Stuttering Therapy: I don’t know what to tell parents and teachers!

This is a transcript from our podcast episode published September 5th, 2021. The podcast episode is offered for .1 ASHA CEU (introductory level, related area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.

A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.

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Kate Grandbois: We have the great pleasure of welcoming Nina Reeves back to the show today. And we spent 20 minutes in laughter hanging out with the great Nina [00:02:00] prior to this recording. So Nina, thank you so much for joining us again. We so love having you here. You're so much fun. Welcome.

[00:02:05] Nina Reeves: Well, thanks for having me back. I'm really happy to be here again, and I know that there are smiles. People can hear our smiles. So we're going to have a little fun talking about stuttering, certainly. 

[00:02:21] Amy Wonkka: And Nina, you are here to discuss communicating with parents and teachers about stuttering before we get started.

Can you tell us a little bit about yourself?

[00:02:30] Nina Reeves: Why yes I can Amy. I think that I think the major thing to know about me is that I'm a stutter nerd and everything in the area of stuttering or cluttering or any other type of fluency variation. I probably have read about it, talked about it, trained about it, and I just lovetalking to people about stuttering and working with children and adolescents who stutter in my private practice. And [00:03:00] I've been a school-based SLP all of my career because I really believe that that's a lot of where the rubber meets the road and that's where most kids are going to receive their therapy.

And so I love being in the public schools and I hope I can continue until they kick me out. 

[00:03:20] Kate Grandbois: I seriously doubt that will happen. Um so you mentioned a private practice. You are, I wondered if you could tell us a little bit about stuttering therapy resources, because you're for anybody who has not listened to one of our previous episodes with Nina um this is your third installment with us here in, in the, in the den of nerds, in the den of speech nerds, I guess letting you go, you're not trapped.

It's fine. We're going to move on. Otherwise, we're just going to keep laughing. So I wonder if for those of um so people look for people listening, who maybe aren't familiar with you and your work. If [00:04:00] you could tell us a little bit about stuttering therapy, resources and your website, because it is so full of information and so dense with resources.

And I wonder if you could tell our listeners a little bit about what they can find there. 

[00:04:14] Nina Reeves: Well, thanks for that. It's great to, to talk about that because um it's, it's our publishing company. So Scott Yarus and I have been co-authors and partners on so many things across, over the years. And we had written some books together and found out that um publishers, big publishers aren't as keen on stuttering as we are.

And so finally we decided to create our own publishing company so that we could keep our costs low and our value high. And so stuttering therapy resources was born at my kitchen table um 10 years ago in June of 2011. So, um happy anniversary to us pretty soon. And we, we loved just [00:05:00] creating our mission statement is to help SLPs help people who stutter.

And so our mission is to create resources and provide as much information as possible to SLPs who work with people who stutter. And then also we have resources for parents of children who stutter and for teachers, because we know as we're going to talk about today, we know the stakeholders around that child need as much information and support that they don't often get because they're not in therapy, right.

They're not there every week to have the speech language pathologist with them. And so we like to make sure that they feel covered in that way. 

[00:05:47] Kate Grandbois:So, and, and just for the sake of saying it, you know, one of the things that we're passionate about here at SLP nerd cast is connecting people with resources. And I want to make it clear that you have a ton of free resources on your website.

So if you are a speech language pathologist, [00:06:00] and you are interested in learning more about um working with people who stutter, please visit her website or their website um because there really is a lot of great resources out there to help improve your practice.

And you have been tremendously generous. Um and you've created a discount code. So anybody who wants to learn more can get 10% off on your website through the end of this year. So that's through December 31st, 2021 using the code SLP nerd, because that's, what other code would you use really? And um and the website is www.stutteringtherapyresources.com.

So now that we've got that behind us um we're really, really excited to learn from you again. I think, you know, Amy and I arequote, AAC specialists. So stuttering is not within our scope, but every time we talk to you, we learn something that is applicable to our practice. So I'm really excited to talk to you again today.

I think I'm going to start by reading our disclosures and learning objectives. [00:07:00] So Nina Reeves financial disclosures. Nina is the author and co-owner of stuttering therapy, resources, Inc. She has royalty and ownership interest in intellectual propertyn those resources, Nina Reeves, nonfinancial disclosures.

Nina is a past volunteer for both the national stuttering association and the stuttering foundation of America. Kate, that's me financial disclosures. I'm the owner and founder of Grandbois Therapy and Consulting LLC. And co-founder of SLP NERDcast. My nonfinancial disclosures. I'm a member of ASHA, sig12 and serve on the AAC advisory group for Massachusetts said, because for children, I'm also a member of the Berkshire association for behavior analysis and therapy, Mass ABA, and the association for behavior analysis international and the corresponding speech pathology and applied behavior analysis, special interest group.

[00:07:39] Nina Reeves: 

[00:07:41] Amy Wonkka: Amy,that's me. 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, SIG 12, and I also serve on the AAC advisory group for Massachusetts advocates for children

[00:07:56] Kate Grandbois: Learning objectives for the day learning objective number one, list three [00:08:00] aspects of creating a long-term support system for children who stutter. Llearning

Objective number two, identify at least four major concepts for educating stakeholders about the disorder of stuttering. And learning objective number three, describe two counseling concepts for learning to listen to and support stakeholders of children who stutter. 

