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Intro

Amy Wonkka: [00:00:00] Welcome to SLP Nerd Cast. I'm Kate. And I'm Amy. And we appreciate you tuning in. In our podcast, we will review and provide commentary on resources, literature, and discussed issues related to the field of speech language pathology. 

Kate Grandbois: You can use this podcast for ASHA Professional Development. For more information about us and certification maintenance hours, go to our website, www.slpnerdcast.com.

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Amy Wonkka: Just a quick disclaimer, the contents of this episode are not meant to replace clinical advice.

SLP Nerd Cast. Its hosts and its guests do not represent or endorse specific products or procedures mentioned during our episodes, unless otherwise stated, we are not PhDs, but we do research our material. We do our best to provide a thorough review and fair representation of each topic that we tackle.

That being said, it is always likely that there is an article we've missed or another perspective that isn't shared. If you have something to add to the conversation, please email us. We would love to hear from you. 

Kate Grandbois: Before we get started in today's episode's, financial and Non-Financial disclosures, um, I am the owner and founder of Grand Wa Therapy and Consulting, LLC and co-founder of SLP Nerd Cast.

Amy Wonka is an employee of a public school system and co-founder of [00:02:00] SLP Nerd Cast. Uh, we are both members of ASHA's six 12 and both serve on the a a C advisory group from Massachusetts Advocates for Children. I am a member of the Berkshire Association for Behavior Analysis and Therapy, mass, a BA, the Association for Behavior Analysis International and the corresponding Speech Language Pathology and Applied Behavior Analysis Special interest Group, 

Amy Wonkka: ZA Za 

Kate Grandbois: Za.

So what are we talking about today? 

Amy Wonkka: So today we are talking about generating and using a a c implementation plans. 

Kate Grandbois: Implementation plans are so important, but I also find that that word is very bulky to say, 

Amy Wonkka: would you like to abbreviate it? 

Kate Grandbois: The only thing I could come up with was mp. MP plans, but that's not appropriate 

Amy Wonkka: sounds.

It's very Game 

Kate Grandbois: of Thrones. 

Amy Wonkka: Game of Thrones, yeah. 

Kate Grandbois: Very 12 hundreds. So maybe we don't abbreviate it. Yeah. Yeah. All right. We're just gonna say it. Starting off on [00:03:00] strong foot today. My foot is, so, implementation plans. Implementation plans. Okay. So why did we choose this topic? 

Amy Wonkka: I think that implementation plans are something that I didn't learn about in school.

Kate Grandbois: A agreed, 

Amy Wonkka: however, super helpful, particularly when you're working with multiple stakeholders, which, if you're an SLP or an educator. Working with people who are using a, a c you probably are working with multiple stakeholders. 

Kate Grandbois: Right? And so just to take a second though, and, and even back that up. So I hadn't even heard the term stakeholders until I started working more deeply in augmentative alternative communication.

Oh. Again, our are different backgrounds converging like Voltron to create the knowledge in this podcast. So, so a [00:04:00] stakeholder, what is, we're gonna stay focused. So what, when you say multiple stakeholders. Stakeholders you mean multiple. Multiple communication partners or people who have stake in their communication partners progress.

Et cetera. 

Amy Wonkka: Yeah, and I think, I mean, if you read some, if you read some research, the Pesco framework from OUTTA Children's in Boston comes to mind. Stakeholders are also thinking about funding sources, right? So if you are in an outpatient environment, a stakeholder would be the parent or guardian who came to you, the person who is using augmentative communication, the funding source, perhaps their, you know, teachers in school.

So there, it's, it's kind of everybody who touches and has, has a stake in, in the communicator and their needs. Okay? 

Kate Grandbois: And so, and the PESTLE [00:05:00] framework is a, we will put a link to that up on our website. Um, for those of you who don't know what that is, but that's essentially a framework that looks at 

Amy Wonkka: you think about stakeholders among other things.

Kate Grandbois: Um, the, among other things. Okay. So rewinding, but now that we understand what a stakeholder is, the implementation plan. I had never used implementation plans either, and now that I use them, I can't do my job without them 

Amy Wonkka: because they're the best. 

Kate Grandbois: Right. Yeah. I mean, I feel, you know, both of us work in more of a consultative role, um, instead of a direct service role.

But I think even if you're in direct service, having a plan that clearly outlines your teaching strategy that you can share with members of a team, so many SLPs work as part of teams, that's sort of a no brainer, right? So I think maybe people use implementation plans and maybe call them something different, but the, [00:06:00] the literature and the framework around an actual implementation plan really makes it so concise and so well thought out that I think it's a great thing to adopt as part of your regular approach to therapy.

Amy Wonkka: For sure. I agree. For sure. 

Kate Grandbois: All right, well, let's dive right in. We covered Voltron derogatory terms for other people from the 12 hundreds and all of these other things. Let's just move right along. Moving on. Um, okay, so our learning objectives for today include one, what is an a a C implementation plan and why should we use them?

What are some frequently used components of a a c implementation plans, learning objective? Number two, what are some potential benefits to using a a c implementation plans? And number three, what are some hurdles to a a c implementation plans? 

Amy Wonkka: Sounds like a, sounds like a solid plan right there. It's a solid plan.

We have a good [00:07:00] plan about our plans. 

Kate Grandbois: A plan we like to plan about plans. That's so nice. Mm-hmm. All right. So doing a little bit of background information, we have sort of maybe addressed this. We didn't know what a, a c implementation plans were way back in the day in our, in our youths. Um, but what, so what are they?

Amy Wonkka: Well, it's interesting in, in preparing for this episode, you know, we looked at a lot of different sources where we usually go for resources. One of those is Asha. Um, in looking on the ASHA practice portal for a a c, they do in the section about school-based settings. They do reference implementation plans, and when they talk about possible challenges in the school-based environment, Asha proposes a a c implementation plans as one possible way to overcome or prevent the challenges.

But they don't really tell us very much about what an a a c implementation plan is here. Just that it's sort of shocking to me could be helpful. 

Kate Grandbois: Is is that not shocking [00:08:00] to you that they would use, I mean, the resources available to ASHA are immense. That website is huge, but that they would recommend a, a c implementation, implementation plans and then not put a little link that's like.

Read this, this is read more about implementation plans. I just found that sort of interesting. 

