Monday, February 10, 2014

Today I learned ---- It's OK to do contract work part time.....

But if you try and make it your full time only gig, you as an SLP get screwed....

Had a guest speaker recent graduate from the master's program come talk to our class today, and she just finished her CFY (Clinical Fellow Year --- first year out where you are supervised but still collecting a pay check) at an agency doing contract work for day care centers and families.

She has to do ALL HER OWN BILLING! (And if she does an evaluation and the kid doesn't qualify, she doesn't get paid for that hour, sometimes 2 hours!) I see now why people do this as a part-time after hours gig in addition to their job where they are collecting insurance and have someone that is paid to bill and talk to insurance companies. She said she loved the work, but she is young (23, not married with no kids) and has all the free time in the world, apparently.) I can't imagine how long people do this type of work before they BURN OUT. Just something to think about.

Here are the notes I took.

Dynamic Speech Group
Farah Cox  (405) 226-4911

Non-verbal/Severe population
Billing and reimbursement
Contract work
SLP does all of this herself

Low SES population
Very good people
Hispanic/language barriers
Google translate—translate letters
Caseload of 30 at a time
Sooner care has been approving kids for twice a week
Piedmont, Bethany, Oklahoma City, and Edmond…drive a lot
Homes and daycares
Evaluation contact high
Child doesn’t qualify – no payment

Establish rapport – build trust with people and daycares
Turned off the fact that you want to help
Very rewarding once you get past little things

How do you qualify a child for services?
1. Parent Consent – forms look different everywhere
Name, physician name and phone number – child must go to doctor and the parent must say that speech and language is a concern
Sooner care will deny a submission if the SLP dates for the parent

2. Screening
PLS 5 on an iPad – for a 3 year old
Screening summary
Meet parents

3. Parent note for the Doctor
Sooner Care will deny a “speech-language delay.”
They want more specific information.

4. Permission to Evaluate
Do an evaluate
PLS
Goldman-Fristoe
Write up evaluation
IEP must be submitted
List of 8 items that you must have in order to bill for service

5. Documentation
SOAP Format

6. Milan Medical – Software used for Billing
Name
Date
Time
How long you saw them
SOAP Note
Can audit at any time
Billing and invoices are due Monday morning











