What does an Early Intervention Speech-Language Pathologist Do, Anyway?
On this episode of the Learn With Less® podcast, Ayelet sat down with Grace Bernales, a pediatric SLP based in Los Angeles, and owner of Graceful Expression, providing in-home speech/feeding therapy. Grace works with the early intervention population (birth to three) and elementary-aged children, and provides helpful information and play ideas on social media and in her store on the site, Teachers-Pay-Teachers.
We’ll discuss:
- Grace’s personal and professional background, and how she came to do the work she’s doing today
- What does a speech-language pathologist do with an infant or toddler during early intervention services?
- What is the “parent coaching model” and why is it so effective?
- Grace’s top 3 tips and resources for parents and caregivers who want to use everyday materials and routines to support their young child’s language
Resources Mentioned in This Episode:
Learn With Less® podcast episode on Parent Coaching and Routines Based Intervention, with Cari Ebert
Connect With Us:
Grace: Website / Instagram / Facebook / Teachers Pay Teachers
Ayelet: Facebook / Instagram / Pinterest
Text Transcript of This Episode:
Ayelet: Okay, welcome. So today I’m speaking with Grace Bernales, a pediatric speech language pathologist based in Los Angeles and owner of Graceful Expression, providing in home speech and feeding therapy. Grace loves working with the early intervention population and elementary aged children and provides extremely helpful information and play ideas on social media. And in her store on the site, Teachers Pay Teachers. Grace’s primary passion is providing speech and language therapy for the three and under population as well as preschoolers, and she truly enjoys coaching families and believes in the importance of empowering parents to connect with their child. So Grace, I have just loved getting to know you a little bit on social media. And I want to welcome you today to Learn With Less®!
Grace: Well, hi, Ayelet, thank you so much for having me. I’m so excited to be here and talk about the early intervention population.
Ayelet: That’s it. Yes, a passion for us both. So I have asked you to come onto the show, of course, today to speak to us about early intervention, and really, what a speech therapist does with infants and toddlers. But first, why don’t you tell us a little bit more about you and how you got into the work that you’re doing today?
Grace: Yeah, sure. So I knew growing up, I always wanted to work with children or help people somehow I just wasn’t sure yet. I initially actually wanted to be a school or clinical psychologist, so I had my degree in psychology. So while I was in school, I worked as a behavioral therapist, and a lot of the children were children on the spectrum, or with Down Syndrome, and they often had speech therapy and a communication device.
So that’s kind of how I learned more about the field. And then I decided to do a few observation sessions, larger opportunities for that. And that’s kind of how I got into it. And then also, my dad had his own clinic as a physician, and I just, it kind of inspired me to do my own thing and also open up my own clinic, but that’s how I came up with Graceful Expression!
Ayelet: That’s so great. I love that. Well, let’s dig right in. So what does a speech language pathologist do with an infant or toddler during these early intervention services, specifically, Speech and Language Pathology, off course, is we can speak to
Grace: Right, that’s a great question. And I feel like, you know, coming into the family’s homes, or just, you know, for the initial session, not many families know exactly how the sessions work. So usually, I’ll, you know, tell them, you know, it’s very important for the families to be involved in this each session versus just, you know, sitting on the chair, or watching the therapist or being on their phone, I like to explain to them, you know, it’s very important for the families to be involved, it does involve a lot of play.
And I always tell families to me with when we’re just playing, but we’re actually using a lot of different sheets and language goals and to target using different toys. And it also, you know, it’s very common for a speech therapist to interact with the parent, you know, we kind of talk about how the session goes, I explained to them different strategies that they can also do with their child during that session. But now, now that COVID is around, of course, my sessions are virtual, and it’s still very much the same. It’s just more parent coaching versus me, showing them ways their child can play.
Ayelet: Right, well, this is a great sort of lead into the next real question that I have for you, which is you were speaking so much about, you know, that involvement of the parent or caregiver with the child within a therapy context. So tell us a little bit about, for those families who don’t really know what this is, what is the parent coaching model? And why is it considered so effective?