Amy Wonkka: Well, it's funny because it's something that, as you had said, I think is used in a lot of other disciplines. Like you hear as, as people who both work closely with BCBAs, board certified behavior analysts. They write behavior plans all the time.

Kate Grandbois: Mm-hmm. 

Amy Wonkka: That that's what comes out of most of their assessments, right, is the behavior plan. And I think that we make plans, we make treatment plans, but a treatment plan is different from a implementation plan. I was 

Kate Grandbois: just about to ask you this, how 

Amy Wonkka: we're gonna talk a bit more about that. I think big broad differences are that an implementation plan is something that is more about a process, a [00:09:00] collaborative process.

With multiple people working on it together. It's something that's modified in an ongoing basis, but it contains a lot of components that aren't in a treatment plan. A treatment plan is about your goals and objectives and how you're gonna get there. 

Kate Grandbois: So if you're a speech pathologist working in direct service and you're writing your treatment plans, an implementation plan is an extension of that.

That involves other stakeholders. Yeah. Or the communicator. It involves other team members, communication partners, that kind of thing. So that's like, I think to me, that's a really important distinction, um, because an implementation plan is really rooted in bringing other people into the fold. 

Amy Wonkka: I, I think that that's, it's both the value in an implementation plan is both the process and the product equally.

Kate Grandbois: I think equally. 

Amy Wonkka: I think so. 

Kate Grandbois: Okay. I love, I love that. Um, so Asha doesn't really give us a whole bunch of. [00:10:00] Specificity on what an implementation plan is. So not 

Amy Wonkka: that I could find on. So 

Kate Grandbois: where did this come from? If it's not on the ASHA website, where in the universe did it come from? 

Amy Wonkka: We, I learned about it from my work in schools and particularly with assistive technology specialists.

Shout out to my number one at specialist. You know who you are So great. Quite hard. Um, when we look in the literature and even what you see posted on our website, I think that the key article, a lot of times we say, if you're only gonna read one thing, read this one thing. If you're only going to read one thing, read that article titled Assistive Technology Implementation Plan, A Tool for Improving Outcomes.

Um, that I'm 

Kate Grandbois: Margaret Bosch and Melinda Alt. 

Amy Wonkka: I, I didn't. Now 

Kate Grandbois: I-A-U-L-T-I 

Amy Wonkka: figured I was gonna say them both incorrectly. But yes, read that one. B, [00:11:00] botch and 

Kate Grandbois: ALT 

Amy Wonkka: gets into the nuts and bolts of the components of it, of an implementation plan. Um, and a lot of the work that has been done that I've read with implementation plans and the, and the literature that's out there, the resources that are out there do come to us from special education in the field of assistive technology.

And I think it's interesting to note that when you think about a, a C and you think about. How your role varies as a speech language pathologist, depending upon your work environment. When we are looking at it in the school environment, you are looking at a a C as assistive technology, which is different from when, you know, we were working outpatient together and doing a a c evaluations.

Then we're at A a C as DME or durable medical equipment. So we're looking at medical needs instead of educational needs. So while a lot of the framework is similar, a lot of the things are different too, depending upon your work environment. 

Kate Grandbois: I think that's also [00:12:00] such a good point. But I do, I also think that no matter where, what setting you're in, you are always, you should always be placing some priority on the communication partners of the client or student that you're working with.

And that's where, so there's always room for this. I think 

Amy Wonkka: I do too. And I think, you know, we'll talk a lot about schools because. In our understanding, that's really where the assistive technology implementation plan comes from. Mm-hmm. But if you are outpatient and you are working with pediatric clients and you don't think about the educational environment where your client spends a lot of their day, you're not Oh my, setting them up for success.

Are 

Kate Grandbois: you gonna open this box? 

Amy Wonkka: I am gonna just like I would the lid. We have so many 

Kate Grandbois: things to say about this, but it's, it, I guess at the, at the cornerstone of it is that no matter where your environment is, but especially if you are not part of a team environment, you know your work, we've both worked outpatient, you know?

Yes. We know what it's like to be [00:13:00] treating a student, a client or patient in a sterile white room with all of your materials. That person, that student is gonna leave and they have a whole host of communication partners that they're going to interact with. So using an implementation plan as a bridge from your sterile white room into all of the other places is very important.

Amy Wonkka: Yes. And I think, you know, having both worked outpatient, I also know, you know, I think we both know the challenges of that environment. You're Yes. Typically in a productivity centered model, oh my god, 

Kate Grandbois: that pro those productivity standards, like take my pen and stab it in my eye. That was, that was not, that was the, my least favorite part about working outpatient.

Amy Wonkka: Right? And, and those, so depending on your work environment, you have different constraints upon you as well. And time, time is a real one for everybody. But I think, and as we've 

Kate Grandbois: covered in another podcast, productivity standards do not include time for collaboration. You are not going to get paid for spending a million years [00:14:00] collaborating with your school counterpart.

Amy Wonkka: But you should, because that is such a key component. Having everybody on the same page and having an open dialogue about a communicator's different environments and the tasks within those environments is so vital to having a successful outcome. Um, so you can't make 

Kate Grandbois: therapeutic decisions in a vacuum?

Amy Wonkka: No. I mean, you can, but they're not, they're not, they're bad 

Kate Grandbois: decisions. Then. We're just gonna say it. We just said it. 

Amy Wonkka: Yeah. No, you did. Well, we opened the box. Why? Moving 

Kate Grandbois: on, let's shut the box. 

Amy Wonkka: So we're gonna close the box, but we're going to reflect upon, in the school environment, we are operating under the guidance of IDEA, which was reauthorized in 2004.

Um, when we consider a a c. In a school environment, we are considering it as assistive technology and that is really an at device is any item piece of equipment or product system, [00:15:00] whether acquired commercially off the shelf, modified or customized that's used to increase, maintain, or improve the functional capabilities of a child with a disability.

The term does not include a medical device that's surgically implanted or the replacement of such device. So you can, you can read that's just from the ed.gov website. Um, but you know, at has been included in IDEA since 1990, so it's been there for a while. A a c has been included in there for a while. I think the advent of iPads and Apple devices in 2012 and then the, you know, following with a lot of our.

Longstanding vendors developing robust apps. Access to a a c has changed a lot for people. I think a lot of students, which in 

Kate Grandbois: general is a really great thing. 

