm also a [00:07:00] member of the Berkshire Association for Behavior Analysis and Therapy.

Amy Wonkka: Amy, that's me. Um, my financial disclosures are that I'm an employee of a public school system and co founder of SLP Nerdcast, and my non financial disclosures are that I'm a member of ASHA Special Interest Group 12, and I participate in the AUC Advisory Group for Massachusetts Advocates for Children.

All right. Now we're through that stuff. Heather and Karina, why don't you start us off by telling us a little bit about that first learning objective. So what are three additional service delivery domains outside of assessment and treatment? Because I have to say, I, 

Heather Caska: I can't think 

Karina Kadhi: of what those might be.

Um, so the, the way we kind of like to break it down is we like to think about, um, the, in general, the service delivery domains that fall under our scope of practice as speech language pathologists. And so, um, straight from ASHA, they break that down into those, I mean, let me count them really quick. [00:08:00] One, two, three, four, five, six, seven, eight, eight of those, um, Service delivery domains and it's collaboration, counseling, prevention and wellness, screening, assessment, treatment, um, that modalities, uh, technologies, instrumentation, and then populations and systems.

So that's, that's not new to us necessarily. We know those. And so the way that we like to, um, bring awareness to the role that we as speech therapists and speech pathologists can play, um, In dyslexia intervention is under each of those domains, bringing attention to things that we could do to support these students under collaboration under counseling under prevention and wellness, we recognize that the direct intervention.

It's most likely not our role, especially in a school setting. We know that we're not the reading specialists, but we feel strongly that we can play a very impactful role in supporting these students because a lot of the skills [00:09:00] with literacy overlap in our wheelhouse, you know, um, So, uh, there's, there's eight different ways that we can support these students besides just intervention.

Um, and we kind of want to go into each of those and talk a little bit about, um, how we can support these students. I also wonder 

Kate Grandbois: if we could take a step back just for a second before we dive into each one of those because that was, those were all things I've never considered, uh, and thinking about the larger picture of dyslexia in general, could you tell us a little bit about, first of all, maybe defining it for us for any listeners out there who have been working in a sniff for the last time.

Thank you. 15 years and need a refresher. Um, could you define dyslexia for us or talk a little bit about why early intervention is so important? 

Heather Caska: I think so. This, this is such a great question. Um, and unfortunately there's not really [00:10:00] an easy answer for what dyslexia is. And it's actually one of the biggest barriers to identifying dyslexia is that across the board, there's many different professionals that are involved in research for reading disorders and learning how to read.

Um, but. There's not really a consensus on what dyslexia is. So, um, I will read the International Dyslexia Association's, um, definition for dyslexia, but then kind of also talk about another definition that we really like. Um, so it's kind of a mouthful, but IDA's definition is dyslexia is a specific learning disability.

That is neurobiological in origin. It is characterized by difficulties with accurate and or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to the other cognitive abilities and the provision of effective classroom instruction.

And secondary consequences may include problems in reading comprehension and reduced reading [00:11:00] experience that can impede growth of vocabulary and background knowledge. So quite a mouthful. Um, there's a lot. I love that it highlights it really incorporates that reading comprehension, those secondary consequences that we see as far as A language development and and just reading comprehension, but one thing I don't love about it is the the line where it says these difficulties typically result from a deficit in the phonological component of language because more and more research is coming out showing that only about 50 percent of the kids with dyslexia actually have a phonological deficit, and then we're talking about phonological awareness so there's a couple different subsystems subtypes of dyslexia.

Um, As far as like you have an orthographic piece where that's more of like those letter sequences, orthographic mapping, um, versus a phonological where someone's really struggling with that awareness of sounds and words. And so I think that definition specifically kind of eliminates. Or maybe, [00:12:00] um, if a, if a child is tested and they have really great phonological awareness skills, but they're struggling orthographically, if you're looking at that definition, then that child might not be classified as a student with dyslexia, but, but they are, um, so Dr.

Hugh Katzen, Dr. Tiffany Hogan put out an article in 2021, um, that really talked a lot about more of looking at like multifactorial, um, basis of what dyslexia is and what these students are kind of experiencing. And so, um, the article is called dyslexia and ounce of prevention better than a pound of diagnosis and treatment.

And so it's really talking about that early identification and prevention, which is. What we're so passionate about, but they kind of proposed this definition that dyslexia is a severe and persistent difficulty learning to read and spell words despite adequate opportunity and instruction. So we really like this model and this definition because it's highlighting [00:13:00] that there's no single deficit or even like a.

small group of deficits that are consistently associated with dyslexia. And so it's letting you look, it's, it's highlighting a preventative model. I also want to highlight that we do know that there's no, really no cure for dyslexia, but when we're talking about prevention, what we're talking about is just identifying these students early and getting early intervention in place.

So maybe they might not need an IEP or they might not struggle or fall as fall. As far behind in school they may, we may still see, you know, some, some difficulties that they have, um, because again, we know that there's no cure for it, but that early identification is so important. Um, so I mean, that's kind of a, uh, a long winded answer for that question as far as like what dyslexia is, but that's really how complicated it is, is that there's no, um, single definition.

Yeah. There's no checklist that, you know, there's nothing that you can just check these boxes. Um, we really need to look at the whole child, but, um, [00:14:00] but yeah, that's kind of the definition that we really like and educate others on.

Kate Grandbois: Seems like. There's a really big missing piece then in terms of making sure that kids can get identified to get the services that they need. Can you, this is sort of a tangential question, um, and maybe it's just because I'm not familiar with this area, but in terms of that differential diagnosis process, do you find that Most kids are getting picked up through the school screening system, or are they needing neuropsych evaluations?

What does that identification process look like with this very loosey goosey or inaccurate definition of what it is? 

Karina Kadhi: I feel like a lot of times in school settings, the approach that we see is that wait and see approach, um, especially for, um, early identification of things like this. Um, I kind of want to get into the Dyslexia Paradox right now.