Grace: Right! So parent coaching is a very interactive process between the therapist and the parent, it involves a lot of observation, reflection and action to help promote the parent’s ability to support their child’s participation during the session. So for example, oftentimes, you know, before a session, I’ll speak with the family, whether it’s on the phone or email, I’m asking, like, Hey, is there any specific toy you want to work with today? Are there any specific words or strategies you want to work on today, and then we’ll come kind of come up with something together prior to the session. And then oftentimes, the session or the toys that we use are, of course, what the parent has already, I don’t expect families to, you know, go out and buy their own toy, I like to use whatever is already within their home.
That’s kind of part of the parent coaching model where I tell them, you know, we can use these toys, today if you like, we can use those toys, and then usually throughout that parent coaching I’ll, while I’m observing them, or I’ll kind of include them if you fix that, you know, they could adjust or I’ll kind of help them build up on strategies that they’re already doing themselves, as well as adding on new skills that they can share with their child throughout the session or throughout the week when I’m not speaking with them. But yeah, and I just feel like parent coaching is just so effective because a parent is with the child 24-7. The therapist is not there 24-7, you know, they’re the one that’s interacting with their child throughout the day, throughout the week, throughout the month.
It’s really important for the family to be hands-on with the child, you know, versus a session where let’s say the family sits in the waiting room or the family is the sitting on the couch, it’s going to be very different, or difficult for the parent to try this strategy without seeing it themselves or doing it themselves. And I know most people are very hands on – I know, I’m very hands on. So I feel like for me to really understand a strategy or do a certain skill, I need to feel, I need to be able to also get in the action.
That’s kind of why I feel like parent coaching is so effective, because we’re having them do that particular strategy with their child. And that way they can at least remember like, okay, Grace showed me how to do this, I did this during the session. So I can do this with my child more, so I feel like that’s why parent coaching is just so important.
Ayelet: Right, because it’s an, it’s like an active learning process. So it’s so interesting, because I think so often we as the adults in the room, and as a parent, for instance, we oftentimes will assume like, okay, my child is receiving services. So my child will be the one who this therapy session is focused around. But really, in many cases, early intervention is so much about parent education, and about building up that parent’s or caregiver’s capacity to really be able to feel confident that they can do that, that they can serve their child that they can support their child, and that they have the tools to connect with their little one and support their little one within play, within everyday routines.
I’m just curious to hear from you, you know, I think we do, in general, as a society, and as parents in this day and age, focus on the tools themselves instead of those interactions. And play can really – obviously, as you know, and I know that you share this all the time on say Instagram, for instance, play can happen and developmentally supportive and enriching play can happen with everyday materials. And in those everyday routines and interactions. And I’d love – we’ll get some specific tips from you in just a moment.
I’d love if you could share just a few of those actual materials that you might recommend, whether they are the, like a toy, or the everyday material “version” of a toy, for instance, that you might sort of gravitate towards or help families gravitate towards within your sessions.
Grace: Yeah, sure. So a few that come to mind at the top of my head, number one would be a paper towel roll or toilet paper roll, which I’m sure everybody has. So, I always tell families, when you run out of paper towels or toilet paper, you know, save those because you can do a lot of different things with them. One of the main things I like to use it as is like a microphone. Because I feel like children just love hearing like how their voice echoes or how your voice echoes, so I like to tell parents to use that. And then it’s also fun to play an “I Spy” game with if you have two of those, so that, you know, you can get a lot of language with those roles.
Then I also like to use boxes. And a lot of I’m sure, especially people these days are using Amazon boxes or whatever they’re shipping to their home. And I’ve had kids where they pretend it’s like a car. I’ve had parents draw wheels on it, and they push them in the box, but it’s also turned into a fort or like a castle where you can draw windows on it. So you know, definitely toys don’t have to be actual toys. Like you said it could be everyday items.
And then I would say the third everyday item that I like to use often, too, is a muffin tin. Right. I like using muffin tins because you know, the parent can put whatever item or toy they can put in there. And then I tell them to cover it up with some tape or painters tape. That way they can use that for a lot of requesting, labeling, and it’s fun for kids to also riff off the tape. It’s like they’re opening a present each time. So that one’s definitely a favorite of mine, too.
