Wyoming

Speech Language Hearing Association

September 1, 2015
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ASHA CONVENTION in DENVER

Friday
November 13, 2015
Tivoli Center

ASHA OPEN HOUSE

You are invited to the Colorado/Wyoming Open House at ASHA!

The University of Wyoming along with CU-Boulder, UNC-Greely, and Metropolitan State
University-Denver are hosting a joint open house at ASHA on the evening of Friday, November
13 at the Tivoli Center Student Union. The time will be announced soon. The Tivoli Student
Union is located at the Auraria Higher Education Center and is a short walk from the Convention
Center. We hope to have a large group attend from Wyoming!

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From the Pen of the President

Dont cry because its

over, smile because it

happened. ~ Dr. Seuss.

Yes, summer has once again

ended leaving us with happy
summertime memories. I
do smile as I think about my
past summer, which has left
me rejuvenated to begin
another academic school year.
This time of year seems to be the busiest for me as Im
sure it is for many of you, with initial screenings,
transfer IEPs, annual IEPs, staff development meetings,
and never ended testing. While Im doing all of these
important tasks, Im also providing treatment. Ah, yes,
just a typical day for a speech-language pathologist.
While I look forward to another school year, I am also
gearing up for ASHA this year in Denver. Its so nice to
be able to attend ASHA so close to home. In this
addition of the Pitch, you will find information about a
joint open house Friday, November 13th, with the
University of Wyoming, Colorado University, Metro
State, and University of Northern Colorado. This is a
wonderful opportunity to reconnect with fellow UW
graduates as well as make new acquaintances with
neighboring university graduates. I hope to see you all
there!
The WSHA board will be meeting again in October for
our quarterly meeting. We are in the process of
finalizing our contract with Craven and Associates who
will be assisting us with our convention, database, and
financial management. We look forward to expanding
our relationship with Craven as other state associations
have reported remarkable outcomes with this
management company. In addition, look for our
revised WSHA By-Laws that were approved at our last
WSHA Business Meeting in June. They are now up on
the WSHA website for you to access.
Donna Shippen has officially taken over as our WSHA
Treasurer. We also welcome Shannon Freeburn as the
new awards committee chairperson. We look forward

to having Donna continue on the board in this new

position, and introducing Shannon to our Board.
In closing, I wish you all a happy Fall! Remember, Fall
is just a second spring when every leaf is a flower! Of
course, with the Wyoming wind, we only get to enjoy
those colorful leaves for a split second!

Respectfully,

Sue Torney, M.A., CCC-SLP

2015 WSHA President

Wyoming State Education Advocacy

Leader Report
by Laura Nickerson, M.S., CCC-SLP
Wyoming State Seal

Hello fellow WSHA members! As many of you know, I

recently attended the ASHA Schools Convention, where
many of the SEALs from across the US met for a half day
meeting prior to the first day of the convention. It was
wonderful to put a face to some of the names and voices I
had been hearing on our conference calls, and as always it
was a pleasure to see both Eileen Crowe, Director for State
Associations Relations and Arlene Pietranton, ASHAs Chief
Executive Officer. During the SEALs meeting, Heather Bupp,
Director of Ethics for ASHA, gave a thought-provoking talk on
ethical considerations, and I wanted to share some of what I
learned with you.

Consider this question:
When was the last time you felt that you were in an

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ethical dilemma, or were faced with a situation
where you had to stop to think about ethics before
making a decision on how to proceed?

