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Taking Chances

For a couple of years now, I've been talking about wanting to develop continuing education workshops. I have loose sketches of ideas in various places, but little in the way of something cohesive. Early this year, I saw a call for proposals for the ASHA Connect conference. I attended this conference for the first time last year under its former moniker, the ASHA Healthcare and Business Institute, and found it be one of my favorite conferences I've attended to date. It's more intimate and less overwhelming than the large convention (which I also love, to be sure), and there's time to really get to know fellow attendees.

Having never submitted a proposal before, I was excited to learn the process and give it a try. I was also very nervous. In the past, I've found that quite often I'm great at visualizing things, but less great at making those things then happen. As a result, having a deadline for submission, as well as a template to help provide an outline, proved to be very helpful. Instead of just letting ideas buzz around my head as I often do, I had something that helped me make sense of the many ideas which have been bouncing around for so long.

I designed my proposal to be a two-hour presentation. One of my current goals is to develop and present day-long workshops, but having to think about a smaller scope was a helpful way to get more focused. I also wanted to be flexible, so when I submitted everything, I offered to have my proposal considered for other formats (in this case, a poster presentation). I did this for two reasons: (1) I thought additional perspectives would be beneficial, and (2) I wanted to have the opportunity to present, and have appreciated how posters offer immediate interaction and discussion.

In late February, I learned that my proposal had not been selected for a presentation. While no feedback is provided regarding what kinds of improvements can be made, I reviewed my proposal and found a few things I felt could improve it. I reworked it and submitted it for the ASHA Convention in November, so am excited to see where it goes.

Then, about two weeks ago, I got word that my proposal was selected as a poster for the ASHA Connect conference in July. I am looking forward to presenting my ideas at one of my favorite conferences, and even more than that, I am eager to see how it resonates with my colleagues there. I couldn't be more honored and excited to take this next step.

My poster will be about making the most of working with interpreters in clinical settings. I'm excited to be discussing two things so dear to me, and which are an everyday part of my work. If you're heading to the conference this summer, come say hello! I have a lot of work to do in the interim, but can't wait to get started.

◆ Looking back and moving forward.

2015 started out as a year of uncertainty for me: I was leaving my job of over three years to venture out into the unknown. I was stressed out, exhausted, and not sure how to proceed. I had tied much of my professional identity to being an acute care SLP, and the thought of changing was incredibly daunting. Would I be able to jump into the world of rehab and know what to do? Would I like it? Would I be able to make ends meet?

In the midst of this large professional shift, my family was having its own challenges. My mom was in the middle of chemo and radiation treatment for cancer, and making sure I was present for my parents was very important to me.

This blue bear served as a frequent reference point for me when trying to navigate the Denver convention center at #ASHA15.

This blue bear served as a frequent reference point for me when trying to navigate the Denver convention center at #ASHA15.

When I first wrote about this change I had no idea what all these changes would look like. As these things so often seem to go, nothing goes according to plan. Because the credentialing process for insurance takes a very long time, and because I was the very first SLP at the private practice, I had to find other work while waiting to be approved to provide services in that setting.

To sustain myself in the meantime, I picked up a PRN position in home health. This was (and is) a fascinating and challenging position, and was a wonderful way to rebuild my therapy skills. I also picked up freelance interpreting work. I was a sign language interpreter before becoming an SLP, and have long kept up a small handful of hours on the side. Picking up more hours was a helpful change of pace, and afforded me a nice variety to my work.

With all that said, here's some things I've learned in 2015 that I believe will make 2016 an even more exciting year.

The Denver convention center was an easy walk from the hotels and the sunny weather made for a very pleasant convention experience. 

The Denver convention center was an easy walk from the hotels and the sunny weather made for a very pleasant convention experience. 

Trust those instincts.

From figuring out how to proceed in therapy, to knowing what kind of work to accept, pay attention to that little voice especially if it expresses nervousness. In the process of my hiring for both the home health and the outpatient positions, I noticed a fair amount of disorganization that left me nervous, so I accepted only PRN positions to afford me more flexibility in that environment. As a result, I've been able to be flexible with my hours and make sure that my caseload is manageable.

Learn new things.

It's no secret that I enjoy conferences. They are in part a social experience for me, since it's a chance to see colleagues from around the country (and world). Meeting new colleagues is equally important. The interaction with my fellow SLPs and audiologists allows as much opportunity to learn as the workshops themselves.