Heather, what are you thinking? Yeah. Okay. Um, so now I 

Kate Grandbois: need to know what it is. 

Karina Kadhi: [00:15:00] So you have to say it. Um, so there's the, um, let me go over here so I get my resources correct. One second. Um, there is this idea of Dyslexia Paradox. Heather, can you help me with the, um, referencing who it is? I know it's 

Heather Caska: Dr.

Nadine Gabb. 

Karina Kadhi: Um, okay. And so it's the idea that, uh, intervention is most effective early on. Um, preschool, kindergarten years, um, maybe even first grade, right? But, um. Most students with dyslexia aren't formally diagnosed or even like 

Heather Caska: identified, 

Karina Kadhi: um, until like second or third grade, which means we missed that prime time for early intervention or identification in order to intervene early.

Um, and so there's this sweet spot early on where intervention research shows is more effective. Um, And [00:16:00] so in, in, in school systems, especially in Arizona, what we're used to seeing is in kindergarten when, um, we might have students who have some, um, risk factors that we noticed, um, and most of them, by the way, are already on our caseloads for speech and language services, right?

That we had, there's a lot of pushback with wanting to screen for other areas because they're the approaches. Well, they just haven't had time to adequate instruction. So we don't know yet. We have to wait and see. But going back to looking at the whole child. Yes, they may not have had enough time for adequate instruction but if we know that there's a speech and language.

History, right? If there's deficits in that area or if there's family history of things, we could look at the whole child and kind of narrow it down and, um, decide that well now is the better time to intervene for that child versus the wait and see approach. So we really like to, um, that's why we [00:17:00] push so much for considering other factors in that because we see a lot of that wait and see.

And by the time we see, uh, it's kind of late in the game for them in terms of intervention. Yeah. 

Heather Caska: I think an important note too is a lot of states do have legislation are in the process of getting legislation in place. So Arizona specifically within the last couple of years passed legislation where all students, I think it's kinder through third are screened.

For dyslexia using a universal screener. Um, and the state has approved screeners. So once, um, once the screener is administered, if they fall a certain below benchmark, then they are required to receive like tier two intervention. So we're seeing huge leaps, um, across the nation, I think, uh, which is great.

But I think some of the missing piece too, is then what intervention is being. Implemented and how how strong is that intervention? And that comes down to [00:18:00] even just like educating teachers and and administrators specifically as to what needs to be done for these students. So we're seeing a big push and some gains in that early identification, but we are still seeing a lot of that.

That wait and see, but again, kind of where Karina and I came in and we were like as speech language pathologists, we, like Karina mentioned already, so many of these students are on our caseload because of a speech or a language, um, disorder. And so if we, as SLPs are more aware of what some of these early indicators are and what dyslexia is and how we can kind of implement some of these.

Early interventions into our speech and language therapy, we have a huge role in that prevention because we know that most likely that kindergartner that first grader is not going to get referred for testing in the school yet. They are going to have to go outside and get evaluated by an SLP or a neuropsychologist to for that, that diagnosis or that [00:19:00] identification I mean and we know that schools aren't going to diagnose students like in the school they're identified as SLD, you know, a specific learning disability.

Thank you. In the schools, typically under like basic reading or older students are often like under reading comprehension, but, 

Kate Grandbois: Can you tell us a little bit about any of the early indicators for 

Karina Kadhi: dyslexia? Yeah, definitely. So some early indicators early on, like in those younger years, like maybe, um, preschool, kindergarten. Um, family history is a huge one family history of speech, language and learning difficulties. Um, on the intakes that we do, um, Heather mentions a lot that, um, oftentimes you, 

you 

Karina Kadhi: will get a skewed answer if you ask specifically for a history of dyslexia, right?

Because most, most of the time, parents, um, don't have a diagnosis or don't. Don't realize that that's what they're struggling with, but once you start talking, uh, it may come out that, oh yeah, mom and dad had a hard time with school or grandpa struggled here, you know, and so, um, family history can really give [00:20:00] us a lot of information, um, delayed speech and language skills, um, the comorbidity rate between dyslexia and, uh, speech and language disorders is about 50%.

Um, so that can be an early indicator, especially for those younger kids that, again, we might already have on our caseload. So when we're seeing some of these other, um, just oddities with them, um, that might stand out as an early indicator as well. Difficulty, um, with learning labels and names, vocabulary for things like shapes, colors, numbers, days of the week, or letters that, um, kind of speaks a lot to, uh, working memory and some underlying deficits that might, um, be associated with it.

Um, difficulty pronouncing words, um, obviously we already talked about this. Speech skills, but these are more like abnormal pronunciations of things that don't, won't really be picked up on like a GFTA or an eval screener type thing, um, but you just notice something's off with the way they're pronouncing, um, [00:21:00] some words and then they might even be like word specific.

mispronunciations. Um, we already mentioned, uh, difficulty learning new vocabulary, um, and rhyming and identifying sound so that those phonological awareness skills, um, might be low. And then in, uh, slightly older students, now maybe we're thinking second, third, older, um, difficulty with, uh, knowing left from right, kind of that, like, orientation, um, struggles with sight word recognition.

Um, in a sense, all words become sight words because you don't decode them. Every single time, um, but with those true sight words, they might still be struggling at that, um, slightly older age with recognizing those sight words, um, poor spelling, uh, difficulty memorizing number facts. Um, so kind of, we mentioned it earlier, but bleeding into that math realm, right?

Is it the math computation skills or more of like the language revolving around, um, math and math facts, things like that. Frustration with school and [00:22:00] homework, going back to that social emotional piece, um, difficulty understanding what is read, so comprehension, um, and written expression, putting ideas into writing, uh, could, might be really difficult.

They might tell you this elaborate story, and they go to write it, and all of a sudden it turned into like this super dull, um, sentence. An example of that, I have a student, or I had a student years ago who, um, She was writing for me and she was going to write about the kitchen and she, instead of writing kitchen, when I looked over her sentence, she changed it to the chef, the cook's room.