[00:08:18] Amy Wonkka: All right, Nina. We had such a great time talking to you last time and the time before last time you, you know, you know how it goes, tell us all the things, you know, drop some science, no pressure. Yeah, let's go. Let's go.

[00:08:26] Nina Reeves: Cause it's going to be, you know, it could be a short one. It could be a long one. It depends on what you want to know about, but we're going to really, I think, try to focus our energies today um on the overarching purpose of any stakeholder contact. Okay. Because I, when I say stakeholder, think parent, think teacher think grandma, grandpa um daycare provider think um [00:09:00] educator, all of the people, peers, siblings, these are all people who have a stake in the environment of being with a person who stutters because stuttering doesn't happen in a vacuum.

It happens in a dynamic family and communication environment. So when we have any kind of stakeholder, stakeholder contact our our greatest mission, in my opinion, is to look at whatever that contact is and say, am I in this moment, doing my best to create a long-term support system for this child, because the people surrounding this child, you're not going to be with them forever.

There's going to be SLPs who come and go in their lives. There are going to be times they're not in therapy at all. And the people around them. If we can help the [00:10:00] stakeholders, understand the disorder of stuttering and understand the lived experience of the person who stutters. I think that can reframe so much for our students and provide them with a long lasting support system that is going to go in, in the positive directions and not take a, let's say a child who stutters down the, you must be fluent or you're not doing the right thing road.

And so if you want to create a long-term support system, one of the first things to do is to meet the stakeholders where they are. Now, this is a tough one for, for us as professionals, because we tend to focus a lot of our energy on our students, which is great on our students and clients. It's supposed to be student centered.

Right. But it's family based. It's community-based, it's [00:11:00] environmentally based because that's where communication takes place. So if we want to help that child who stutters throughout their lives, we've got to find out what do these stakeholders know about stuttering? What do they understand about stuttering?

And I'm going to talk about why those are two different things in a minute. We have to do a lot of listeningsts. A lot of gathering information from parents and teachers and others to find out their stories of what, what they think about stuttering, what their perspectives are, and then not only collect that information, but validate their feelings cause their concerns and their journeys are so relevant um to the journey of the child who stutters.That's [00:12:00] number one. 

That's [00:12:00] number one. 

[00:12:01] Kate Grandbois: I, I just, okay. We're like less than 10 minutes into this and I am already having brain explosions. And I just want to recap two things you said that I ,CA I think we could repeat on repeat for this entire hour, because they're so important. Number one, the importance of having considering that stakeholders are with that student or client or child for the long term and you are transient and accepting that I feel like is critical, but number two, learning, meeting people where they are in terms of their own learning.

So we do this with our students, but for some reason, when we go to train communication partners 

or stakeholders, if they're adults or our peers in some capacity, we just expect them to understand it instead of really taking a minute to reflect on our own bias, really take, you know, ask them some of those, use that counseling approach to listen and ask open-ended questions and then validate.

I mean, that is just so amazing. So yes. Thank you [00:13:00] so much for saying that. I have nothing else to contribute. 

[00:13:02] Nina Reeves: Well, thank you for that. And, and, you know, to that end, you know, when we talk about listening to their stories and validating their own journeys, because they're on their own separate journeys of learning, how to deal with stuttering in their families, in their classrooms um to that end, if you're going to validate their thoughts, their concerns, you've got to know what they are.

So the second part of trying to create a long-term support system is to um recognize and support those social, emotional aspects of the, of the people surrounding the child, because the pain of a parent is really. It's, they, when they lack confidence in understanding and knowing what to do when the child is stuttering, that's real, but it's also normal.

It's not abnormal for a parent not [00:14:00] to know what to do with stuttering. And we have to take that into our own consideration so that we understand when someone reacts, what we think is incorrectly,.i It's not incorrectly for them because their, their knowledge of this disorder and how to handle it is lower than ours.

So we're there to support that. We have to find out what, where they are and support their journey with that. And anything that they do to react or respond to the stuttering um or to expect something from us in therapy. To the idea that our, the goal for them may be different than the goals we understand we can do.

That's also real and normal. And so even if we have to step in and try to give the bigger picture, that's part of our role, we can, and we must [00:15:00] respect that heart space of the people surrounding this kiddo, because they're not coming at this from a head space, they're coming at this from fear, worry concern.

Um and that is, um, where they're at. And if we can't help them manage that and work through it, you know, who is it? Is it, did David Luetterman say you can't solve a problem at the level that it's created or is that Wayne Dyer? I think that's a Wayne Dyer thing. So when if, if a parent is in fear and stays in constant fear about how their child is going to do, and what's going to happen to their child, then problem solving is out the window because our cognition doesn't play well in fight or flight.

Right?. And I think that's an important concept when we want to [00:16:00] recognize and support the social emotional aspects. 

[00:16:04] Amy Wonkka: And maybe you can talk a little bit about, I think so often in our culture, we're not comfortable as clinicians with those feelings because we're not comfortable with those feelings. So I think part of it, part of what can be challenging for me, not, not in the context of um working with people who stutter, but as a clinician is, you know, kind of reminding yourself that it's okay.