Last week? Last month? Last year?
With each passing day, we seem to get busier and busier.
With so much on our plates caseload, supervision,
paperwork most of us probably dont stop to consider
ethics each and every day. In fact, if you answered that it
had been a long time since you had to consider an ethical
dilemma, you might be feeling grateful that you rarely
encounter these situations in your place of work. However,
Heather would argue that limited ethical considerations are
not a product of a dream-job or competent co-workers or
supervisors. Rather, she might say that those of us who
arent considering ethics every day are skating on thin ice:

Ethical considerations dont come up a few times a
year, or once or twice in your career. Ethical
considerations should be a part of your daily
practice. Heather Bupp, Director of Ethics for
ASHA
Im not suggesting that if you havent been considering
ethics day in and day out that you arent an ethical person.
In fact, as professionals, most of us consider ourselves to be
ethical by nature. We believe that if we simply strive to
do the right thing, we will be operating ethically. But, while
listening to Heathers presentation, I realized thats not
enough. And it hit me like a ton of bricks I have been guilty
of sitting back, assuming that I will make the right decisions
based on my own moral compass.

If you are not well-versed in the Code of Ethics,
you are being willfully blind, and are putting
yourself at risk for a violation, despite your best
intentions. Heather Bupp, Director of Ethics for
ASHA

consider the ethical principles that apply. Analyze your

decisions, big and small, and dont rely on your own sense of
right or wrong. Most importantly, stop and consider the
ethical principles, and/or reach out for guidance before you
act.

If you choose to take an action, and realize
afterward that it is unethical, it is too late. You have
violated your code of ethics, and accidental or not
there are likely to be consequences. You may think
you are doing the right thing, but morally right
versus morally wrong is not the distinction you
need to make in your clinical practice. You need to
think: which ethical principal applies to this
situation? Heather Bupp, Director of Ethics for
ASHA

There is no dearth of resources related to Ethics. ASHAs
practice portal has an Ethics Resource page that has links to
many helpful sources. Heather encouraged us to print the
Ethical Principles Poster and hang it in your workplace. She
also pointed out that you can ask for guidance without
actually filing a complaint: call 800-498-2071, or submit your
questions via e-mail to ethics@asha.org.

Here are some helpful links:
Wyoming Board of Speech Pathology and Audiology:

http://speech.wyo.gov/rules-and-regulations

ASHAs Practice Portal: Ethics Resources

Find the Code of Ethics, Ethical Principles Poster

PDFs, and many more links here
http://www.asha.org/practice/ethics/

When was the last time you cracked open that document?
Do you have a copy on your computer or in your desk? Ill
tell you when the last time was for me in my ethics class in
grad school. But if graduate school isnt the end of our
education on clinical treatment and assessment topics,
surely it shouldnt be the end of our education on ethical
issues.
As the new school year begins, dont risk unintentionally
putting yourself in an undesirable situation. I encourage you
to spend some time refreshing and updating your knowledge
of ASHAs Code of Ethics, as well as the Wyoming Board of
Speech Pathology and Audiology Standards of Ethical
Principles. Think through your daily routines and carefully

Rules and Regulations, Chapter 10: Standards of

Ethical Principles

Specific information from ASHA on Ethics in Schools

Practice
http://www.asha.org/slp/schools/prof-
consult/EthicsSchoolsPractice/

Issues in Ethics Statements from the ASHA Board of

Ethics

http://www.asha.org/practice/ethics/ethics_issues_inde
x/

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Wyoming Ace Awards 2015

During the January to March 2015 period, the following

ASHA members and /or certificate holders were presented
the Award for Continuing Education (ACE) by the Continuing
Education Board. The ACE is a formal recognition of
professionals who have demonstrated their commitment to
lifelong learning by earning 7.0 CEUs (70 contact hours)
within a 36-month period. WSHA members are marked in
blue:

January 2015
Alisa Martinez

Cheyenne

March 2015
Susan O'Neill Lowry
Sheridan
Cara Straw

Green River

select members eligible in any year to receive awards from

WSHA. Currently, three awards exist: Volunteer of the Year,
Honors of the Association, and Friend of the Association.
Shannon is a speech language pathologist, who currently
works at the Child Development Center of Natrona County in
Casper. She grew up in rural Wyoming, on a ranch outside of
Ft. Laramie. After receiving her Bachelor of Science in Speech
Language and Hearing Sciences from the University of
Wyoming, she attended graduate school at Southern Illinois
University. As a graduate student, she quickly stood out
among her peers as an excellent clinician, and she completed
prestigious practica at Cardinal Glennon Children's Hospital
in St. Louis and Northern Colorado Rehabilitation Hospital in
Johnstown. A true Wyomingite at heart, she returned to the
state after graduation.