And I asked her, why did you call it the cook's room? That's interesting. And it was, um, she changed the whole sentence up, um, because she didn't know how to spell kitchen. And so, um, Getting those ideas into writing can be really difficult for a number of reasons, either that sentence, like generating the sentences or even making them more simple, just to avoid words that are going to be difficult to spell.

So they're awesome. [00:23:00] Some indicators we might see in our younger and our older students.

Kate Grandbois: I want to talk about some of these more specific components in our first learning objective about service delivery. And I have to assume that that is related to the SLP role here and you've already described.

The SLP playing a role in early identification, right, if these kids are on our caseload. You've also described the SLP's role in, um, educating staff and, you know, that collaboration piece, right? So making people even aware of the holes in this definition, everything from, you know, that to how to use a screener or which screeners they should use.

I can imagine that the collaboration and education pieces is really wide. Can you tell us a little bit more about. Just the role of the SLP and how that might relate to, um, the different service delivery areas. I'd also love a review of those service delivery areas sure. 

Karina Kadhi: So should we, should we get into those and we can kind of go, um, kind of break down each of those [00:24:00] areas and think about our role in them through the lens of, um, supporting literacy skills, I guess, maybe that's not what we're, what we're thinking about when we go into our speech room and to do that intervention, but that's kind of what we want to bring awareness to today.

So we could start off with collaboration if that's okay. Um, we've kind of already, uh, talked a little bit about that piece, but we, we know what, what collaboration means and in terms of how we can support these students in a school or even a clinic setting through collaboration, um, is that education PC already hit on that and educating the, the rest of their support team, right?

Whether it's their teachers, um, whether it's, If we're, if we're working in a school setting and we know that they're getting intervention somewhere else, collaborating with that therapist, we all have that common goal, um, in supporting these students and so, um, collaboration is, uh, could be a big one in both in a school setting and in a.

In that clinic setting, um, especially with the classroom [00:25:00] teachers, I think finding, um, as an, as the speech therapist at, at the campus, um, the skills that we possess really overlap with, um, literacy and structured literacy, which we'll get into a little bit later or next time, but, um, And so realizing that we possess a lot of the skills to support these students, even though we're not the ones doing the direct reading intervention.

Counseling is another one, another big one that we really like to talk about and bring awareness to the role that we can play through that counseling domain. That just it just supporting our students with any, um, things that come from the speech or language disorder that they're dealing with right in this term and or in this case thinking about struggles that they might be dealing with, um, secondary to difficulties with reading and writing.

And we see that that has been a huge one for us, [00:26:00] especially these last couple years, Heather and I have been working with older students and we're typically used to working with I worked with a group of middle school students, these past couple years and that my role in that counseling piece was huge for them because at that age.

And at that point in their, the game for them and in terms of their learning, um, they had a lot of shame built around, um, their learning and themselves and their, their skills and they had already. These literacy skills were have been hard for them since kindergarten. Right. And at this point, we're in sixth, seventh grade, and they have this wall up in there.

They truly had so much shame around their abilities. And, um, so our role in supporting these students and building rapport with them. Was huge because it wasn't until that, that we, um, got some breakthrough and were able to make some gains in their literacy skills, um, especially because in [00:27:00] that middle school age, they're, um, more embarrassed about it, right?

They're more sensitive to that. And so coming into the speech room to work on this, it was not always fun for them. And so really building that rapport and that trust in the, with those students, um. Was crucial to then the learning that could happen after that. So our role in counseling, whether it's with your student has dyslexia or not, right?

Like that rapport is so important. So our role in that counseling domain is really huge to, um, And one that in the last couple of years has come to light for us, um, and the impact we can play there. 

Heather Caska: I think, too, there's a lot more research coming out as far as the relationship between dyslexia and anxiety.

And they've found that, um, researchers found that anxiety to be related to decreased academic achievement, um, and Performance as early as first grade. So we're seeing it early on in these students. And again, remember a lot of these students aren't getting identified [00:28:00] yet. So there's definitely a bi directional relationship between these reading difficulties and anxiety.

So like, obviously as reading difficulties are, are increasing, so are your levels of anxiety, but then also like increased levels of anxiety. Are going to negatively impact your response to intervention. So I, you know, I have parents ask me a lot to, you know, I'm seeing a lot of anxiety in my suit and my child, you know, around reading.

And I was like, honestly, if we're not addressing that piece there, like if our students aren't mentally in a right place to learn, um, you know, and. And to, and to build, you know, these cognitive, um, connections, then no matter what intervention you can get the best interventionists and the best programs, like it's not going to be as beneficial.

So I think we have to be really mindful of that and really working with our students. So, um, Dr. Sharon Vaughn, anything. Dr. Amy Grills, I think is her last name, or gills, I can't remember off the top of my head. But they are doing a [00:29:00] lot of research together as far as the anxiety and um, and dyslexia and the reading piece.

We do have a couple links, um, on our Instagram and our bio to some videos. Um, I think it was through one of the dyslexia. Um, Programs. I can't remember off the top of my head, but they have some free videos online of presentations they did and a huge, um, really, really great resource, um, to kind of learn a little bit more about the anxiety piece and, and dyslexia.

And kind of, 

Karina Kadhi: we can tie this back to collaboration too, is if, if we're in a school setting where we don't have, um, a counselor, or we feel like we are not able to support these kids, knowing that we can, um, collaborate and refer out to get these students the support that they need, talking to their parents to refer out, or if we're in, um, a clinic setting, talking to some of our other, um, The therapist and within other disciplines or again, referring out.

Um, so those kind [00:30:00] of always go hand in hand. We can always kind of tie back to that collaboration piece where if we don't, we don't know everything. We're lifelong learners, right? We can't fix it all, though. We think we can sometimes. Um, and so knowing that we can, um, refer out to support this area or any of any areas that fall under our domain service delivery domains, um, when needed.