It's okay for people to feel these feelings. 

[00:16:39] Amy Wonkka: And it's not that we're all working toward this narrow continuum of like, it's okay to feel happy and to be actively working toward this one thing. And those are the only emotions that are kind of acceptable. I didn't know if you had some tips for clinicians to step out kind of like navigateppy, like the, you can tell that the family is feeling these feelings. Like if you're uncomfortable about that, [00:17:00] how do you help them?

[00:16:59] Nina Reeves: Like if you're uncomfortable about that, [00:17:00] how do you help them? Well, um, it's, it's so interesting for clinicians to move into a space of dealing with feelings. If they haven't dealt with some of their own feelings. And if they don't have a lot of that type of experience, then this may be challenging. So one of the things that can help is that um speech language pathologists can learn more about counseling.

Okay. We're not, we're not trying to be counselors. Let's, let's get that fact right out there. I'm not saying I need you to go get a counseling degree, everything I've learned about counseling. In communication disorders is it's counseling based. It's from the psychological literature, but it's brought into communication disorders because that's our scope of practice.

[00:18:00] But if we don't know that we have to deal with feelings, then we're probably not going to sit at an IEP meeting and feel very comfortable because when we diagnose um a challenge for a child, there are going to be emotions. And so I think helping people navigate those feelings and not try to run from them.

Pretend they're not there. No, you can't feel that way. So that validation is um is part of it can be learned. That's the good news is that these types of things can be learned. And if you don't know a lot about it, there are places, you know, we were talking before the show about acceptance and commitment therapy, you can learn about soaboutso many things, but if I can give you a resource that I've probably given before, how to talk, so kids will listen and listen . Sso kids will talk by Faber and Mazlishslin. [00:19:00] I mean, talk about learning how to speak with people so that they feel comfortable sharing with you and then learning how to not, you don't have to get on the rollercoaster with people, right.to help them. But you can acknowledge and validate because as you were saying, Amy feelings are feelings. There are no good feelings and bad feelings, positive feelings and negative feelings, they're all feelings and they're all okay. And they're all normal. And I think that's what we have to remind ourselves of as clinicians.

[00:19:42] Kate Grandbois: Okay. I just, everything, everything you say is brilliant, but that aside u m just for the sake of saying it, I think my personal takeaway from that is not isn't the instinct of pushing your feelings away or it's more about accepting them and changing your relationship with them. [00:20:00] So, as an example, if you have anxiety using some of these strategies to, instead of say, don't have anxiety, you say, well, anxiety, you're here.

I'm going to change my relationship with you and start to accept it. So if you um we have two podcast episodes published on acceptance commitment therapy um with a whole bunch of show notes that with lots of literature and books and references. So if you are interested in learning more about acceptance commitment therapy called ACT actum you can cruise over to those show notes and there's a lot of books and references.

I just wanted to mention that quickly. 

[00:20:31] Nina Reeves: Yeah. And it's okay if you're feeling nervous about that, if you're thinking, you know, I'm not a counselor except that you are, because guess what? Ccounseling is a lot of? Ccommunication. Counseling is communication. It's listening. It's um reflecting. It's a lot of how you say what you say, and if we aren’t at semantic people, I don't know what we are.

And so I think that [00:21:00] understanding that counseling is a part of our scope of practice. And instead of running from it, moving towards it and saying, I don't have to have a counseling degree to be better at this. And then that then serves my students and their families. And by the way, makes my therapy outcomes much more long lasting.

[00:21:29] Amy Wonkka: I think those are such great points. I also just want to put in a plug for, we interviewed Dr. Luterman, who's another wonderful um podcast to listen to. I felt like that was another mind blowing episode for me. And I really enjoyed that. We talked a lot about this. Yeah. 

[00:21:47] Kate Grandbois: And, and I, I just think it's, it's another component of our skillset as speech and language pathologist that is relevant, no matter who you are working with, it doesn't matter because communication impairments [00:22:00]  are, create emotion either for the individual who has the communication impairment or the stakeholders or the family, or the friends or the siblings or the neighbors, or et cetera, et cetera, et cetera. So, um and it's not only those skills, not only give you better outcomes, they also teach you self care because as you said, if you are, you know, not able to deal with those emotions personally, then you really need to do some of that work to bring more to the table. As the, as the saying goes, you can't pour from an empty cup. 

[00:22:00] Nina Reeves: are.

Create emotion either for 

[00:22:04] Kate Grandbois: the individual who has the communication impairment or the stakeholders or the family, or the friends or the siblings or the neighbors, or et cetera, et cetera, et cetera. So, um and it's not only those skills, not only give you better outcomes, they also teach you self care because as you said, if you are, you know, not able to deal with those emotions personally, then you really need to do some of that work to bring more to the table. As the, as the saying goes, you can't pour from an empty cup. 

[00:22:22] Nina Reeves: 

[00:22:25] Kate Grandbois: 

[00:22:28] Nina Reeves: [00:22:30] Kate Grandbois: 

[00:22:36] Nina Reeves: 

[00:22:39] Amy Wonkka: I have a question. Nina, you mentioned the difference you, how you're gathering information about what the stakeholders know. And what the stakeholders understand, or stand, how do you figure that out? 