This year, I stepped out of my comfort zone and attended some sessions in areas which I don't currently treat. For example, I attended a session about transgender voice therapy, and it turned out to be one of my favorite sessions of the entire convention. When thinking about why this was, I realized that it was because I got to think about therapy in a different way for a change. Also, one of the topics emphasized in the talk was principles of motor learning, which is a hot topic in the areas of dysphagia and motor speech. Hearing it discussed in new ways, by SLPs who talk about their work differently than I do, was a fantastic way to really start to get a better grasp of the concept and understand why it is so vital to therapy. On top of that, it helped me learn about an area I have interest in, but not experience or training. It may help open new doors in the future, and in the meantime has already helped make me a better clinician.

The main entryway in the Denver convention center. 

The main entryway in the Denver convention center. 

Do the right thing.

Ethical challenges come in all shapes and sizes. It may be a company that accepts more patients than they have staff to accommodate. It may be an employer with unethical billing practices. It may be pressure to see more patients than you are able to handle.

In the past year, all of these situations have presented themselves to me, in varying degrees of seriousness. It proved to be to my advantage to accept work only on a PRN basis, as it has afforded me more control over my time and my work. I do not accept new patients unless I know I can commit to providing their treatment consistently. Having become all too familiar with burnout, I recognize and honor my limits, and always remind myself that if I don't take care of myself, I'll be a less present, and therefore less effective, clinician for my patients.

I love windows that move up tall buildings, and appreciated all the light they brought to the convention.

I love windows that move up tall buildings, and appreciated all the light they brought to the convention.

Move forward.

For me, 2015 was a chance to reboot. Though I wasn't looking for it at first, change found me and reminded me I needed it. Challenges presented themselves and I found strength I didn't know I had. I re-invented myself in ways I hadn't imagined I could, and in the process of learning about myself, I found myself growing both personally and professionally. My patients were a big part of that growth, and have helped me to identify new goals for myself.I never used to set goals for myself. In my last job, we had an annual performance review, and I always had a hard time thinking about what I wanted to accomplish in the next year. "I just want to do my work and do well at it," I used to say. This year, I find myself having tangible goals I want to accomplish. Among these, I want to more readily identify ways to target and help my patients meet their goals. I want to start a business and learn to establish contract relationships so I can be more flexible and mobile with my services. In this vein, I want to write about what I learn, both so that I can hold myself accountable with my goals, have a way to look back on what I've learned, and also that others may learn from my experience (both the good and the bad).

Cheers to 2016. Let's make this year an awesome one.

★ On Making Strides

One of the great things about the field of speech-language pathology, and incidentally one of its biggest challenges, is that you never really stop learning. Just when you think you've gotten the hang of something, a new idea or presentation comes along that turns your understanding on its head and makes you rethink just about everything. This is always a good thing, but that doesn't mean it isn't frustrating. I've been following my own learning path with video swallow studies. I had minimal exposure during my CF, and at that they weren't even proper fluoro, so when I took this position I asked that I be retrained so I could learn "from the ground up" to do them well. My learning curve has gone roughly as follows:

  • Observe the process and work with supervisor to interpret results.
  • Learn procedure and setup, as well as progression of studies.
  • Start to perform studies with supervision, and notice that they're agonizingly slow when you do them.
  • Notice that you gradually start to get the hang of things.
  • Feel comfortable going through the motions, and starting to also catch more instances of penetration and aspiration.
  • Realize that there's more to swallowing than those two favorite things.
  • As you start to observe the "bigger picture" of swallowing, realize that you're slipping in terms of efficiency.
  • Work to integrate knowledge of swallowing function into study to make for more complete evaluation.

I have had to remind myself in recent weeks that this is perfectly normal. It helps to lay it out as I have above, to really see the trajectory and remind myself that I am, indeed, making progress. I had found I was getting down on myself for things that, when I look at them this way, are not actually issues. As my supervisor said very well, "We've all been there".

When she said that, it made me think back to my days learning ASL and on the road to becoming an interpreter. I've been an interpreter for going on six years now, and realize now just how far I've come.

I was thinking about learning my second language. It dawned on me that as I was learning, I would take things in, acknowledge them, and try to incorporate it into my use of the language. I could go through the motions, but I didn't really *get it*. After some time (days, week, or even months later), it would suddenly click, and I would find myself actually *over*using it. Eventually, I would tone it down as it fully sank in and use it appropriately.

With regard to my clinical skills as an SLP, and to video swallow studies in this case, I'm still in the middle of this process. Nothing happens overnight. I think back to nearly one year ago, at the ASHA Convention in San Diego last year, and conversations I had with Tiffani Wallace from Dysphagia Ramblings. She helped me rethink my perspective, encouraged me to keep going out and doing and re-learning. Nearly one year later, I realize that I *have* made progress. I'm on the right track. I keep challenging what I think I know, and when I don't, a new patient puts me in check to keep thinking critically.

It's a process. A difficult one with an enormous learning curve, but one that is very much worth the time and effort. I can only imagine where I'll be in another year.