Kate Grandbois: I just want to take a minute to say thank you for unpacking the importance of mental health in the journey of our learners. Um, I know when I am anxious, I'm not available for much of anything, no, much less learning something that presents a challenge for me or learning something that I have already learned is difficult for me or getting my, you know, Getting that cool, common, collected feeling when you take on a challenge and you're really putting your all behind it.

I'm not doing any of that if I'm anxious and I really appreciate you reminding us of that. Um, and [00:31:00] anybody who is listening, who is maybe reflecting on their learners on their caseload who might have dyslexia. Maybe considering the social emotional components of this as part of the treatment package, instead of just, Oh, that's something that the counselor down the hall deals with.

That's not my domain. 

Karina Kadhi: Absolutely. Yeah. It's our pleasure to do that. It's like I said, it's something that has really, um, come to light for us in these last couple of years, working with a slightly older population. Um, but quickly we realized that needed to be front and center for that. And then in terms of treatment, a way like we could adapt that is noticing, like, When we have to put our goals aside, right, to address the child in front of us, 

and oftentimes I think we get stuck in, we got to collect data, we got to have this, we got to do this, and we push our agenda, right, not being mindful or noticing even some of the struggles the student might be dealing with. In front of us. And so if we have to set our goals or aside for a second to address that student that is still, um, With we're still [00:32:00] servicing them, right?

Just in through a different domain. So, 

Amy Wonkka: I think you make such great points to just for all of us and and like you had mentioned, I think, Karina, you know, regardless of sort of the Karina, specific challenges that have brought the student into our, into our therapy room, just being cognizant of the importance of relationship rapport, but also just creating a safe space where our clients are feeling empowered that they are able to do these things.

And we're here to help them out, but we're not the fixer of all their problems. It's something that we're doing together and they can do it. Um, and, and their time with us is a place where they are safe. to kind of be the full spectrum of all the feelings that they're feeling in relationship to, um, the challenges that they're experiencing.

So I think you make wonderful points for our people who are working with clients who have dyslexia, but also I think that these are wonderful points for all of us, you know, kind of regardless of who we're trying to help.

So looking at your learning objectives, another term that I am not familiar with is the term [00:33:00] upstream thinking. So I don't, I don't want to rush you ahead, um, in your presentation, but it's something that I'm super curious about.

I see it in two of the three learning objectives, um, and I'm just curious kind of what, 

Heather Caska: what 

Karina Kadhi: that means. You're actually segwaying us right into the next, uh, service delivery domain. So that was perfect. Um, and so that kind of hits that next, um, one of those eight service delivery domains we talked about, um, is prevention and wellness.

And so that idea of Um, upstream thinking is stopping a problem before it happens, right? Getting ahead of something before it becomes problematic. Um, and so when we think about upstream thinking and, uh, dyslexia or upstream thinking, um, and the SLP, there's kind of three things that we can do to get ahead of something before it becomes, or get ahead of, uh, reading and writing difficulties, difficulty with those literacy skills before it really becomes [00:34:00] problematic.

Um, and so it's through education, um, early identification, and then that early remediation are three ways that we can, um, be upstream thinkers or apply that idea of upstream thinking. Um, To, to, to prevent further difficulty or, um, maybe even a need for like an IEP like Heather mentioned earlier, um, and then with upstream thinking, we kind of break it down into, um, like everything there's barriers, right?

Um, and so with upstream thinking, we, there are a few barriers that could get in the way, um, whether we're working in a school setting or a clinic setting. Um, and so those three barriers are, I can't see the problem. Thank you. So maybe, um, we have a student on our caseload who just has articulation goals, right?

There's no reading things here. So why am I going to address this? Or the wait and see. They're just in kindergarten. It's not an issue yet. Um, the [00:35:00] problem isn't mine is another barrier. Maybe it's not within my scope of practice to address this reading. Uh, I'm not the reading specialist. So why am I working on this?

Um, and then another barrier is I, I just can't deal with it right now. Thank you. Right. I don't. There's all of those, um, different admin and procedures. Um, Heather knows more about this area than I do. I don't do evals, obviously, but, um, just more of those. Uh, admin and things that kind of get in the way of, um, just screening a kid or e mailing a kid.

Kind of those precursor things that, um, need to happen before. And so that, that is that idea of upstream thinking. And we would like to think, um, of speech therapists and SLPs as the, the perfect role to really play a huge role in upstream thinking when it comes to these students specifically. Thank you.

Amy Wonkka: I was just going to ask. I know you mentioned a little bit earlier. I think [00:36:00] Heather, it was you who was who was talking about kind of other things that we might be able to do if we identify a student through a screen or they might get tier two intervention or something like that.

Heather Caska: Do you have experience working 

Amy Wonkka: with. Like schools, I guess, in particular, who do a really nice job with RTI, MTSS, and actually do kind of support kind of, to your point, Karina, support some of these students well enough through that intervention model that they actually don't need to go on to develop an IEP and have more of those 

Heather Caska: specialized services.

What might that, what might that look like? I, that's such a great question. Um, So I have, you know, I've worked in just a couple of different school district, not even districts are like charter schools in the area and we're right now, um, where we have been working as a private school. But as far as like what that would look like.

I mean, all schools in Arizona right now are doing early identification early identification as far as those universal screeners but you know they [00:37:00] do that. Or two typically is looking like small group. What I've seen done a lot is they're going, you know, they go to a different classroom, but a lot of times it's a computer program, um, which I don't think is always super effective for these students.

You know, it really just depends on the child. So, um, I think I saw more so recently last year to try to score was I was working out a little bit. They did a combination of both. So they had a they had someone in there that was doing more hands on intervention and the other students were kind of getting extra practice on a computer while she was working with a smaller group.

And I think that can be really effective. But I think just that tier two intervention if it's always just like a computer program where they go and they're sitting by themselves. So the computer and they're just getting this extra practice of that phonics instruction is not always going to be super effective.