Amy Wonkka: It's great, it's great. Um, but it means there's a lot of a, a c happening in school-based environments. Um, if you're in a school setting, you may have heard of implementation plans, you may be [00:16:00] using implementation plans.

But if you are somebody in a different environment, like an outpatient environment, I can say when we worked outpatient together, I never generated an implementation plan. 

Kate Grandbois: No, I didn't even know what it was then. I don't think. Yeah. That was not part of my, you may have, but I, I, that was not part of my, my toolbox.

I would. Maybe have time for a phone call with a school speech pathologist, but that usually only happened at the request of the school speech pathologist or the parent. Um, time is a real issue when you're working outpatient, trying to squeeze in these phone calls, especially during the school day. So you might have time at six o'clock when your clients are finished and you're like hungry and tired and you have a commute home and you know, that's when you're being given time.

Either that or when you eat lunch, but school 

Amy Wonkka: is closed at six o'clock at night. 

Kate Grandbois: Right. That's a, that's what I'm Right, exactly. That's what I'm trying to say. So I feel like the implementation plan is a permanent product. [00:17:00] It's written down. It's a really nice, again, like that a, a bridge between your outpatient room and the outside world.

Amy Wonkka: So, as we move through this, if you are an outpatient SLP or you are in private practice, or you're not, you know, you're not embedded within a school environment, I don't think it means that an implementation plan isn't, isn't applicable to your practice environment. I think that, you know, like Kate was saying, it can be a really nice way to promote some asynchronous communication with the school team.

Um, you may, your process might look a little different, but it also might not. Um, I think, you know, it can still be a very helpful tool to promote communication and recognition that the environments and the tasks are going to affect communication in different ways and make it more clear to all the communication partners kind of what the expectation is and who's gonna be doing what.

So. I think a fantastic thing about being [00:18:00] somebody who is a school-based provider is just that opportunity for ongoing collaboration, extension of your services beyond your, you know, speech and language session or time in your office. But with all of those wonderful things come a lot of challenges.

Right? So we've just talked a little bit about the challenges on time that are connected with an outpatient environment, but a lot of those challenges are just as real for the school-based providers. They don't necessarily have somebody sitting over them giving them their productivity numbers every month or whatever.

Um, and you don't have busy time is 

Kate Grandbois: an issue for any busy as, I mean, it's just a problem everywhere. 

Amy Wonkka: It is a problem. It is a problem, and part of it is that those indirect services aren't billable, I think. But regardless, another 

Kate Grandbois: box, another, 

Amy Wonkka: another box. Open that one for the sake of staying on track. Um, when we think about a school environment.

You know, you, you may have a lot of different people supporting the student who ideally [00:19:00] you want on board with at least some understanding of what, you know, we're, we're hoping for in terms of communication. And everybody has their own experiences, and all of those experiences are different. People have different backgrounds and education, they have different values.

And so everybody's bringing all of those different perspectives together. Um, and being able to communicate within and across that larger group of people is really helpful, but also really challenging. 

Kate Grandbois: I, I, I, I totally agree. And I, I feel like up until this point, we've sort of talked about the implementation plan as this ambiguous thing, but what we're talking about is a, is a permanent product, so a piece of paper, something that is written down.

Yep. And I know that yours probably look different than mine. Mm-hmm. I tend to focus on. Having an implementation plan that is easy to read. I'm not gonna hand a long ass, pardon? That's a curse word.[00:20:00] 

I am not going to send, um, a long ass thing to a speech pathologist who I, who is I know already super busy. Um, so I use a, you know, it's a table format. It's something that is one page something you can glance at what I mean. So when we say implementation plan, we're talking about writing a permanent product, but so what do yours look like?

I know we'll talk about the specific things, but I'm just trying to get at. Like, it's not this big robust report. It's like a tiny, not tiny, but what do yours look like? 

Amy Wonkka: So, so yes. Similarly, I am, I'm shooting for that same thing. I struggle with being verbose. That's like a challenge I have in life. Um, and so I am striving for one page.

I can't seem to get one down beneath like one, two sided page and then sometimes blobbing over onto a second piece of paper. But mine tend to be the [00:21:00] broad strokes of something. So that's not back to when we were talking about treatment plans. That's not where I'm gonna put in, you know, specific activities or different things.

Um, it is meant to be a broad overview of the tools and strategies that we're using. Why we're using them. What our big, broad, you know, anticipated outcome would be strategies that are connected with the tool. Kind of some basic operational information about the tool. So if there are access issues or just thinking about transporting it, what are the things that all of the people who interact with the person on a somewhat regular basis should know to help promote, um, opt highlights, highlights and, and roles and responsibilities is a big one.

So, and we had talked a little bit about this also. You know, one other nice thing that an implementation plan does for you as the clinician is it kind of helps you stop feeling guilty. When people aren't doing things that you [00:22:00] had a conversation and agreed upon that they would be doing 

Kate Grandbois: right. So you like told the aide or the direct para or you know, the RBT or whoever's working directly with your student, you, you feel like you've told them 7,000 times, oh my god, this is the target word.

This is, you know, Johnny has to have his device, blah, blah, blah. And. That poor, you know, unbeknownst to you, that para or that aide, classroom aide or that RBT or whoever it is, is overworked. They have a thousand things to do. So I feel like this, writing it down is a nice way, not only for, and we're gonna talk about this later, but not only to alleviate your guilt or alleviate your, you know, I feel bad I have to keep reminding them or how do I give them the feedback that they keep forgetting or we did have this conversation.

It's also accountability. So you have something written down that you don't wanna, like Lord over their heads, but you have a, a written agreement, almost like a little contract. [00:23:00] We talked about this, you, and it's something that you do collaboratively together. 

Amy Wonkka: Yes. And I mean, having been one of those people I worked for like five or six years as a one-to-one in school, in home environments.

And it's exactly that. You know, you are trying to keep track of everybody's priorities all the time, and you're working one-on-one with another person and you're trying to, you know, remember all the things the OT told you and the PT told you, and the speech therapist and the teacher and transition.

'cause it's recess. And you have to remember that this kid, you know, it's, 

Kate Grandbois: it's a lot. Not to mention your own life, you're also in the back burner. You're like, oh, what am I gonna have for dinner? Like, right, so and so blah, blah, blah. Um, the comparison that I make a lot at work is when I go to the grocery store, I don't keep all of my grocery items in my head.