[00:22:45] Nina Reeves: Well, um, well, it's a Luterman thing. I mean, let's talk about it, you know, we're geeks of um Dr. Luterman. So I am [00:23:00] going to say that one of the things I've learned from him um is the idea that um and I, and I'll say this again in, in, in this episode, but knowledge is not counseling. Okay. Knowledge is at the level of cognition. Okay. So I can spout information. So information is great and it's important.

So what stuttering is what stuttering is and who caused it, nobody caused it. What? Okay, so we get all of that and I'll be talking about that in a minute, but that's not counseling. Right. That's informing. And so information is fine and that's how we know. No something, but understanding, and my, my experience is taking it from your head and getting it to your heart.

And that's the understanding of what stuttering is. It's [00:24:00] experiential. Even if I don't stutter, I can listen to the lived experience of people who stutter. And I cannot maybe relate to being out of control of my speech mechanism, but I can relate to feeling out of control of other things and feeling like I can't get my point across sometimes, you know, cause everybody doesn't stutter.

That's a myth, but we all have things that we can find common ground in. And that's, I think where the understanding part comes in.

[00:24:41] Kate Grandbois: I think that makes a lot of sense. I wonder if um you could talk to us a little bit about just the, the, not only the reasons why it's important to educate and counsel stakeholders, but maybe when are their conceptual [00:25:00] frameworks that you use, what are the cornerstones that guide your education when you're really working with, with families?

[00:25:06] Nina Reeves: I absolutely would love to talk about that. And it's, it's going to surprise you that the cornerstone that I use is in our ASHAAshleigh scope of practice, but I'm going to get to that in just a second. If I can um go back to the idea of the long-term support system, Um I want to give two more, very self-explanatory, .

I don't need to narrate through it, but a couple more points on that. I believe that we have to see caregivers as an extension of our students' needs. Okay. So whatever our student needs, those caregivers are a part of our therapy. They're not ancillary. They're not something here's your hand out now go forth and prosper.

You know, it's like, you've got to know that [00:26:00] working with and through the caregivers is going to serve that student's needs and make your outcomes more effective. The other thing is we have to think about getting people connected. On this journey. So there are so many ways to connect parents with other parents to connect all of those caregivers with other people who are traveling this road with someone who stutters in their classroom, their family um in their, in their space.

And um there are organizations and we'll put those in show notes. These organizations live and breathe to help people who stutter feel supported and connected with each other because there's a fellowship among people who stutter, just like anything else. When you find like individuals, there can be a power um [00:27:00] that your speech therapist has been telling you this stufftime.

aAd nauseum, but all of a sudden, another parent of a kid who stutter says it, and then it's like, wow, I didn't know that it finally comes. 

[00:27:13] Kate Grandbois: You're making me think of something that David Luterman said to us, which is the power of support groups and how it is completely within our scope as speech pathologists to create and facilitate support groups.

And what that, what you're saying just makese, it just seems to hammer that home so much. 

[00:27:34] Nina Reeves: Yes. Because there are national ones, there are regional support groups. There are local support groups. And if there's nothing around you, you can do something in your district, within your own practice to try to find that connection, because it doesn't always have to be people sitting in a room, especially what did this year teach us? .

Hello. [00:28:00] Now, if you go to a national stuttering association support group, I can tap into the one in New York. If I want to. If I just look on the website, find out when they're meeting and I can, I used to not be able to do that. Now I can, I don't know how long that lasts, maybe forever, but it doesn't always even mean that, you can do newsletters.

You can look at um internet searches as long as you're vetting them first, please, please. And um you know, you can find ways to connect for kids or parents who may not want to like go to a group or tap into an internet group, but may read an article or a newsletter or watch a YouTube. 

[00:28:50] Kate Grandbois: Those are really great resources.

[00:28:51] Nina Reeves: Yes. And so that's the connection part. So that's for that long-term support system. And I'm going to, if it's okay. I can go [00:29:00] on to the idea of what are we going to inform? How are we going to inform. that sounds great. Okay. So before I go that way, let me do a little Luterman and I'm sorry if people are so probably sick of us talking about this, but um we've bonded over this and we found Dr. LutermanLindemann in different ways, but he, he resonates. And so we know that he is out there as a resource, and I, I love your, your episode with him. It was amazing. And so his most recent article, which we will put in the show notes um it helped me reconceptualize something I knew I was already doing, but didn't do to the extent that he's talking about and didn't have words for, I was just doing it.

So I love a good, somebody who helps me understand what I'm doing. And so, um that, [00:30:00] that listening and support of the stakeholders and how much, and when we give information is very important. Cause I'm going to talk about the information in a moment. But before we do that, let's think about, he called it in the um, in the article, which when he calls it the client centered model, switching out of that medical model of dispensing information and switching into um listening without an agenda, which is something we were not trained to do. We always had ado. A clipboard and a checklist. Um and then including the stakeholders in the assessment and diagnostic process, it's like, I always knew I was including them in the goal writing and planning. And of course in collecting the [00:31:00] case history data and all of that, but maybe not as much in the actual, here is the transcription. 