Save the Date!

IMASH 2017 will be held at the Boise Convention
Center in downtown Boise, Idaho October 5-7, 2017.

Introducing WSHAs new Honors

and Awards Committee Chair,
Shannon Freeburn

by Laura Nickerson, M.S., CCC-SLP

This summer, Deb Crist stepped down from her position as
Honors and Awards Committee Chair. We are so thankful for
her service to WSHA!

Shannon Freeburn, of Casper, has been appointed by WSHA
President, Sue Torney, to fill this position. For those
members who may not be aware, the Honors and Awards
chair is a non-voting WSHA board member. The person who
holds this chair is responsible for forming a committee to

Shannon enjoys music and reading in her spare time, and in

fair weather months, she spends time in the outdoors,
camping and hiking. Shannon also loves browsing Pinterest
for crafts and culinary creations, and she is an enthusiastic
Green Bay Packers fan. Many people also do not know that
Shannon is an identical triplet! One of her sisters, Becca, also
lives in Casper, with the other, Kenna, residing in Kansas.

Welcome, Shannon, to the WSHA board!

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Book Review: First Things First

By Darcy Regan, M.A., CCC-SLP
Wyoming Institute for Disabilities

First Things First (2004), a book by Charity Rowland and
Philip Schweigert , delves into early communication for
children with severe disabilities through a teaching and
decision-making guide. This book walks readers through the
steps of developmental progression of communicative
behaviors and includes steps on how to help facilitate
learning of the social world so our children with profound
disabilities can understand and use language for
communication.

Rowland and Schweigert critique the l predictable training
process for children for communication. They write, Just
because they [a child] may be able to activate a mechanical
dog that barks, does not mean that they can figure out how
to make a person respond to them, (19). Individuals with
profound disabilities rely on these toys to help make sense
of our social world as most toys and objects are predictable.
For example, when you shake a bell, it will ring, if you flip on
a light switch, the light will turn on. However, social
communication is so unpredictable that babies learn early on
that when they cry, mom doesnt always come, or she
doesnt come on time! This puts our children with profound
disabilities at much greater odds of learning how
communication works. We cannot always make the toy the
center of the activity; we also need to teach social
relationships.

With training, Rowland and Schweigert believe that
communication partners can become better able to interpret
the childs behavior as the child uses more natural forms of
communication. They recommend giving the
communication partner a script to facilitate communication.
Scripts can help multiple communication partners use
consistent language when interacting with the child so the
child can better learn to predict their role in the
communication process. Communication scripts can help
teachers take a closer look at the relationship between the
environment, the child, and the communication partner.

First Things First examines two main areas where children
with multiple disabilities most often encounter challenges:
Purposeful movements: Children with orthopedic
impairments may have difficulty possessing any
purposeful behavior such as reaching toward a desired

toy; and therefore, may not react consistently to

stimulation.
Sensory Impairments: Children with sensory
impairments may have restricted ability to perceive
objects or opportunities in their surroundings. Does the
learner have enough experience with, or awareness, of
the choices presented to be able to make a real choice?

Rowland and Schweigert also guide the reader through steps
and activities in order to progress their child from the pre-
symbolic, unconventional behavior stage, to the intentional
behavior stage.