I write them down because I am a regular person that cannot remember the fact that I need these 17 things in the produce [00:24:00] section and these eight things in the meat section and these, all these other things. I write it down because I am a person that needs visual supports, not because I'm, I have a learning difference, but because I'm a human and I feel like the same applies to the staff that we're working with in classrooms.

Um, or if you're in an outpatient setting, the same applies to the teacher that you never, ever get to talk to or the SL school, SLP that you never get to talk to or the parents who have a, the whole host of, you know, their own lives at home. So by writing it down, you're really doing a service to everyone involved, um, to not only keep them accountable, but give them a visual support to reference when they are trying to do their best with the student against all of the other things in their life.

Amy Wonkka: Well, and I feel like for me, another piece of it is it helps. Distill the priorities from all the other things. When we did a podcast a while back on partner training, we talked about how, you know, you don't wanna work on too many things at [00:25:00] once. That's actually not helpful when you're doing partner training.

And I think it, a piece of that is kind of applicable here too, where you think about, I had a supervisor once who said, you know, when I walk in to observe a staff member, they should know the things that I think are the most important. And that was an interesting moment for me where, you know, I. I re, I connected it with implementation plans.

Because what you're really doing is you're telling whoever you're sharing this plan with, that these are the things that are the most important. 

Kate Grandbois: You're helping them prioritize. 

Amy Wonkka: Mm-hmm. And this is what made it on the plan. So perhaps there are all of these other things, and when you're working, you know, in OT and you're doing a co treat, we are doing some more deeper therapy, you know, in, in that moment.

And you're thinking about more things. But, but the big most important things are on this list. And therefore that helps everybody else be aware that like, these are the things that we've decided again, collaboratively as a [00:26:00] group are the most important. And I think that that gets back to another. I think vital element of the a c implementation plan is that it's not a static document, so it is something written down.

It's something, it's a living, 

Kate Grandbois: breathing thing that changes and evolves over time with the communicator. Right? Yeah, totally. 

Amy Wonkka: Because you're not, I mean, in an ideal world, you are meeting, you know, with all the key people, let's, let's place it in the school environment. You're in the school environment. Maybe you have somebody like one of us come in who's in this sort of facilitative consultative role.

You're with the SLP who's providing treatment. You're with the special educator. You're maybe with the general educator, the ot, the pt. You have all those people there in real life that. That's like magic when all the stars align and everybody's available, you know, Tuesday at 10 o'clock. Um, so it also gives you that piece of communication.

Okay. You know, three of us met. We thought that this was, this was our draft. These are the things that we think are important. This is how we think it's gonna be [00:27:00] used in these different ways, broadly, generally. And then you can share that with people, email it to them and say, please take a look at this and make any edits.

And so by having it be something that's tangible. You're also able to engage other members of the group who might not be physically able to participate. And I think that that would be true. Just thinking back to the days, you know, when we were in, when we were in outpatient or, you know, being in private practice.

That's something you could do there too. I, I wrote these things down. I'd love your feedback. Um, and I also, 

Kate Grandbois: you know, and that sort of branches onto, not to interrupt you, but something that has been rattling around in the back of my head as we talk about all of these things, I feel like this is particularly helpful with those who are very complex communicators.

You know, individuals who have a lot of other things going on. They're working on a lot of other skills. Or you have a communicator who has a complex team. So, you know, the parents feel strongly that they, that this is the parent's goal at [00:28:00] home and the goal at home is in a complete contrast or totally different from the goals at school.

So how when you're ra drafting up an implementation plan, having that conversation to prioritize what happens in different environments can be so important because yes, it would be great if Johnny used, you know, these 10 core words. We are also trying to get Johnny to not hit his head 75 times, or, you know, in a minute or, or whatever it is.

Um, so I feel like I'm just basically reiterating the importance of helping people prioritize these things for some of these kids who are, or students, clients, patients, whatever, who are working on a whole bunch of things at once. 

Amy Wonkka: So for me, I feel like there are three big kind of. Broad types of implementation plan that I write, I do you feel the same way?

Do you feel like there, or do you tend to write kind of the same format? 

Kate Grandbois: I, you know what's funny is I, as I'm like going through these notes with you, I am [00:29:00] realizing that I do have these kinds of implementation plans, but to date, I have not called them implementation plans. So, so go on. I have, I think that the, I, I, I, we've just called them different things, just not implementation plans, but yes.

Amy Wonkka: Okay, so, and this might be true for listeners too, I think one of the ones that we use a lot would be the implementation plan that's drafted after an initial assessment. So, you know, in the schools when you're doing an a, a C assessment, or if you have a student who's gone out to an outpatient clinic, they've had an a a C assessment, oftentimes the recommendation is an extended trial of that tool.

Or maybe multiple tools and some related strategies where data's collected. You know, if we're looking for a third party funding source, you're, you need to have specific types of data in specific environments. If you're looking for. School, you know, school funded tools or things like that. You [00:30:00] don't have the same funding based constraints, but you do wanna demonstrate that the tool is effective across multiple environments and tasks.

And so there's the trial implementation plan, right? So we would draft that when you're trying things out and try to make a determination about if it's a good fit and what is the best fit. 

Kate Grandbois: I have a question about that, particularly when you're talking about funding and trying to document success or lack of success in different environments.

Do you typically create different implementation plans for different settings? So will you have one implement implementation plan for home and then a different implementation plan for school? Based on the different stakeholders and different communication partners and the different data you're trying to collect, or do you try and make it cohesive across all different environments?

Amy Wonkka: So, I don't know. I try and make it cohesive across all of the environments and then describe how it would look different in different environments. How about you? What do you do? [00:31:00] 

Kate Grandbois: So, because I have a, I, a lot of my clients have varied residential situations. Mm-hmm. Sometimes we will create different implementation plans because the tasks that we're asking the individual to do are so significantly different based on their residential situation.

Amy Wonkka: So again, I don't think that there's a right or wrong way to do it. I think that what you are doing is through using these plans and writing things down and documenting them. 

Kate Grandbois: I should also say as a caveat that the, it's the same structure. The plan has the same structure across the different environments, but the communication partners and stakeholders have varied levels of training, have varied levels of exposure to other people on the team.

And I think those are the components that differ, not the structure. So each implementation plan still has some of these core elements, like what tasks we want the student to the individual to accomplish, who's responsible for [00:32:00] what, you know, what the password is, if it's a high tech tool, you know, all of those kinds of things.