I still think that hands on, um, and small group, like in person instruction with a body, with a teacher, um, that, that one is also educated in, in dyslexia and what that intervention should look like. Um, [00:38:00] another. The case that Arizona implemented is they have each school, um, each elementary school, K through five, um, must have what they call a dyslexia trainee designee, um, and so it's typically a kinder through third grade teacher, one teacher that gets extra, you know, they, they're kind of in charge of getting all of that dyslexia education, you know, continuing.

Education. And they're kind of like the go to person for that school campus. So I always tell the SLPs, find out who your dyslexia training designee is at that school and become best friends with them. Like together, you two can make a world of difference for those students. Um, so I think that's kind of my big thing again, you know, there's great programs out there.

Um, but I just, there's something to be said about that. You know, doing that intervention like with the student and having a body and not just putting them as a tier two, like putting them on the computer program to kind of 

Karina Kadhi: piggyback off of that, Heather. I think the thing that is. That is said about that in person intervention is that the, the clinical skills that [00:39:00] the, whether it's the reading interventionalist or the therapist can bring to the table, um, in terms of individualizing the, the intervention, right?

Um, these programs are like the online practice that Heather's mentioning, things like that are. It's going to be the same for the kid that logs on, for every kid that logs on. Nothing's really individualized in terms of cues or visuals or supports that they might need. And so while it might work for one kid, it's not going to be designed to be effective for every single student that gets on there.

Right. And that's where that, those clinical skills really come in where we can individualize those supports and scaffold things appropriately. Um, so that we can, uh, ensure like, uh, a cognitive connection there, you know, and not just exposure to material kind of a thing. Um, so I think that's another, um, huge benefit of being able to support students, um, outside of just, uh, an online program.

Kate Grandbois: I [00:40:00] have a question related to this concept of upstream thinking. Is that what it is? Upstream? Yes. So this concept of, uh, upstream thinking and. The general nature of the infrastructure that we work in. So I always use this colleague as an example, but I have a colleague who works in a public school district here in Massachusetts, and she has a caseload of 100 and some students and, you know, it's, it's knowing that for a lot of us working in schools, our resources are limited.

Um, are the support that we have from our administrators is limited, and our scope of practice is so wide that I can see the situation arise frequently where there's the, and I think every state does it differently so your resource specialist or your reading teacher. Or whatever your designated person is, I could see that the experience of, well, I don't have time to do that.

I don't know anything about X. That's Linda's job [00:41:00] down the hall. Um, I don't have this in my scope of competence, so I'm just going to work on phonology. How would you recommend an SLP Get ahead or do that sort of upstream thinking in terms of addressing some of these resource deficits or competency deficits in a way that feels a little bit more manageable.

What made me think of it was when you said become their best friend, because I genuinely do think that sometimes when we even have lunch with a colleague who has a difference and we're talking about our weekends, there can be this experience of shared knowledge. Um, and I just, I didn't know if you had any suggestions for how to specifically address.

Some of these real world issues that we're facing in terms of, of the resources that we have available 

Heather Caska: to us. Yeah, that's, and all of those things that you brought up are what we hear from SLPs all the time. So some things that I would recommend doing is we're required, you know, for our license to get continuing education.

[00:42:00] We have to. You every year. Um, so the International Dyslexia Association, they offer CEUs local branches, even if it's not your state, um, different state branches offer CEUs and they offer ASHA CEUs for speech language pathologists. So that's, it's a great resource to get a little bit more education and competency in this area.

Um, And so the International Dyslexia Association has a big conference every year, just like, uh, ASHA does. So that's one way, um, and in your, if you're in the schools really advocating, um, to be part of some of these literacy trainings, um, because like I said, every, most states have some sort of legislation now.

The schools and where they're having to have more education on it. And so you might, and I think even a lot of schools will require you to participate in certain, a number of professional development every year. Just advocate as an SLP. Like I'd like to be involved in some of these literacy, you know, trainings or for reading to, [00:43:00] to really kind of increase that competency.

And again, we, we recognize that SLPs cannot now just be like, okay, that kid has dyslexia. They need to be on my caseload. That's not realistic. And we completely understand that, but just by kind of educating yourself and being a little bit more aware, there are a lot of things that you can do just to support these students with what you're already doing.

So one thing we kind of always talk about is this common knowledge versus common practice. So a lot of what we do in our trainings and what we tell SLPs, it's may not necessarily be like. Brand new information. Like we're not going to really blow your minds, but what we're going to do is help increase that awareness and help you identify activities and things that you can do to be a little bit more intentional with what you're already doing to support these students.

And most of what we do in our therapies, um, like in our clinic and with our students, we don't have fancy materials. We have a whiteboard. [00:44:00] Dry and dry erase markers, you know, so you should see my pictures. Yeah, I mean, we create, we create materials for students, um, like therapy materials for them to take home with literally construction paper or index cards and markers.

And we have them drawing. And I mean, there's a ton of great resources out there for dyslexia. Um, and materials, but we also understand that like, that's not always realistic to have to have those accessible to you. So there's a lot that we do and we try to share a lot on our social media of like practical things we're doing in our therapy sessions.

Um, that you with things you already have. In your classroom. 

Karina Kadhi: Um, I want to, if I could add something to that, another thing that Heather does really well in terms of that, um, kind of addressing the issue, uh, with, um, resources in a school and getting these kids identified and stuff is, um, collaborating with the rest of the evaluation team and like the school psychs and stuff.

She does a really great job at that. And even [00:45:00] sometimes Heather, maybe you can go into more of that, but like breaking up the. Um, like the subtests and like one that you may do versus the psych. And, um, so I think she does a really good job and maybe that kind of. helps with some of those, um, access to the resources and things to make this, um, a smoother process.

Yeah. 

Heather Caska: I, I've definitely heard horror stories from other SLPs about their relationship with like the school psychologist that they've worked with. I fortunately have never had that experience, you know, because I think sometimes we get that pushback, like, Hey, stay in your lane. Like I, you know, I'm the school psychologist and nothing again.