Pre-intentional behavior is behavior that is not under the
individuals own control (e.g. comfortable, uncomfortable,
hungry, thirsty, etc.) Caregivers and communication
partners interpret the childs individual state by observing
their behaviors such as body movements, facial expressions
and sounds. For example, a child will laugh when he is
happy and cry when he is upset or uncomfortable. At this
stage, the majority of childrens behaviors appear to be pre-
symbolic because they dont involve symbols and
unconventional because they are not socially acceptable as
we grow older. Speech incorporates the use of symbols
(spoken language). For those who are not able to
communicate through spoken language; they must rely on
other types of symbols such as colored line drawings or
object miniatures. An example they explore is when a child
might whine or cry, but, might not realize that, If I fuss like
this, Mom will come running right over with a bottle (5).
Intentional communication behaviors include making
requests, protesting, or directing a communication partners
attention to something desired.

It is important to continually identify behaviors the child can
perform, and then consistently respond to these behaviors
so that the child makes the connection between the action
and the result in their environment. Rowland and
Schweigert recommend targeting activities where the child
needs to signal more of something to continue the action
(e.g. while swinging, stop and wait for him/her to do
something that could serve as a signal of wanting more.)

One criticism of this book is the use of pre-intentional and
pre-symbolic. These words are based on typical
communication development stages. The problem is:
individuals with complex communication needs (CCN) have
sensory-motor challenges therefore making it difficult to
define the symbolic or intentional stages for their
communication and behavior. We cant get hung-up on
thinking the pre is before the use of symbols. Like all of us,

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individuals with CCN use lots of non-symbolic behaviors as
part of their multimodal communication. Therefore, it is
imperative that we begin to learn about how we can best
support children with CCN through these stages and for the
rest of their lives.

Additional Resources to supplement the use of the book:
The Communication Matrix:
www.communicationmatrix.org
The Communication Matrix is a free tool that evaluates the
current level at which the child is communicating and future
goals to advance the child to the next level. The
communication matrix will evaluate the skills up to the point
where the child is combining words and is designed for all
individuals of all ages who function at the early
communication stage.
Communication Support Inventory Children and Youth
(CSI-CY): www.icfcy.org/aac
The CSI-CY evaluates communication supports across an
entire educational program.

New Website for Wyoming Board of

Speech Pathology and Audiology

Wyoming Speech Pathologists and Audiologists,












On behalf of the Wyoming Board of Speech Pathology and
Audiology, I am proud to announce the Board has a new and
improved website at

http://speech.wyo.gov/

Please take some time to check out the website and make
sure to update your bookmarks for the new address !

Thank you!

Emily Cronbaugh

Executive Director
Board of Speech Pathology and Audiology
2001 Capitol Avenue
Emerson Building, Room 104
Cheyenne, WY 82002

Treatment of Children with ASD

Eileen Crowe, ASHAs Director of state associations would
like to share the following
message of the US
Department of Education
on the need for
comprehensive
evaluation and
appropriate treatment
for children with autism
spectrum disorder (ASD)
with WSHA members.
She reports that ASHA
worked very closely with
the Department to obtain
this guidance. The
Department sent this to
all state special education
directors and Part C
coordinators. Eileen states that ASHA encourages members
to have this information in hand when advocating for SLP
services for children with ASD.

U.S. Education Department Says ABA Is Not the Only

Treatment for Children With ASD.

Here is what you can do to advocate for speech-language
pathology treatment.

Background
The United States Department of Education (USDOE) issued
a guidance letter clarifying the roles of providers and the
importance of coordinated delivery of services for children
with autism spectrum disorder (ASD). The letter noted that
school and early intervention programs should not rely on a
single treatment method for children with ASD, such as ABA,
and should include speech-language pathologists and other
professionals in all decisions regarding evaluation and
treatment. This follows extensive advocacy efforts from
ASHA on behalf of members and state leaders concerned
about the lack of consistent procedures pursuant to IDEA in
the assessment and treatment of children with ASD.