Chapter 3 Speech Science lecture notes --- hardest class this semester

Chapter 3. Articulatory system
– Spectrographic analysis of vowels and consonants (stops, fricatives, affricates) – Lecture 8 – 02/10/14
·      Spectrographic analysis
o   Spectrography is a method of identifying frequency, amplitude, and duration of sounds.
o   Frequency is displayed on the vertical axis, time is represented on the horizontal axis, and intensity of acoustic energy is represented by the darkness of the trace on the screen.
·      Spectrographic analysis of vowels
o   Vowels are characterized by first three formants.
o   They appear as wide, dark horizontal stripes, reflecting the concentrations of intense acoustic energy at those harmonic frequencies that have been amplified by the vocal tract formants.
o   The first format (F1) in vowels is inversely related to vowel height
§  The higher the vowel, the lower the first format (and vice versa)
·      High /i/ and /u/ à F1 ~ 280-310
·      Mid-high /I/ and /ʊ/ à F1 ~ 400-450
·      Mid-low /ɛ/ and /ɔ/ à F1 ~ 550-590
·      Low /æ/ and /a/ à F1 ~ 690-710
o   The second format (F2) in vowels is somewhat related to degree of backness
§  The more front the vowel, the higher the second format (but affected by lip rounding).
Front
Back
Frequency Range
/i/
/u/
F2 ~ 2250 ~870
/I/
/ʊ/
F2 ~ 1920 ~ 1030
/ɛ/
/ɔ/
F2 ~ 1770~880
/æ/
/a/
F2 ~ 1660~1100
·       
·      Spectrographic analysis of Diphthongs
o   A diphthong is a vowel that changes its resonance characteristics during its production.
o   Characterized by first three formant frequencies
o   Produced by uttering two vowels as one unit.
§  This results in formant transitions.
§  Steady-state formants at the beginning of the sound, followed by formant transition, and then another steady-state portion.
·      Spectrographic analysis of Stops
o   Four important acoustic features
§  Silent gap
·      Time during which the articulators are forming the blockage and oral pressure is building up. Seen as voice bar for voiced stops.
§  Release burst
·      Follows the silent gap. Seen as vertical line extending into high frequencies. Lasts for 10 – 30 ms.
·      Seen for stops in initial and medial position, but not for final position.
·      Bilabial stops – diffuse spectrum, with energy spread out over a wide range of frequencies and more energy in the lower frequencies than in the higher.
·      Alveolars – diffuse with increasing energy in the higher frequencies or spread out evenly.
·      Velars – Compact with energy concentrated in a relatively narrow region.
·      Voiceless stops have bursts that are longer in duration due to aspiration.
§  Format Transitions
·      Articulators move from constricted position to open position following the production of the sound.
·      Can occur either from a voiced sound occurring before the stop, or both, lasts around 50 ms.
·      The slope of transitions – depends on the place of articulation of the stop and vocal tract position following the sound
·      A very low F1 – complete constriction of the vocal tract.
·      The transition for F1 starts from nearly zero and increases to the appropriate frequency for the following vowel
§  Voice onset time (VOT)
·      VOT – time between the beginning of the stop burst and the onset of the vocal fold vibration for the following vowel.
·      This is measured in milliseconds and indicates the coordination between laryngeal and articulatory systems.
·      Four categories of VOT – depending on the timing between the release of the burst and the onset of the vocal fold vibration:
o   VOT lead – VOT is negative indicating that the vocal folds are vibrating before the articulatory release (occurs for voiced stops).
o   Simultaneous voicing – voice onset and articulatory release occur at the same time.
o   Short lag – onset of vocal vibration follows shortly after the release burst.
o   Long lag time – vocal fold vibration time is delayed relatively long time after the articulatory release
·      VOTs for Voiced stops –    - 20 ms to + 20 ms
·      VOTs for voiceless stops –     +25 ms to 100 ms
·      VOTs depend on the place of the stop articulation and increases as place of articulations moves backward.
·      Bilabials -  shortest VOTs.
·      Alveolars – intermediate VOTs
·      Velars – longest VOTs
·      Fricatives
o   On a spectrogram – wide band of energy distributed over a broad range of frequencies.
o   Energy in fricatives is much longer in duration than stops.
o   Specific range of frequencies and the intensity of aperiodic sounds depend on the place of articulation of the fricative.
o   Fricatives are characterized by white noise, which is aperiodic sound that has its energy distributed fairly evenly throughout the spectrum.
o   The spectrum for fricatives depends on place of articulation because fricative noise is resonated most strongly anterior to the articulatory constriction.
o   Fricatives that are produced anteriorly (e.g., /f/, /v/, /ϴ/) do not have much of a front resonating cavity, so they have very low-intensity spectrum spread out over a broad range of frequencies.
o   The alveolar and palatal fricatives have more intense acoustic energy at high frequencies because of the way that they are resonated.
§  Stridents (/s/, /z/, /ʃ/, /ᴣ/) have much more intense energy than the nonstridents (/f/, /v/, /ϴ/, /ᶞ/)
·      Affricates
o   They are produced quickly combining a stop with a fricative, so the acoustic characteristics of affricates have elements of both stops and fricatives.
o   Affricates have a silent gap associated with the stop part of the sound.
o   Frication noise related to the fricative portion of the affricate sound follows the silent gap.
o   Fricatives and affricates look very similar on a spectrogram, except that affricates are shorter in duration.
·      Relevant questions for exam(s)
o   Identifying the spectrograms of vowels (your clue would be mainly based on the first two formant frequencies)
o   Identifying the spectrograms of vowels (your clue would be the transition of formant frequencies)
o   Identification of spectrograms of stop consonants (clue would be voice bar (if any), release burst, VOT, and formant transitions)
o   Identification of fricatives (based on the spread of intense acoustic energy)

o   Learn the VOT for voiced and voiceless stops

Friday, February 7, 2014

Update, sort of

I've posted this before, but I'll post it again as I continue to slog my way through really difficult but important material. SLPs...when did you truly feel comfortable in your field? Does the feeling of confusion ever really go away? 

What are your weekend plans? I wish I had some, but I have really got to hit the books. Quiz on Monday and two tests on Wednesday. Bills are paid for the month and probably going to dinner with a friend but other than that, it's all study, study, study around here.

Sunday, December 15, 2013

You know you're a SLP in training when....

I love this blog: http://whatshouldwecallslp.tumblr.com/

Right on, right on bro.

Sunday, December 8, 2013

Anxiety Disorders and Panic Attacks: Alison Sommer at TEDxCarletonCollege



This is one of the most poignant, real, and frightening representations of panic/anxiety disorders I've seen and it's worth the watch. The first step to mental health progress is awareness and openness, which this girl does well. Well worth the 15 minutes, give it a watch....