Here's the video I took of your child. And these are the moments in the transcription that I think are salient for you to see. And this is what ended up showing up on the paper, instead of just talking about what's on the paper, this is why this is on the paper, and this is how we framed whatframedwhat I learned about your child's stuttering and his experience with the stuttering.

So I just think that's amazing. And then I love how he talks about the judicious provision of information. That's a greatIn other words,. Oh my gosh. I just love that because it helps me not do the big dump. Here comes everything you need to know about stuttering and stuttering therapy., um mom and dad, um caregiver teacher [00:32:00] in this one IEP meeting, here's all of it.

And so they're not going to remember it. They're not going to understand it and it's going to be overwhelming because they just got a diagnosis or a confirmation of a diagnosis. So it's about asking, what do you need right now? Doesn't mean, you're not going to give more information later, but what do you need from me right now?

What do you need to know now? And then parsing out judiciously information um Mo uh, but acknowledging that info is going to bring up as we were just talking about painful um feelings, feelings were, and, and trying to help people move toward their feelings rather than away from them, which is something that humans aren’te fabulous at all the time.

And so I think the um, [00:33:00] acknowledging the fact that before we even give one piece of information, we have to, I call it swivel your chair around. Okay. So put yourself on the other side of that table and realize you're about to talk about not just data and info and research, but you're going to, you're going to be sharing in this family's lived experience.

And at that point they don't need a lab coat. They don't need a clipboard. They need a listening air and a validating spirit, and they need you to watch what they're ready for and ask what they're ready for. and validate spirit.

[00:33:48] Kate Grandbois: I'm sorry, I just cut you off, but I just love that so much. That's it? That encompasses so much.

It's so simple. Sorry, go ahead, Amy. I was, I was overcome with emotion.

[00:33:58] Nina Reeves: Amy Wonkka:You're [00:34:00] feeling it, having feelings you were!

[00:34:00] Kate Grandbois:, 

[00:34:03] Nina Reeves: 

[00:34:06] Amy Wonkka: I mean, I feel like this is something that I'm still working on. Having been a clinician for quite a while, it's not something that is necessarily easy. If it's easy for you, that's amazing, Um but I feel like, you know, it, it is almost something if it doesn't just come naturally to you having that, self-monitoring to kind of check in with yourself as a strategy to say, okay, am I doing an information dump, possibly because I'm not comfortable with either being there for someone else's feelings or helping navigate that.

And um my, I try to compensate with, with just more information and expertise than my lab coat of my clipboard and my numbers. And, you know, I think that even, even just little things like that, like you were saying, you know, it can be, it can be learned. And, and just like we might ask our students to self-monitor for these different things.

I feel like that's a strategy that people can [00:35:00] think about using too is just, you know, do a check-in with yourself. Are you doing, are you employing the strategies that you. Wwould like to employ because you know that they are beneficial to your treatment of  the whole client, including all of those stakeholders.

[00:35:12] Nina Reeves: 

[00:35:13] Amy Wonkka:

[00:35:18] Nina Reeves: That is brilliant because I'm going to say checking in with yourself,. Llet's get honest about the fact that even research tells us, clinical anecdotal evidence and research tell us that stuttering and other fluency conditions are low men on the totem pole of comfortableness and confidence for speech language pathologists.

So you're already coming to the table with feelings, feelings of uncomfortableness, feelings of inadequacy, feelings of, oh my gosh, I want to help this person, but I don't really know how, feelings of [00:36:00] fear. And so when you, uh, if you're not checking in with yourself, you are going to do the information dump in the clipboard, because guess what, that's comfortable.

I can get this off the internet. Like I can read Scott Nina's book and I know, you know, the ICF model and blah, blah, blah, blah, blah. And then it just becomes rote info instead of a connection with where are these people at and what can they, what, what are they ready to handle?

All right. And I want to, and I don't want to run out of time. So if it's okay, I'm going to lean towards the enhancing the understanding of stuttering part of this, because I don't know how to not give info. I just know better now when to give info. So, when um and, and how much at a time, um, depending upon the person that I'm working with, but [00:37:00] the good news is, is that understanding um some information about stuttering can be easily frameworked within the ICF model, .

oOkay. Which is the world health organization, ICF model diagram, that's in the ASHA scope of practice. So ASHA.org. Scope of practice. There's the ICF model and um Scott Yaris and um Bob weasel had adapted it for stuttering and now um Scott and um Dr. Seth tensioner, he's a PhD. Whew. um I have readapted it.

Um and it's so helpful. Um you can find a lot of that information on the app. Um oh, practice portal, ASHA practice portal. And so [00:38:00] please, there's a lot of evidence maps and things there that you're going to want. If you ain’t been there, you ain't been nowhere right now. So that's a good stepping off point.

It doesn't give you everything you need to know, obviously, but there's a good place to start. And so this, this model in this diagram, helps us go back to what we talked about before bringing the big picture to the table because stakeholders and people who stutter can be um laser focused on what's happening in the mouth.

Just because that's what they see on the, it's the surface stuttering behavior. And people don't understand that there's a whole lived experience underneath that. There's a whole person and a whole picture. So, quick rebrief. Reba rebreathe of the ICF model function, reaction environment, and impact. So is there an impairment [00:39:00] in the body function or structure?