So those elements stay the same, but sometimes there are tweaks as I guess what I should say. Anyway, go on. 

Amy Wonkka: No, that's, that's helpful. Um, so those would be the components or that would be one type of plan would be the trial implementation that's generated for a trial specifically? Um, I think the second type of plan would be just the ongoing plan.

So we've conducted the trial, trial was found that a specific tool or tools and strategy is helpful for the person. Um, so the ongoing implementation plan doesn't look a whole lot different. It has a couple of different sections. Um. And that that is separate because you're not outlining specifically what the criteria are to determine that the trial was effective or not.

I think, and it tends to be a bit more robust in terms of access to [00:33:00] other content. Most of my plans are HyperDocs, so most of my plans contain, it sounds 

Kate Grandbois: like a space word. 

Amy Wonkka: It does, it does put the, put the gear shift in Hyper Doc. Yeah. You gotta, you gotta swing your turbo charger all the way up to using Hyper Doc.

Um, those are, you know, just contain links to external resources. So I tend to write a plan that I hope is accessible to all the communication partners. So writing it for the person who has the least amount of training or background, and then provide a lot of external links to other things that may be relevant for some members of the team, but not all.

So that could include a link to a data sheet that we're using or a link to a really specific lesson plan or a link to, you know, I do a lot of links to Carol's and Gary's website, the practical a a c website. I think that they have really nice, digestible, accessible content for people who. Are [00:34:00] not speech language pathologists, so parents paraprofessionals.

Um, so I, you know, it may include links to places like that. Um, and that's kind of the ongoing plan. 

Kate Grandbois: We will put those links on our website. 

Amy Wonkka: Yeah. And then the last one is sort of the big T transition implementation plan. So this would be, you know, if this might be in addition to the ongoing plan or it might replace it entirely.

And it's just a very specific focus. It tends to be more detailed, it tends to be a bit longer. Um, and talk kind of more broadly about all the communication supports for a person in anticipation of a big transition. 

Kate Grandbois: Transition. And, uh, just to sort of piggyback onto that, you're talking about transitioning out of the school.

So if you are transitioning at the age of 21, 22, 23, depending on what your state law is, that's the, you know. Transition, the, the kind of transition plan you're talking about. And I think a good extension of that into the outpatient world or the medical world would be, you know, maybe you re revisit [00:35:00] the implementation plan during any change in medical status, or maybe you revisit the implementation plan for any major transition or change.

So the student, the client you're working with, you know, had, you know, in your sessions in outpatient you were using a light tech tool, but the, a high tech tool was, I mean, obviously a tool change, a change in medical status, a change in residential status, um, or any other major jump or Right. You know, I think would, would warrant revisiting the implementation plan.

Wouldn't you agree? 

Amy Wonkka: I would agree. I would agree. And, and maybe developing something that's a bit more robust. Mm-hmm. Because you are not necessarily going to be able to have a conversation with those people. I think when you, when I'm developing either a trial implementation plan or an ongoing implementation plan, I'm developing both of those supports with the expectation that anybody who I'm giving them to could contact me in some way.

We might not have time to have it face to [00:36:00] face, but you could shoot me an email or we could set up a phone call. When I'm doing a, like a big T transition plan, it's also, I'm anticipating that the people who receive this plan may never reach out to me or. So I'm trying to give them more information. Um, often what I've found that I've been doing lately is with this kind of more robust plan, doing like a single page, bullet points, takeaways, um, that could be easily accessible to people who, you know, English might not be their first language.

Mm-hmm. Um, maybe working kind of in more of a PCA or residential, you know, care type position. Um, just so that the, the big, like the top 10 things are accessible to those folks in. Easily readable, um, format. 

Kate Grandbois: And I think this, I mean, again, all of this conversation just goes back to the cornerstone of the implementation plan.

That it is a [00:37:00] evolving living document. You know, so anytime there is this change in status or you know, you are going through a transition there, there is, you don't necessarily have to start from scratch, but you have to update the plan as the communication, as, as the individual changes and evol and evolves.

Amy Wonkka: So, yes, I agree. Right? It's an ongoing plan. It's a living document. You are gonna figure out what format or formats work best for you as you start using them, and you'll find yourself constantly tweaking it. Another nice thing though, about having kind of a set format or couple of formats that you use is that you will be sure to think about all of these things.

So back to your, you know, you bring your list to the grocery store that you don't forget the things. Even though maybe you buy eggs every, every week or two, you might forget the eggs. And so by having, you know, a graphic organizer is essentially what mine are. When I come in to meet with a team, I bring like a i, I like that 

Kate Grandbois: it is a graphic organizer.

It absolutely, totally. 

Amy Wonkka: Yeah, so it's like a blank graphic [00:38:00] organizer. I give copies to everybody and I say like, okay, let's think about all these things. Like what are we gonna try? Let's write it down. How's the person going to transport it? Let's write it down. And it reminds me as somebody who does this all the time, like going to the grocery store, that I should ask these questions and think about all these parts rather than miss something.

So it's also helpful from a procedural standpoint. It sort of guides the flow of conversation to make sure that you are. Focused and considering all of these individual elements for a person. Um, 

Kate Grandbois: so let's, as your plan, let's try and recap this a little bit because this is a lot of information about what goes into an implementation plan.

So we've talked about, we've talked about what the, what it is fundamentally, um, you know, permanent or small. It's not small, easily digestible permanent product. Um, we've talked about why it's important, staff accountability. Um, making sure that that communication goals are prioritized. Um, you [00:39:00] know, making sure that all of the stakeholders are, have participated in building it, prioritizing skills, all those kinds of things.

Communication, collaboration. Um, we've talked about the, we've talked a lot about what the frequently used components are, and I just wanted to review those, um, quickly to make sure that our listeners have a good grasp on exactly. If they leave this podcast and they wanna go write an implementation plan, what would they need to include?

Amy Wonkka: Okay. I'm gonna list the things that I tend to include and then you add. 

Kate Grandbois: Oh, this will be a fun 

Amy Wonkka: game. Right? So I tend to always include who is involved. That includes who drafted it, Uhhuh. So all the different people who drafted it. What tool or tools will be, will be tried when we're thinking about a trial plan, how long, how long are we gonna try them in which environments and tasks.