And school psychs, but I have had the absolute pleasure of working. I've worked with two school psychs, um, in my career and have. Developed like the best relationship with both of them. Um, they're another one that you should definitely try to make your besty in, um, when you're working in the school setting.

And we [00:46:00] have just collaborated so well as far as, um, the evaluations, you know, when there was one time where. There was a student that was referred an older student that was referred due to academic concerns like reading comprehension and they're like, I don't think we need speech, you know, it's just academics, it's just reading comprehension.

And I was like, Whoa, hold on. And I was like, you do need us. And I said, because reading comprehension is decoding word recognition, and then language comprehension, like we are the ones that should be, they do, they will, you know, school psychs will assess language. To an extent, but we're going to do a more in depth thorough analysis of their language skills.

And so we absolutely should be involved in those. And again, I know people are like, well, I can't add any more evaluations to my schedule either. And I, and I understand that, but at least Consulting being advocate to be consulted. Um, when it comes to these other referrals, especially if it comes to, to reading.

I mean, and I see this in even with math students that are really struggling with math. [00:47:00] Is it math computation? Are they struggling with the language of math? The word problems, you know, um, and so we definitely have like a big role when it comes to, and again, all this ties in, right? This goes back to the collaboration piece and, um, and that prevention, because again, we'll probably, we're probably more likely to test these students In first grade than a school psychologist would so I really recommend making sure you're incorporating if there's a if there is, you know, it's a speech sound disorder concern and you're testing for articulation, you should also be assessing phonological processing as well and phonological awareness, you know, to make sure that there isn't something going on.

Because most of the time they're there is, um, so you're kind of getting your foot in the door before the school psychologist is going to come 

Karina Kadhi: in, which kind of takes us to that next, um, service delivery domain, Heather of screening, which kind of might even uncover a little bit more information on how we're identifying these kids in order to have them on our radar and then [00:48:00] collaborate with those other professionals and stuff.

So, um, yeah, one of those other areas, service delivery. Don't domain. Sorry. Um, is screening. And, um, that's kind of in the realm of what we're already talking about in, um, identifying these kids. These kiddos early and stuff and so we can, um, get into maybe some areas to screen if we have students already existing on our speech and language, um, caseload for speech sound like whatever they're already on there for, um, we could be more aware and intentional about some of these other early indicators, um, or even Do little screenings with them.

Um, if we suspect something. Yeah, 

Heather Caska: I think to to add on to that, Karina is when you again, most states, most school districts are probably already doing some of these universal [00:49:00] screenings, um, where they're meeting these requirements. So like kindergarten, you want to make sure you're assessing phonological and phonemic awareness like segment segmentation blending.

Um. correspondence, looking at nonsense, word fluency, rapid automatic naming. Those are a lot of skills like in kindergarten. So those are typically probably already being done by the teacher. But if this student is on your caseload, you know, check in with the teacher, how did they do with their screening?

You know, how did, how did they perform on any areas come up as, you know, concerns, are they meeting benchmark on everything? And if not, then how can we also support that skill specifically? So, um, you know, like let's say they're really. Struggling with that sound letter correspondence, but you're working with them for like articulation or speech sound disorders, then you incorporate that, that visual, that grapheme with it.

So if you're working on that snake sound, you better have that S up on the board and talking about, this is the letter. So when you see that this is the sound it makes. And so that's going to be another really important piece. [00:50:00] Um, as far as maybe you're not the one doing the screening, um, but. Check in goes back to that collaboration.

Check in with the teacher are where are they struggling? Are they struggling anything I can do to support them while we're working on, you know, whatever you may be working on in the classroom. 

Karina Kadhi: Because that phonemic awareness can easily easily ties into right that articulation therapy that we're doing.

Amy Wonkka: Well, and it sounds like just to connect it back to some of those learning objectives. One of the things we can do with SLPs to sort of get on that upstream thinking is making sure we're acting, asking these really specific questions with the other, you know, particularly if we're school based, but 

Heather Caska: also if you're in a clinic, you know, like you can, as long as you have consent, 

Amy Wonkka: like reach out and collaborate and have those ongoing conversations with the other, with the other members of the child's team.

And I think I liked your point just about asking. Asking questions about the specifics of the things that they're looking for in the classroom too, not just, Oh, how generally, how are they doing, but [00:51:00] how did they do on this measure that you looked at for all of the students in the classroom? Was there a pattern in their errors or something like that?

So I think those are really helpful points. And again, not, not limited to the setting in which you're working, like be part of, be part of the team as much as you can, no matter where, you 

Heather Caska: know, no matter where your 

Karina Kadhi: office is. That makes me think of another point that we, going again back to collaboration, um, that I I didn't mention it, but I want to highlight, um, just that collaboration, even within your own discipline, within your own team.

I always like to highlight the relationship between an SLPA and an SLP, um, because most of the time I'm the one that's doing the intervention and Heather is doing the assessment and send the evals, right? And so I'm, it's the SLP, the one who's doing, or the SLPA rather, who is going to notice these, um, Maybe early indicators or these red flags or, um, these areas to screen.

And so that collaboration with your supervisor as well, even [00:52:00] amongst your own team. Um, is really important because oftentimes the SLP who is gonna, who might be doing the collaboration with the, um, other disciplines, um, they may not know that student as closely as the treating therapist, right? So even, uh, collaboration within your own team helps these other, um, service delivery domains like screening and, and other ones we've mentioned.

That's a great point. 

Kate Grandbois: Can you tell us a little bit about the assessment process and all of this? I know we've sort of touched on it briefly in terms of whether or not the school is going to do the assessment, you know, how, but what is the SLPs role in all of this? You all obviously have a unique relationship and that one of you is an SLPA.

So that role is clearly delineated. But for a lot of us working in the schools, I say us, I never worked in a school for a lot of SLPs who work in schools. Okay. Thank you. You know, based on your state, based on your caseload, that might not be in [00:53:00] your case. Yeah. And in your role on the team that might not be part of your role.

So what is this upstream thinking? How does that, how are those two things related? 