Ayelet: I love that. Yeah. Do you, do you like to use the like solid metal ones? Or have you ever experimented with the the rubbery sort of foldy ones that can that can be heated up in the oven?
Grace: Yeah, I’ve done both. I think most of the times they use a regular, the actual muffin since you put it in the oven. But I’ve had some families where they had the rubbery one. And that was just as fun too!
Ayelet: That one’s fun too, for sure. Awesome. Well, we’re gonna just take a very brief break to hear a word from our sponsors. And then we’ll hear just a few tips from Grace about what you can do to support your young child’s communication development using what you already have. And we’ll hear about her favorite resources to share with families.
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Ayelet: Okay, Grace. So what tips – other than everything you’ve already said – what tips do you have specifically for families who are curious about, say, using everyday materials, and using those routines to really support their child’s language development?
Grace: Sure. So the number one tip and I get this is difficult to do on is to decrease questions.
Ayelet: To decrease questions? Okay, great.
Grace: So decrease questions and instead turning them into statements, because you know, it does take the pressure off the child. So for example, let’s say I’m sure a lot of us are watching our hands these days, you can have your child as they’re washing their hands, instead of asking, What are you doing? You say, oh, wash hands, wash hands, we’re washing our hands. So doing a lot of narrating and just remember, and instead of asking the question, turning that question into a statement.
So another example could be, let’s say, you know, your child is eating a cookie. Oh, what are you eating? What flavor is it? What color is it? You can just say, oh, you’re eating a chocolate chip cookie, or you’re eating a cookie. And that way the child is hearing the words that we want them to say and it takes off the pressure because I feel like oftentimes, you know, when I see children get asked so many questions, they kind of shut down and they shy away more versus when it’s more indirect. So I would say…
Ayelet: That’s such an interesting point.
Grace: Yeah! That’s probably one of my favorite tips to give. And then I would say another tip I like to give is providing choices. That way, when you give a child choices, it makes them feel like they’re in control. And this can be helpful I feel like with meal times. Of course, you know, when you do give the choices, don’t give them something you definitely don’t want them to like two sugary meals!
Ayelet: Right! It has to be – both both choices have to be something that you feel comfortable with.
Grace: Exactly. Yeah, so you can even ask, oh should we eat an apple or a banana? That way they can choose, but in their mind, they’re like, Oh, I get to choose which one I get to eat. So providing choices. And that can be done during many routines, whether it’s meal time, dressing up, maybe you know, their little ones like to choose their own clothes, they can say, oh, should we wear our red shirts today or white shirts today? So that one’s another helpful one that can be done throughout the day.
Ayelet: That’s a great one too. Because in that like “choice making” you’re also bathing them in all this language, right without, like, drilling the colors, for instance, which I think a lot of us as adults tend to get stuck in and like my child has to learn how to say red, white, blue, green, purple. But in reality if they can’t communicate, like the things that we want them to communicate, of course are within that everyday context and everyday routine. So if they can indicate which one they’re interested in, or say “shirt” or whatever, like or say “that!” That’s the word “that” is a way more useful word than the, than the word read. For instance, I love that.
Grace: Yeah, no, especially with the colors, because like you said, I do often see a lot of parents focusing on like, Oh, my child doesn’t know their letters or their colors yet. And I say, you know, that’s okay, what about other words like “help,” or “want” or “open?” Do they know that yet? So that’s another good point you said, too, is focusing on those functional words because that way they’re able to communicate better. If the child only knows or colors, how are they going to ask for help? They can’t just say “red.” Yeah. So yeah, I like that point that you made there.
And that’s another thing is I guess this goes along with using everyday items too, is well one with toys and when families ask me like, oh, what toys, kind of toys that I get from my child, and I’m looking to get them something for their birthday or for the holidays. So I remind them, you know, it’s really better to get a toy, the less a toy does, the better. And that way, so specifically toys without sounds, without any battery, and you know, when I tell them that they said, Oh, really, that’s interesting, why is that? And I said, Well, you know, the toy is already making the sounds and the words, will your child say the sounds or the words and the sounds? And they’re like, Oh, no. So it’s really helpful to get a toy that has no sound. And I mean, a few of my classic toys are like blocks, wooden type puzzles, pretend food, because that way the child is able to do different sounds with it, they can label it, as a toy isn’t doing it for them already.