And this can be like pretty broad and generic or quite specific. Um, what strategies will be tried or [00:40:00] used? I think that when I first started writing these, I didn't include strategies, but I think the strategies are just as important as the tool, if not more so in some cases. 

Kate Grandbois: Um, when you say strategies, you mean like button specific?

Gesture prompt? 

Amy Wonkka: Mm-hmm. Yeah. Gesture Prompt simulation or Yeah, sentence 

Kate Grandbois: completion tasks, whatever your teaching strategy is. 

Amy Wonkka: Co-constructed utterances, like, and, and the top ones. So again, you, you and your speech and language session might use multiple strategies, but the key ones, 'cause we're writing this for the person with the, for other 

Kate Grandbois: people, right?

Amy Wonkka: Correct. Um, the plan for training and support both around operational tool skills and strategies. So that gets at some of that partner training stuff again, uh, roles and responsibilities for each participant and indicators that the tool strategy is working or not working. And that goes across all of the plans.

That's not just something that's part of the trial that is reflecting the fact [00:41:00] that when we think about a, a c it should be something that we're constantly reflecting on as a team. And because people change, people grow, people change. You're in a new environment, you have different tasks. Something that was appropriate in a best fit for you three years ago might not be anymore.

Mm-hmm. And we wanna make sure that people remember that. 

Kate Grandbois: Mm-hmm. 

Amy Wonkka: And then last, what is the plan for ongoing monitoring and follow up? 

Kate Grandbois: How about you? Are 

Amy Wonkka: there other things? Are there different things? So we 

Kate Grandbois: cover a lot of those things. We tend to, um, I say we, it's mostly me, um, because of, because you know, I work in a, in varied places and work with a lot of paraprofessionals.

I use a very generic. Layman's terms. So I do a who, what, where, so who is gonna be using it? What are you gonna be using? Where do I expect you to use it? Um, I do a lot of a, BA, I work in a lot of a, b, a settings. So we usually do a, a data collection column. I do a lot of these in tables. Um, and there are a lot of staff [00:42:00] working with my students and clients.

So I also tend to include some operational kind of things like what's the password? How often, you know. To get to realize language or some sort of automatic data collection tool. This is with a little arrows. Click this, click this, click this, click this. Yep. Um, if you have some sort of pa, you know, there's like the general iPad password, but then if you have an editing password, is that different?

Um, so we do a lot of like house we cable out of housekeeping things on there. And then we also for, um, I, I also try to include like a, a wishlist item. So if you're, someone is working with the student and they had this great opportunity to model the word. Peanuts, I dunno. And maybe not the word peanuts.

What would be another good word to model? Like, wait, they had the great, they had this great opportunity to model the word, wait, we're waiting. And the word wait was not on the device. Write it on the implementation plan. So it's something that's, that's [00:43:00] up in the student's area or up in, um, you know, if there's one that's at home, you know, it's in the kitchen, it's on the fridge and you wanted to add something, then write it there so that it's all, you know, it's laminated, it's whiteboard, you know, use like a whiteboard marker.

That's one other thing. Oh, and we usually list the objectives if it's an IEP and I suppose if you are on, um, in an outpatient setting, you could like maybe write the goals, like so as a reminder of why you're doing these things. Um, so to tie it back to that legal document or insurance related document to make sure they might not always be cohesive, but there's usually some anchor usually.

Reason why you are working on what you're working on. Um, and I find that for a lot of the staff I work with, having the objective on there can be really helpful. If they're trying to collect data for a specific objective later on, um, it sort of helps them as a reminder like, oh, this is why we're doing what we're doing.[00:44:00] 

Amy Wonkka: I think that's great. I think those are, that, that sounds like a very functional document for your environment and I think that that's the big key, right? So we have different components that are in ours. I think a lot of the stuff that is in yours would be something that would be a link in one of my documents, and that is a big piece, like make something that works for the people who you're working with.

Mm-hmm. Um, I would say don't. Don't be beholden to your structure of your form. If you're working, I think especially somebody like you, Kate, who's working across different teams. Different teams are going to want different, they have 

Kate Grandbois: different learning. The teams have different learning needs, and what you want is this document to be helpful.

You want them to want to go to it. You want them to not be intimidated by it. You want there to be a low response effort. You want it to be something. What you're trying to do with an imple implementation plan is use it to help change the behaviors of the communication partners. So you want them to reference it so [00:45:00] that they remember, oh, I'm supposed to model this word, or, oh, I'm supposed to make sure Johnny carries this into the gym or around in the hallway, or takes it off of his desk or, um.

You know, the, the, in the outpatient therapist is working on this word, so maybe this would be a great opportunity to do it in the classroom, you know, when and vice versa. Um, so, so yeah. I'm glad that we recapped all of those things. I wanna move on to our second learning objective. What are the potential benefits to using a a c implementation plans and why should anyone bother using them?

I feel like we've covered a lot of this, but, 

Amy Wonkka: and before we go there, I will say one other piece that I left off my list that I do think is important, I put a footer on all of them with my contact information. 

Kate Grandbois: Ooh, that's a good one. 

Amy Wonkka: Yeah, so also put in, because we do exactly, we want it to be a resource for the person they're going to, it, going to, but if they have questions, all your contact information is there, um, potential benefits.

I mean, practically, it's like the grocery list, right? Mm-hmm. I mean, there's, there's not. [00:46:00] In contrast with some of our previous podcasts folks who have listened, um, to our earlier podcasts. There's, there's not a big meta analysis, or, or at least I couldn't find one, um, that demonstrates clear evidence of, you know, efficacy of a, a c implementation plans across varied participants and settings, you know, but Asha does suggest it, it suggests implementation plans is potentially helpful in their practice portal.

Uh, based on my personal experience, I would agree. Um, it's a recipe. You know, when I, I have, I like 

Kate Grandbois: that, like a, a recipe card. 

Amy Wonkka: It, anybody who's ever gotten the food in a box, right, would you get the food in the box and the food in the box? A box, right? Like any of you, you mean like a meal delivery 

Kate Grandbois: service?

Or like one of those, like food in a box. 

Amy Wonkka: They're like, here's your little package of spices, here's your little mayonnaise, like 

Kate Grandbois: prison food. There's you food in a 

Amy Wonkka: box, food in a box, a little packet of spice. I mean that little card. And that card is sort of the implementation plan, right? There you go. Right?