Okay. And for stuttering um it's the moment of stutter. It's the out of control moment where the, the speech won't come out in some way, there's extra tension in the speech muscles. And so there's a moment of stuttering, reactions is how I think, and I feel, and what I do in reaction, not just in the moment of stutter, but in reaction to the other aspects of the ICF model, which are environment, talk about stakeholders, environment and impact am I M umam I reacting to .

tThe fact that I think you're going to think something, or that you might look at me funny, or that I don't want to raise my hand in class. So that's the, the, the environment and the impact coming in to this thought and [00:40:00] feeling, and moment where I decide what I'm going to do. Am I going to talk or not? Am I going to say the word I want to say or change it?

So function, reaction environment, impact. They all feed on each other and I could do three hours on this. So I'm just going to say if you want more information, there's plenty of places to get, to get further into this, but bringing that big picture helps everyone immensely because when you're doing goal planning and therapy and there's no longer ever a goal about percents of fluentid speechd, right because you understand that's, that's,  a drug that's trying to address a surface stuttering behavior and missing a lot of the other parts of the ICF model and the lived experience of stuttering.

And so when that [00:41:00] starts to happen, you're going to need to explain it to the parentsmerits. Well, here's the ICF model that helps them take it from just looking at the stutter and looking at the experience of stuttering and seeing that therapy is a lot bigger than that moment of stuttering. It's not all about strategies or fluency.

It's about how do I learn to come to terms with, to handle my stuttering, to feel comfortable and confident communicating whether there's a stutter or not. Am I saying what I want to say when I want to say it to who I want to say it too. And that effective communication overarching goal shines through in, in the ICF model, because what we're trying to do, our role is not to get a kid fluent.[00:42:00] 

Our role is effective, confident, spontaneous communication whether it's stuttered or not. And so that comes through when you're helping caregivers and stakeholders understand that bigger picture. 

[00:42:25] Kate Grandbois: 

[00:42:25] Nina Reeves: 

[00:42:26] Kate Grandbois: Here here. I just, the focus on communication and independence and competence and the whole person is it's just a wonderful lens to look at this through.

I don't want to derail you cause I know we have about 15 minutes left and you have a lot more brilliance to tell us, but when you were talking, it didn't make me think of a question: in looking through this lens in treating um you know, in working with stuttering and people who stutter. There is a lot to work on outside of the mouthask.

[00:42:45] Kate Grandbois: 

[00:42:42] Nina Reeves: Right. There's this, you know, this component of um you know, the emotional piece, the social piece, the stakeholders, when [00:43:00] you're a school SLP and you have three times 30 or whatever's on your grid, or I'm not sure what the standard would be, depending on where you are. Do you have recommendations for how to use your time effectively when you don't have regular access to the family, or when you, you know, you have legitimate workplace barriers that might make it feel like addressing some of these things is impossible.

[00:43:24] Nina Reeves: That is a fabulous question. I do have some recommendations for that because as a school-based speech language pathologist, I am a firm believer in the idea that quality therapy can be done anywhere you are. So let's just say, for instance, I, you know, when I'm in my school setting, I don't have as much access to the parents or the families, but guess who I have access to?. TheLet teachers and the peers and pretty [00:44:00] much probably the siblings. So there is unbelievable amounts of trade-off here that can help us understand. There's not, it's not just one place gets you the best because in my private practice, I have access to the families.

But I have limited access to the peers and, or the teachers.

 Kate Grandbois:Interesting. 

Nina Reeves: And yeah, the teachers let's forget that they spend more time with the kids sometimes in that hundred and 80 days than the parents do. Hmm. 

[00:44:34] Kate Grandbois: Hmm. Which is totally okay.[00:44:37] Nina Reeves: That's not a moment. That's not a moment of 

 judgment, but 

[00:44:38] Kate Grandbois: I mean, that's the, that's the life, that's the life schedule of our students.

I mean, school is a huge, we say this in AAC all the time. You know, if you don't consider the school placement, you're missing how many hours in a week of an environment. So the, the thought of, you know, as that school, SLP, who's listening and saying, okay, I don't know how I'm going to tackle all of these things in my [00:45:00] speech room.

You know, with the time that I've been allotted to me, I love the idea of embracing your school environment more as, as your stakeholder. That's brilliant. 

[00:45:12] Nina Reeves: And, you know, the, the idea is we all have, you know, and I'm going to be one of those people that just says, I know there are roadblocks, and I know there are stepping stones around those roadblocks, over them, through them, around them.

There are ways to get this done. And there is no such thing as the ideal setting. So every, every school SLP is to think of. Well, you know, private practice is much more ideal for doing stuttering therapy. That's not really true because think about how many times they're coming to therapy with some of their peers from their class.

And when you treat stuttering, as you know, everybody has their thing that they're working on and stuttering is normalized in your [00:46:00] therapy room, then it can become normalized in the hallway, normalized in the classrooms, the cafeteria and the bus. Yes. It all goes to the role of the SLP is to make certain that they're setting, no matter what setting they're in that they're setting an environment of acceptance of stuttering and normalizing and de awfulizing it and making it just the other, not de validating that it's a thing that, you know, this child may be struggling with, but not treating it as, oh my gosh.