Ayelet: Right? And they can engage in those sort of imitative play contexts, like with the pretend food, you know, giving it to the parent asking the parent if they want it, even giving the parent choices. Right, and then they’re imitating what we do to them. And that’s something that we always want to see with, with little ones. So yes, great point. I love that: open ended materials versus those cause and effect toys. Because again, as we’ve talked about, so often on the Learn With Less® podcast, you know, when we have those kinds of toys that purport themselves to be teaching your child, all of these things, maybe, you know, on the side, they’re like complementing that knowledge. But really what they’re teaching is cause and effect, which you can also teach with a light switch. Right?
Grace: You’re right, yeah. A light switch! It would definitely give you that.
Ayelet: So definitely save your money on that. And then how about resources, we’d love to know what some of your favorite resources to share with families are, who are, you know, looking for those practical and simple solutions to support their little ones?
Grace: Yeah. So, a few specific resources that I use… well, Teachers Pay Teachers does have a lot of various resources, and I don’t want to think like, oh, it just says teachers, is it only for teachers? It’s really for, you know, anyone and a lot of the handouts that I make too, are also meant for parents. So, Teachers Pay Teachers, I use a few websites, you know, for parents that want to have an interactive experience online. Of course, I do like to limit the usage of doing it on the laptop or the iPad, but one of one website I like to use is called abcya.com.
They have a lot of different games on there, they have holiday games on there. And what helps is, you know, of course the parent can be there with you. So you can make it interactive for them. You can, for example, there’s one where you can build the pumpkin. So you can ask the toddler, which one should we get? We get the black, the brown one so I like that the website’s very interactive. And they also have stories for children, too. Same with Starfall there’s a lot of different stories and animated activities on Starfall, as well.
Ayelet: So, so you said Starfall – what was the first one you said?
Grace: Abcya.com.
Ayelet: Okay, cool. So, so those are a few great sort of high tech resources for families who are looking for the more technology.
Grace: I’m always getting asked, oh you know, what can we do online, so okay, remember, be there helping make it interactive, vs. just, here you go, go play with the iPad.
Ayelet: Right. And also to point out too, especially with the little ones under the age of three, the most effective, you know, play is is going to be with those actual, physical objects that they can touch and manipulate and move around and lift and figure out how big they are, and how heavy and all of that. But those are really fun resources to like build out, if that’s where you want to go with with some of the time that you’re spending with your little one. That’s great. Any other resources just like for parent education that they can look to? I mean, obviously, your… I want to give a big plug to your Instagram feed because it is so helpful. We both share a lot of information with parents on Instagram. Can you tell us what, just so that they can hear it what your Instagram handle is?
Grace: Sure, it’s @gracefulexpression.slp – So yeah, like on my Instagram, I do also like to share a lot of different handouts and the handouts include strategies that parents can do with certain toys, certain activities, certain daily routine, you can also just provide a few activities or even things you can do for like brushing your teeth, or sometimes I’ll collaborate with other people like with a dentist who talks about the brushing teeth and you know, using sweets and how you can serve sweets with your toddler. So few of them are also a feeding therapy related.
Ayelet: Cool. Great. Well, where can people find you who are looking to find out more about you about the services you provide the resources that you provide, Grace?
Grace: So I’m in Los Angeles, but because of COVID I am doing everything via teletherapy at the moment, but if it wasn’t if it wasn’t COVID and I usually do provide services in the home either in the, I know Los Angeles is a big county, so specifically in the Pasadena area, Glendale area, Burbank, La Cañada, but right now since I am doing teletherapy, then it could be anyone in California because that’s where I’m licensed in.
Ayelet: Excellent. And your website. Where can people find you online?
Grace: Oh, sure. It’s graceful-expression.com!
Ayelet: Beautiful, wow, very, very great. Thank you so much for your time and energy today, Grace. Thank you for everyone listening from home or on the go. Thank you so much for joining us and we will see you next time.