They, they show you what you're gonna be making, why you're doing it. They give [00:47:00] you a little writeup about it, make you feel excited, tell you all the ingredients you need, what to do with those ingredients, um, how long you should do it for, you know, so it's, it's a little bit like that meal card we're just trying to make.

The, the recipe in a box meal card. 

Kate Grandbois: And I, I also feel like one of the biggest things I have taken away from my implementation plans is that the whole crux of this is, is, uh, to facilitate collaboration. And collaboration can be really hard, especially if, you know, plus shameless plug for our, our episode on collaboration with BCBAs.

But, um. I feel like having an implementation plan does such a nice job of giving those discussion structure. So you're not just saying, well, I want the student to do this, and the BCBA is saying, well, I think that they need to do this. And the parents are saying, well, forget all of you. This is my child. I want the child, you know, I want my child to do this.

By having an implementation plan, you [00:48:00] are providing structure. You have a shared set of goals for when you go into that conversation, and I think that can alleviate some discomfort or at least provide a little bit of, um, guidance in terms of why you're even bothering to talk about it in the first place.

Amy Wonkka: That's such a good point. That's such a good point. And you know, by having, by having this template or this graphic organizer, it. It also sets the stage for, here's this blank form that we're all gonna fill in together. All of our perspectives, all of our values are going to be put together and summarized on this form that we can edit and modify whenever we feel like it's necessary.

And I think that sometimes what happens is when somebody's in an expert model role, and whether that's, you know, you're the person at the outpatient hospital who did the eval, [00:49:00] you. It behooves your client to have as many people taking ownership of the approach as possible. Yes. You, you don't want, you know, it goes back to that Jane Corsten quote, but, you know, the, the magic, if the magic only happens twice a week in a 30 minute session, it's gonna take 84 years, you know, to get the input that an 18 month old would have.

You know? So I think we, when we're thinking about A A A C, A A C is communication. And communication happens all day in lots of different places and with lots of different people. So we want as much as possible to get all those different people on board in different capacities so that they are also taking ownership of the process.

And I think back to what we were saying at the beginning, it's, it's the permanent product Yes. That people can refer to. And it's a reference, and it's important like a grocery list or a recipe. But it's also the process of, you know. This is shifting the rules, it's collaborative. We're all doing this together, 

Kate Grandbois: and I feel like, you know, not to beat a [00:50:00] dead horse or whatever that awful expression is.

Where did that expression even come from? It's really terrible. Just like flies so casually off my tongue talking about beating a dead animal. It's really pretty dark. Anyway, um, anyway, I feel like, you know, we did, we did, you know, revisit this earlier in the episode, but accountability, it's also so extremely important.

So there are so many complicated things that go into a a c intervention, um, especially when you have a complex learner or a complex communicator or an individual with complex bodies. You know, you're. Trying to account for so many different variables and having accountability is huge. Um, and it sort of makes me think of something that I say to everyone I work with all the time, and I feel like I'm a broken record.

Um, you could have the best tool in the world. You could have the most [00:51:00] perfect. It is, it is the feature matching process. Got a boner when, when this tool was chosen. It's the perfect, perfect tool. I'm using a lot of weird analogies today, just gonna have to roll with me here. But if that tool, that perfect tool is not being used.

Then it is useless. It is. It is. It's, it's, it doesn't matter. None of it matters. Right. So, you know, we place so much emphasis sometimes in choosing the right tool, but your implementation plan, how that tool is being used is so much more important. And as we discussed in a. Previous episode about, um, partner training device abandonment is also real.

It is also real. And if you have an implementation plan that's been thoroughly and thoughtfully cultivated by a group of people, if at some point device abandonment starts to happen, or you know, ah, well then we're not really [00:52:00] getting it out of the backpack at home, or, you know, it's sort of staying in the backpack at school, or we put it down on the desk, then we don't use it.

Okay, why? Let's revisit the implementation plan. Let's look at the data. Let's look at the who, the what, and the where, and try and figure out what variables we can tweak to increase the the use. So I feel like implementation plans are such an important piece for all of those things. Not only accountability, but trying to prevent abandonment.

Amy Wonkka: Well, and, and I think that that connects to one of the great things that I see in implementation plans, which is as a team you're kind of anticipating problems and troubleshooting them a little bit before they happen, right? Right. So that might be something like, you know, we anticipate this person may develop a very self-directed kind of cause and effect relationship with the tool.

We don't want that to happen. It's a tool for communication. Communication requires another person. If that happens, what might, might we do? That [00:53:00] might be something that goes into somebody's plan. Um, I think it also helps make it clear to everybody what the expectations are. So if you are somebody who's using a, a, c.

To augment your communication. I think this comes up often. Mm-hmm. It's a little clearer if it's your primary mode of communication. But let's say you're somebody who has relatively intelligible speech with familiar listeners in a known context. But when you are with less familiar listeners or an unknown context, you need an additional modality, um, to help repair some of those breakdowns.

Or you're just gonna anticipate, you know, strategically in advance, this person doesn't know me. I'm gonna place my order using my device. Um, I think that that can be also be very helpful to call out the specific environments in which we anticipate the tool will be used and for what tasks, because you may have some stakeholders thinking, these, these other stakeholders are doing a bad job because they're not using it all the time.

But in actuality, you, you don't need to use it all the time. [00:54:00] And the tool is specific to certain environments and tasks, and that's okay too. Mm-hmm. So it, it makes a lot of things transparent and I think it's super helpful. 

Kate Grandbois: I, I agree. I'm just in the interest of time. I'm wondering if we should move on to our third learning objective.

Um, what are some hurdles to a a c implementation plans? 

Amy Wonkka: So, for me, the biggest hurdle is time. Time is, you know, we don't have a time machine. And as we've talked about in, in multiple podcasts, time is hard. It's hard to find, regardless of your work environment, it's hard to find, regardless of who is on your team.

Um. And so when I started doing these, 

Kate Grandbois: I was gonna say, do you have any tips and tricks? 

Amy Wonkka: My, my at specialist who holds a dear, dear spot in my heart said to me, you know, you can't go backwards. 

Kate Grandbois: You know who you are. We both know who you are. Yeah. 

Amy Wonkka: You can't go backwards. And I think that that is a very powerful phrase, right?

So you can't go backwards, [00:55:00] don't reflect back on, you know, the 40 evaluations you've already done this year and say, I didn't do implementation plans for any of those. It's gonna take me 30 years, it will take you 30 years. You don't have that time. You don't have a time machine. But when you do the next one, when you do the next one.