You know, this kid has language and this kid has artic, but oh my gosh, this kid has fluency issues. And it's, you know, it's another communication condition that we work with. 

[00:46:51] Kate Grandbois: Thank you for answering my question. Carry on, carry on. I felt like I interrupted your flow and like the last bit, but I had to ask. So thank you, for answering.

So 

[00:46:59] Nina Reeves: thank you, for answeringFrancis. [00:47:00] No um I'm glad you asked because the other thing I want to say is. Because we're talking stakeholders today. One of the ideas that I would throw out there is the speech note, a book, and we write consistently in our, in our clinical guides for school, age, and early childhood, you're gonna um you're going to see these kinds of activities all through the books that we are putting it down in a notebook or, I don't know an iPad. Now you can do it on your whatever platform you're using and making sure that what we're working on in therapy is being recorded in ways that then becomes the encyclopedia of stuttering. And then they're sharing it with stakeholders, parents, teachers, theirre, their assignments are in there, and yes, there are assignments and stuttering therapy um because [00:48:00] it'll be what happens between the therapy sessions that makes the progress, not always what happens in the therapy sessions.

And so, um bringing that big picture into that notebook so that the parents aren't always seeing this is the strategy we worked on today. Some days you're not going to work on strategies. I know that sounds like heresy. . I know people are like driving off the road right now. What, what do you mean we're not working on strategies?

Um, no, I just don't drive off the road, parkparked the car, have your moment and then get back on, carry on. But I, I, I think it's important to know. We have a free resource about how to start the stutter notebook and there's, there's lots of information out there for school-based SLPs and wherever you work to create that space of continuing the conversation.

So parents and caregivers and teachers can feel connected to the [00:49:00] therapy. This isn’t cCurb therapy. We're not going to drop them off with the therapist and go cure the kid, bring him back. This, this is not how it works. So, you know, family, it's family based child centered. And so we want to make sure that everyone understands not just from the IEP meeting or from when you sent home the progress reports.

But more, more times during those um those therapy sessions where the child can really teach the teacher what they're learning or teach their parents or siblings, what they're learning in therapy. So it's an important part.

Aanyway, because so many good ideas, so many good ideas. Oh my gosh. I, you know, that's why I do what I do. I might be passionate about this, but I don't know. All right. So there's another thought that I just want to make sure that we [00:50:00] get to, is the idea that, okay, from the ICF model, we are giving information, not just about the origin, but about the big picture um and that we don't want to stay too far in our heads, but make sure that we ask and check in.

So how does that feel to you when you learn about this? Because in your gathering of information, you may have found out that the parents think that stuttering is caused by anxiety, and you're going to have to debunk that myth. And you're going to have to talk about neurology and possibly genetics. And if you're going to talk about either one of those things, you better be ready to talk about the feelings that are going to emote from that.

Right? So checking in with them and asking them how they're feeling and knowing you don't have to fix the feeling. You don't have to fix it. [00:51:00] You can just listen to it, validate it, understand it, and you don't have to try to help them make that go away. Oh, don't be afraid your kid's going to be fine. Oh my gosh. 

Please stop talking. Okay. You don't have that crystal ball that Dr. Lutermanindemann talks about nor that magic wand. So let's just let that flow, and just realizing that timing is everything, reiterating that you're going to give information over and over in small pieces when people are ready for it. And sometimes when they're not, but you've said it and then when they're ready for it, this is the fourth time they've heard it.

And they've heard it from you and the stuttering foundation and the national stuttering association and blah, blah, blah, right. Or one of our YouTube that we did for parents um over the, the shutdown. We have those [00:52:00] for free on our, on our YouTube channel. You can get them from our website. You know, there's, there's a lot of info, good, solid information out there, a lot of not good solid information. 

So please make sure that you're looking at it before you refer it. 

[00:52:18] Kate Grandbois: And being at being an informed consumer of information is critical no matter where you are in life. But I think it's even more so when you're considering, you know, working, working with some, you know, soft skills, collecting information and, 

[00:52:33] Nina Reeves: um

[00:52:33] Kate Grandbois: you know, using it to improve someone else's quality of life, that's really important to make sure you're consuming  the right information.

[00:52:38] Nina Reeves: the right information.

And, and that's that you just did my wrap up, but that's cool. What I want. No, it's fine because it, it kind say it 

[00:52:48] Kate Grandbois: You kind of say it better than me though. You're going to do it. So just do it. Okay. 

[00:52:53] Nina Reeves: Fine. Well, it can't be stressed enough thatum [00:53:00] not only do people need to understand stuttering, but they need to understand stuttering therapy, right?

So that ICF model feeds both of those parts, understanding stuttering, understanding the fact that stuttering therapy isn't going to be just on one of those things. It's going to be on the big picture and that it's going to be longer term. We are not going to have a discussion about when is he going to stop stuttering, right.

Or that, oh my gosh, he's still stuttering because that's what stuttering is. And those are very tough things for stakeholders to hear for kids to understand for, for speech, language pathologists, to say. But the truth be the truth. And we want to make sure that we're coming from an evidence base and evidence shows that we don't cure stuttering.