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There is a similar trend in health care to utilize only ABA
specialists to provide care for children with ASD. Singling out
ABA services in legislation, such as in mandates and payer
policies, as the only treatment for individuals with
developmental disabilities, including those with ASD, does
not provide the full complement of appropriate treatments,
and limits consumer choice. Legislators, payers, and policy
makers at local, state, and federal levels should work to
ensure that all therapies, not just ABA services, are included
for coverage. CMS issued guidance on this topic in July 2014
stating, While much of the current national discussion
focuses on one particular treatment modality called Applied
Behavioral Analysis (ABA), there are other recognized and
emerging treatment modalities for children with ASD.
Clearly, CMS supports the full complement of services for
individuals with autism, as does the U.S. Department of
Education.

While this direct guidance is important for ASHA members
and consumers, it is only helpful if all of us endeavor to get
the word out to decision makers at the state level, in
school districts, Part C early intervention programs, Medicaid
programs, legislatures, and health plans. So please review
the letter and share it with decision makers in your work
setting.

Actions to Take
In Schools and Early Intervention
Offer in-service training to staff; include how SLPs
evaluate and treat children with ASD
Suggest to your supervisor ways that SLPs and ABA
service providers can collaborate on treatment
Communicate with Part C Coordinators and lead
agencies about the CMS policy and the USDOE letter

In the Community
Speak with parent groups and local community
disability organizations about the importance of a
comprehensive evaluation and treatment program
(IFSP/IEP), what services speech-language pathology
services provide to children with ASD, and how
services can be coordinated to provide maximum
benefit for children
Communicate with pediatricians and primary care
physicians about the role SLPs play in treating
individuals with ASD, and how USDOE and CMS
guidance supports that role

In health and private settings

Communicate with local Medicaid and department

of health representatives about the CMS policy and
USDOE letter
Communicate with health plan representatives and
regulators about how the CMS policy and USDOE
letter can and should influence payer policies

State legislators and regulators
Meet with legislators to discuss how the CMS policy
and USDOE letter can influence state and payer
policies
Communicate with state insurance regulators about
ACA Marketplace exchange plans that require
habilitation services, such as speech-language
treatment, and how individuals with ASD, who make
up a subset of the population with developmental
disabilities, may need habilitative services, as well as
behavioral treatments, such as ABA

Talking Points
SLPs are uniquely qualified to provide assessment
and treatment of communication disorders for
children with ASD, including social communication
disorders
Under IDEA Part B, a Free and Appropriate Public
Education (FAPE) must be available to all students
with disabilities under the law; allowing ABA
therapists to dictate services is a violation of the law
IDEA requires that decisions about services must be
made by a full complement of appropriate qualified
providers following a comprehensive evaluation
IDEAs IEP and IFSP processes are designed to ensure
that an appropriate program is developed to meet
the unique individual needs of a child with a
disability, and that services are identified based on
the unique needs of the child by a team
An ABA therapist may serve on the team, but is not
the sole decision maker and cannot restrict access to
services by other team members, such as SLPs
No one treatment (including ABA) is appropriate for
all individuals with ASD or other developmental
disabilities
Regarding Medicaid coverage, CMS recognizes that
there are other treatments for children with ASD
besides ABA, and that CMS, too, supports the full
complement of appropriate services

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assessing what children hear in classrooms and what to do

about it; management of auditory processing disorders in
children; and using an auditory brain development approach
to facilitate listening, language and literacy.

This course will be available for on demand viewing on
AudiologyOnline beginning on September 14. It is free to
view - simply register for a free account and then access it
using course number 26492, onwww.audiologyonline.com.

The course is offered for CEUs (AAA, IHS, Tier 1 ABA, and
others) through the AudiologyOnline CEU program, which
provides unlimited CEUs for $99/year from date of sign-up.

Maximizing Outcomes for Children with Auditory Disorders

This 3-hour online CE course is presented by leading experts
in pediatric audiology, Jane R. Madell, PhD, Carol Flexer, PhD
and Gail Whitelaw, PhD. They will provide a practical,
evidence-based approach to the effective management of
auditory disorders in children. Topics discussed will include:

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