Heather Caska: So the first thing I would, I want to highlight are just the areas, um, that we always assess when we're trying to identify a student with dyslexia. So we're always looking at phonological awareness. executive function, working memory, rapid automatic naming skills, receptive and expressive language, phonics, so that's that nonsense word and real word, um, assessments, reading comprehension, spelling, um, oral reading fluency.

So just like reading fluency at the word level, sentence level, and you then even. paragraphs and then written expression. So again, like the spelling and sentence fluency. So a lot of those skills are, are, we're already assessing anyway, as an SLP. And I always tell parents too, that come to me, like in just in a private practice setting, I'm going to give the same assessment, maybe not [00:54:00] the exact.

Same test, but I'm going to be assessing the exact same skills that were assessed or would be assessed by the school psychologist and the SLP in the schools. So it definitely overlaps. But again, the difference is the school's not going to give you a formal diagnosis. They can't. That's not what they do.

They are going to find you eligible under certain criterias in different categories. Um, so if I have a student and they say, well, they were just assessed at the school by the school psychologist, you know, within the last few months, um, and the SLP, then I'm just going to ask to review that testing. I don't necessarily need to do a full blown evaluation.

The data is there. They, they may not be able to give that diagnosis, um, there, but based on that data, and I typically. They will do a little more like baseline assessments or screeners. Um, a lot of times you're not as they don't do as much oral language testing. So maybe that's what I do is I add more oral language testing in, um, you know, to kind of look at that.

There's a big debate in our field whether or not SLPs can diagnose dyslexia, and I'm a big advocate that we can, [00:55:00] um, it falls under our scope of practice, um, but again, it's not something that if you're not well trained or knowledgeable in reading development, reading disorders, and you shouldn't be assessing and diagnosing without I'm not going to walk into a hospital and try to give relationships with someone.

Um, you know, like a fees exam or something like that. It's under my scope of practice. I technically could do it, but I don't know anything about that, you know? And so it's, it's kind of the same thing. We do have a very broad scope of practice. Um, You know, and, and it depends, you know, the diagnosis codes and, you know, that kind of gets into a whole other ball game, but, um, like within our state.

There is like a scholarship that's that parents can get through the state, you know, to get services. And recently one of my, one of my students was given, you know, sent their, their evaluation and that I did, um, he was diagnosed with a mixed expressive receptive language disorder, a reading disorder. Um, and I always just put in, you know, fits the profile of a [00:56:00] child with dyslexia, kind of like in my writeup.

And then they were denied because they were told that I'm not a qualified professional. And I like, and so it's, it's infuriating as an SLP who is a late were language experts. Um, there's no diagnosis code for reading comprehension. So if they're struggling with reading comprehension, which is well within our scope of practice.

I mean it's language, right, that we're still being seen as unqualified professionals. And so that's kind of like my next mission is like, I'm going to get that changed because you can't tell me that, uh, that a pediatrician or a doctor. Or a licensed psychologist is more qualified to diagnose the student with a language disorder.

And I think part of it comes back to like I, the fact that there was a reading disorder diagnosis on there too, but I was like that is reading falls under our scope of practice you look at Asha like how. How are we still being seen [00:57:00] as unqualified professionals for this? Like it's, it's so maddening.

Obviously I feel very strong, have very strong feelings about this because, um, it's, it's, it's just frustrating. Like, and I, I think that happens to us a lot in our field, you know, where we're not. I mean, acknowledged, acknowledged or recognized, we're not acknowledged or recognized, you know, for, for how much we do and how much knowledge we, we possess, you know, and what a difference we can make.

And so it's, it's just frustrating. But, um, I could talk about that all day. So, um, but yeah, so as far as like just being part of that assessment process, it really just, it depends on your role. I'm a big advocate that we should be involved. Um, there's a really great, uh, quote from Dr. Alt from Mary Alt.

She's a professor at university of Arizona and she, um, her and Dr. Shelley Gray, there's a, there's a whole collection of, uh, professors, um, from all over that are working on some [00:58:00] working memory research, and they had a podcast. Episode with Dr. Tiffany Hogan, where they were talking about some of their results as far as working memory and word learning.

Um, and she said, we don't always do a great job figuring out when kids have both oral and written language issues. And there's a lot of research that they're, you know, from their research that they're finding that, you know, students that have both oral and written language disorders struggle. There's there's.

They, there's, they're significantly slower to, to, to learn, you know, and we're learning. So we have to get a lot better at. Being part of that and identifying, you know, it's not just academics, there's probably some oral language things going on as well. 

Karina Kadhi: And that ties back to upstream thinking just with that early identification piece, the, the sooner and kind of that dyslexia paradox idea that we can play a role in upstream thinking through assessment by identifying early assessing early and therefore remediating earlier.

And really. [00:59:00] Um, getting a hold of these students, if you will, um, during that time when intervention is most effective.

And I 

Amy Wonkka: think to the point that you both made too, sorry, just to connect back to assessment by conducting that comprehensive assessment. Not only are you ideally remediating early, but you're remediating in all of the areas in which there are 

Heather Caska: deficits. So if you're early. 

Amy Wonkka: Ignoring kind of that oral language component and you actually have a student where that's a big challenge area for them and nobody's remediating in that area, that's probably also going to really influence their ability to have success and make progress in the way 

Heather Caska: that everybody wants them to.

Absolutely. 

Karina Kadhi: So we have a few, um, like three more, um, service delivery domains to touch on. Um, Okay. One that we can kind of do quickly is so one of those eight is treatment, but treatment I think we're going to cover our role in treatment, how we can support these [01:00:00] underlying literacy skills in the speech and language therapy that we are already doing.

On, on our next one. That one's going to be all about treatment. If so, it's such a in depth one that, um, treatment gets its own, uh, little dedicated spot, but 

Kate Grandbois: for those of you listening, if you are really dying to know about treatment, stay tuned because they're going to come back for another episode. That was a teaser.