So, um that'll help the savvy consumer part of the parents' [00:54:00] world so that they can become savvy consumers of what they see online so that they're not chasing the next big thing in, in the stuttering community, we call it chasing the fluency God, and you know, like, what's the next best thing that's going to, you know, Ms. Nina can't promise fluency, but you know, this guy on online says he can do it over the phone in six weeks. Let's go, well, you know what? I'm not going to I'm, we're going to have a discussion about being a savvy consumer and where is the evidence and who gathered it? And where's the training we're going to do that.

But if that's the journey, the parent needs to go on, that's the journey. Tthe parent needs to go on. And so I don't, I try not to drive agendas. I try to help support knowledge and understanding so that people can make informed decisions on their own. 

[00:54:55] Kate Grandbois: And this loops back to what you were saying at the beginning about making sure we're not only considering the, you [00:55:00] know, not only considering the stakeholders, but meeting them where they are and doing some of that active listening and validating.

I wrote it down when you said it, listening ears and a validating spirit, because I was just so good. And I, I, it's just, you just keep talking, just, just wrap it up. Nina. It's just so good. Wrap it up.

[00:55:14] Nina Reeves: Okay. Well, you know, um I think I just spoke to the fact that understanding um therapy, um is different than just understanding stuttering.

And we want to make sure we're feeding both of those um levels of understanding over time. One of the things that as we come to a close, I want to remind us all about is that the stakeholder roles are varied. Okay. The teacher is different than the parent. You know, everyone needs a certain sort of synergy of information and understanding, but there are pressures [00:56:00] on parents, .

cCcaregiversaregivers, um that are different than the pressures on the teachers. And I think what we want to find out is what are those pressures that they feel? For instance, a parent just reminded me, like I knew this, but thank you for the re- remind is that there are a lot of parents and caregivers who are being pressured by the people surrounding them in the family, the extended family.

And so they feel pressure to try to teach all of them, but they're still learning themselves. And they're feeling pressure to tell the grandma, Joan, not to do stop, start over, take a deep breath, think about what you're going to say and just relax. And because they know that that's no longer part of what they're going to do when their child is stuttering.

The other people in the environment are still maybe on a different page. And so that [00:57:00] caregiver then feels that pressure. And so just realizing that it's not just the person who sits in front of you at an IEP meeting or brings the kid to therapy, it's the people surrounding them. All of my kids are starting to go visit family again. 

And we're starting to have a lot of conversations about what doeis your extended family know about your stuttering and who told him, and who's, who's in charge and, you know, making sure that not just the parent feels that pressure, but maybe the child can be part of helping people in their environment, understand what's going on and setting their own boundaries and advocating for themselves.

There's a power in that as well. 

[00:57:45] Kate Grandbois: Here here. I mean, it's, it's very hard to follow up with something when you speak Nina, because it's chopped full of lots of really good nuggets. I, I you've said everything. [00:58:00] I really can't contribute much else, but in our, in our last minute, do you have any parting words of wisdom that you would like to leave our audience with?

[00:57:53] Nina Reeves: 

[00:57:53] Kate Grandbois: 

[00:58:10] Nina Reeves: Oh, you know, I think most of it, it, since we're on the, the idea of stakeholders, mostly what I would say is that, you know, as a speech language pathologist, your role may feel overwhelming. When we talk about all of these aspects of stuttering therapy that maybe you weren't trained on and nobody talked to you about, but there are resources out there.

There are people who want to help this next generation and all the generations of speech, language pathologists. My, my world is about helping SLPs feel comfortable and confident in what they're doing in stuttering therapy. And then that feeds the caregivers, the students, the [00:59:00] teachers. So when we get better at what we're doing um and I think we talked about this in one of our sessions.

It's okay if you didn't get trained in this, but if you're 30 years into thisold, and you're still not sure what's going on. Then it's time to move towards that icky feeling of being okay to be vulnerable and get in there and get our hands on the experience of working with um people who stutter and making sure that we're mindful that it's not all technical right.

There’s aA lot of clinical expertise that we can bring to the table. And you've got a lot of it already. You just forget that it's there because the word stuttering appears and stuttering, emotes fear. And I'm going to tell you, bring everything that you know about communication and pragmatics [01:00:00] and language load, and all of those things that you already know and bring them to the table in stuttering therapy.

And it's going to serve you well. 

[01:00:09] Kate Grandbois: That's awesome. Thank you again so much Nina for being your brilliant self. Uum if anyone would like to use this episode for ASHA CEUs, they will be available on our website, just cruise over to our website, find this episode page, and you can follow the prompts. All of the resources that we listed today will be in the show notes.

So if you're out and about in your car, you know, I was about to say on your bicycle, I don't bicycle. Maybe someone's on their bicycle, walking around doing, Amy bicycles or cycles. I don't know, but if you're out and about, and you are looking for a list of the resources that you've heard today, they are all listed in your phone, in your show notes.

I'm very proud of us. We didn't laugh or break into a fit of laughter. Not one time. This was ,I'm very proud. We didn't cut our pickles out hard, to pat ourselves on the back here. You know, you're always welcome here and we love having you thank you again for your [01:01:00] time. And we hope everybody learned something here today.