Draft an implementation plan, or maybe you'll, you're gonna start by just doing them for trials and you're gonna say, you know, I'm gonna work on doing an a c implementation plan for my tool trials, and it's gonna be really simple to start, and I'm gonna start small. And then from there, expand out. Um, so think about your work environment, think about your role, think about what you're hoping to achieve through your implementation plans, and start small, start now.

Don't go back in time. Uh, I think another tip is to be as generic as possible. So don't use a template. Use a template, but also don't put people's names in there. So if you not in your template 

Kate Grandbois: Hmm, you wouldn't put identifiers in a template, [00:56:00] right? Isn't that just like a blank? Am I using the word wrong?

Amy Wonkka: Well, template would be like the, the form that you use, but when you draft your plan, still don't put identifiers in there. So for me, oh, in the 

Kate Grandbois: actual plan, like I don't Interesting is gonna 

Amy Wonkka: do this, I can 

Kate Grandbois: repurpose the plan, the student will 

Amy Wonkka: do this and it, and it looks generic so you can repurpose it. But also from a confidentiality standpoint, if you want it to be something that's readily available and accessible to people, depending upon your environment, right?

You may or may not have restrictions around identifiers. So as much as you can depersonalize it, um, so that if somebody else picked it up, they would, they might read it and say, wow, these are great tips for AC implementation, but they're not gonna know that's Kate's plan. Um, so then you can modify it, it can be readily accessible to people, um, and refine it as you go.

Kate Grandbois: Yeah, edit it as things change. And I mean that's, you know, super important. 

Amy Wonkka: I think another, the other big [00:57:00] obstacle that might happen would just be that it's a shift in your practice. So let's say, you know, we get in a time machine and we, we shoot backwards in time p pew to win and you can forget. And, you know, there we are working out patient and we hear this podcast and say, oh man, we should try using implementation plans.

They seem like they could be really helpful and promote dialogue among team members and better outcomes for our clients. Um, it, it's a shift if you're not used to doing that. So I think there's the time component, but also this is just different and it places you in a different role. Maybe you're kind of used to being the expert and it feels a little uncomfortable to not be the expert.

Um, so I would think that that might be another barrier, but I would say dip your toes in the water and feel a little uncomfortable. Um, and consider using 

Kate Grandbois: the professional growth moment. 

Amy Wonkka: Yeah. Professional challenge. 

Kate Grandbois: [00:58:00] Yeah. You always have to embrace a professional challenge. 

Amy Wonkka: Yeah. 

Kate Grandbois: So have all the uncomfortable thoughts and feelings and then use act to, to work out your values.

Shameless love, right? Identify your values, take committed actions. 

Amy Wonkka: So are there any other barriers that you've experienced in your, 

Kate Grandbois: um, time is definitely one of them. I think honestly, the biggest barrier is not that I have, you know, found isn't necessarily in writing the implementation plan, but it's getting staff to interact with the implementation plan.

Um, and I, I think. I have had to work really hard at being present as a re as a human reminder, like checking in often, oh, hey, how's the implementation plan going? And you can see their eyes get real, like, oh, that thing you hung at the student's desk that I haven't looked at in a million years. So I've had to, um, [00:59:00] refine my approach to implementation plans over time to get more buy-in from staff.

Um, I think 

Amy Wonkka: that's a great point. Yeah. Just to remind, um, which 

Kate Grandbois: has been, you know, and that's why I, I switched to the who, what, where it's like a cute little infographic that we hang, you know, that I, I have, I have, you know, stashed around in binders and things. Um, you know, a lot of my particular kind of student or client is very complex, so there's a lot going on.

Mm-hmm. And a lot of times working on carrying the device from place to place is just not the priority. So trying to make sure that I. Walk that line between pushing staff but also respecting where there are maybe other areas, um, that take priority is, is something that I have found to be a challenge, but that's very specific to my population.

Amy Wonkka: I will say for the listeners, if you have gone through this podcast and you're thinking this is something you'd like to try, we will have a number of references up on [01:00:00] our website that will link you to examples. So that article that we've already referenced, that ET implementation plan, a tool for Improving Outcomes, that has some examples up there.

Uh, there's going to be a link to a number of online resources, um, including a couple of different, different presentations that you can look at. We're gonna link you to the practical a a c website. Um, we're gonna link you to a couple of different, um, kind of clearing houses that have forms that you can look at to get a feel for what that looks like for you.

Some of 

Kate Grandbois: them, and I'm so happy to put the template that I use up for free download on our website. It's not, it's nothing fancy. It's just a table. I'm happy to share it. 

Amy Wonkka: Well, and, and, and I would say, you know, pick one of these, pick two or three of these and try using them. Give them a try, 

Kate Grandbois: and don't be a Yeah.

And don't be afraid of feedback. Ask your teams if they work. Tell them that you want to know. If [01:01:00] they don't work, tell them, you know, that you need the critical feedback to make sure you're producing something and providing something to the stakeholders that is, that works for them. Yes. Don't be afraid to be told that you did a bad job, because we all do every once in a while, or, you know, that you just need to make tweaks to it, not that you did a bad job.

Amy Wonkka: Right. Yes, encourage the feedback and make it clear to people that the purpose of the document is for it to be collaborative. And so without their input, 

Kate Grandbois: you can't collaborate. That's exactly right. You're standing 

Amy Wonkka: on, on your first, your first goal. 

Kate Grandbois: Um, well I think that just about wraps us up. It does. So this was.

Very informative. I used a couple choice words and some different analogies, which I'm gonna have some anxiety about later, but it's fine. Gonna listen to this. Anyway, it's, it's fine. Um, so thank you for joining us, everyone. Uh, if you are interested in using this episode for Azure Professional Development, [01:02:00] go to our website, www.slpnerdcast.com.

Go to the episode page, take a quick quiz and purchase your certificate of participation. Um, you can learn more about our services and what we do for Asha PD on their website. Also, you can feel free to find us on Instagram. Leave us a review on Apple Podcasts or wherever you listened. Please shoot us an email anytime [email protected].

Ask us a question, request a topic. Um, stay tuned for some future episodes related to a a c Basics and behavior management in, um, speech therapy, which I'm very excited about. And we will see you back here again [01:03:00] soon.