Heather Caska: Sorry, 

Karina Kadhi: spoiler. Um, but in terms of our, our role in, uh, under treatment, I think the biggest thing to point that we want to point out is that our roles are going to be different in different settings, right? In a clinic setting versus a school setting, our, our role for treatment in a school setting is not going to be directly, um, those, the reading goals or the writing goals.

It's their speech and language goals, but to understand that we have, we do have a role in supporting that through the speech and language. That we're already addressing. And then obviously in a private practice or clinic setting you have a little [01:01:00] bit more flexibility where you might be actually addressing some of their reading or writing goals.

Um, another service delivery domain that falls under our scope of practice is that modalities technology and instrumentation. Um, and I like to call this just assistive technology. These past couple years working with that older population again, I've learned so much about, um, how to support them under this domain.

Um, have you guys heard of read and write? It's, um, yeah. Yeah. Okay. So they use it a lot in the school. Um, uh, so it is an amazing plugin that you add on to like your Google accounts and it, the tools that it gives you. I can do like the basics of like you highlight things and it'll read it for you. Um, or you can like the voice to type voice to text thing.

Um, but also some more. Complicated things [01:02:00] like you can if you're if you have a student who's researching something it can minimize the text on any website, so it makes it more manageable for them versus like this whole web page that not only I have to read, and then somehow understand it can it will minimize it for them so there's some algorithm it uses where it just minimize simplifies the context so that they get the main idea out of it.

You can generate vocabulary lists. Through what you're doing like just amazing, amazing supports and I was lucky enough last year I was working with a, a girl who, um, she really took hold of this and found just, she was so empowered by access to her regular academic stuff guys just on her computer right like she was so excited to be able to have access to this and, um, Participate in the class activities like the rest of her peers.

So, um, read and write is awesome. There's a ton of things that like orbit note. Um, so many audio books obviously are a good one too. So, so many things we could be [01:03:00] doing under this domain to support these students as well. Um, and then that brings us to the last area, populations and system. Um, how do you want to talk about this one?

Heather Caska: Yeah. So this kind of really just ties everything together. So as far as population and systems is, you know, we can play a big part of helping, um, kind of streamline everything a little bit more, whether you're in the clinic setting. I mean, we, my, my company specifically, we obviously we specialize in dyslexia, um, you know, and so that's kind of what I've based my whole practice around, but in the schools, it goes back to collaborating, you know, be part of that team, really.

We have so much to bring to the table, but then we can learn so much from others. Supporting the classroom teachers, collaborating with, you know, if you have something like we do here in Arizona, like the dyslexia training designee, occupational therapist, reading interventionist, a school psychologist, um, and then just always supporting those demanding, those demands, you know, like creating...

So just being more aware of, you know, that the 80 and [01:04:00] how can we support that in the classroom? Um, and then educating, you know, that's the big piece to really just educating others on our role, like what we can't, what we do and, and how great we are. Um, and how much we can support, you know, other, other professionals.

Um, and parents and students. So that's kind of the big piece too. It goes back, just keeps going back to collaborating and educating and, you know, just being aware of, of what we can really do. 

Karina Kadhi: Those, what it really goes back to is those three areas of upstream thinking and those things that we can do to that.

So that, um, That education, that early identification and that remediation. And that brings me 

Kate Grandbois: to my favorite question, which is what can our clinicians do from here? What are your words of wisdom for people who are listening to this, what action steps can we take from here?

Karina Kadhi: Oh, great question. So we always like to end with a little bit of self reflection and a plan of [01:05:00] action. Um, and then we want to leave you guys with one of our favorite quotes too. So I'll start with that. Um, this quote is by Rita Pearson. Every child deserves a champion, an adult who will never give up on them, who understands the power of connection and insists that they become the best that they can possibly be.

And so, um, we want to be our students champions, right? We want to help them, um, get through those difficult things and help them know that they can and that it's possible for them. And so, um, a plan of action, we like to break it up into two like short term and long term so short term going back to school and, uh, now if you're in Arizona, or here in a month or so.

What, what is it that you can implement when you get back to work, Monday or next time you you get back there like what is something that you can start doing in that your speech and language intervention that you're already doing what else can you start incorporating what other which one of those other domains.

Um, can you, uh, [01:06:00] maybe support them better or do something differently, maybe something you're not doing yet, um, and then try to think of two students on your school caseload or two clients that you might have, um, that might have some of those, um, early indicators of, um, later reading difficulty, and if they're already on your caseload or speech and language goals, um, then that's a, uh, kind of an indicator that there's, Some things you can embed into your intervention to support those underlying skills.

So those are, um, kind of two reflecting prompts we like to do for short term. 

Heather Caska: And then long term, I, some things that we like to recommend is do some research, find out what your dyslexia legislation is in your state. Um, you can literally Google, just put that in the Google, like Q would be Arizona dyslexia legislation.

Um, we have a dyslexia handbook through our department of education. And so most states will have that as well too. Um, I also really encourage you reach out to your local [01:07:00] international dyslexia association branches. All states have them. Um, if that, and that could mean literally just. Following them on social media.

Cause then you're going to stay in the know of when they're offering um, workshops or CEUs, things like that. Um, and then also just thinking about how can you support kind of like what credo is saying that an implement some of that early identification, um, you know, so just maybe pick one of those specific service delivery domains at first, so it feels manageable and, and what can I do like create a site differently or, or implement.

This has all been 

Kate Grandbois: so incredibly helpful. Thank you so much for sharing your knowledge and your time with us. For anyone listening, if you heard us discuss anything that piqued your interest, we will have a list of references in the show notes, including some hyperlinks to some resources that you all discussed today.

And as they both already mentioned, you can get in touch with these two lovely human beings at, um. At soar with words through their through their social [01:08:00] media channels at sore with words. Um, is there anything else you'd like to say? 

Heather Caska: Thank you. Yeah. Thank you so much for having us. Thank 

Kate Grandbois: you both. Great.

Thank you so much for being here.

Sponsor 2 Outro

Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

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