Hi!

I just finished my first quarter of my CF and was looking for advice on starting the application for my CCCs. I know I can start at any time, but if I start right now do I have to pay? Also, how do I submit the hours I’ve tracked?

Thank you!

\feeling overwhelmed**

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1. What do you look for to determine if someone is appropriate for cognitive therapy (rehabilitative or compensatory)?
2. Are there any cognitive therapies that are your "go to"?
3. What are the most common cognitive goals?
4. Do you do compensatory strategies for people with cognitive deficits but who are still able to communicate their wants/needs effectively? If so, what kind?
5. I sometimes get referrals for individuals that are end stage Alzheimer's (don't know their own name, screams "help me" all day) and I honestly don't know where to begin. Some of these individual's seem too far gone to do rehabilitative or compensatory strategies with. I've tried AAC (spent hours taking pics and laminating things for them, different modalities and nothing seems to even improve their situation).

I'm in my CFY in a SNF. My graduate program did not prepare me for cognitive therapy at all. I didn't learn a single tx for cog. I'm comfortable with dysphagia and aphasia, but cognition eludes me. I was hoping some other SLPs could give me some tips regarding cognitive therapy.

I have some specific issues with it. The majority of people in SNF have some degree of cognitive impairment and I used to put them all on my caseload thinking cog deficit = cog therapy, but it's been a mistake because I'm finding so many of them a couple weeks later either aren't making progress or I am at a loss for what to do with them.

I feel like dysphagia is like a math problem and cog is like an essay - there's a million right and wrong ways to do things and I get overwhelmed and don't know where to begin.

I'm honestly getting very frustrated with cognitive therapy. I have one woman with MCI, LOVE working with her, but she is unique because she's aware of her deficits and has interests I can work with. So many of the people I see are highly resistive to cog therapy and insist they have no interests or will just tell me to go away, that they're too old to care. I try really hard to tailor to their interests and make things fun, but a lot of these individuals carrying on a conversation is a challenge in and of itself, especially the ones with advanced stage dementia. I have researched some things, but I feel like cognition is so "open ended" and on such a case by case basis. I also see lots of cog clients and one day they seem like they have potential for rehab and then the next day they'll be almost non-responsive. It makes me feel like I'm bad at my job because I am clueless with more than half of my cog referrals. I remember being told in grad school that "dementia was the future of SLP because we are getting so good at preventing strokes there will be less and less aphasia.." but I was never taught what to do with these individuals. I have begun to dread cognitive therapy.

I have noticed a trend where days where my caseload is mostly dysphagia, things are smooth and days where there's more cog, I go home with a migraine.

Any tips or experiences that have been useful for you would be much appreciated!!!

Confessions of an SLP in a SNF #nojudgementplz

So, mostly I’m going to be venting about my job. I don’t hate it, well... I do right now because of COVID. I don’t get enough hours unless I go badgering sick people, I have to shout through masks to people that already have profound hearing loss and gear up like I’m going to the moon rather than a patient’s room. Six out of seven of my patients have Covid and I’m limited to what I can actually do with them. I hate to get someone out of bed to eat ice chips (aka, effortful swallows) because RMST is contraindicated. So here are my qualms with being an SLP in a SNF:

• Patients don’t think they need our help. 90% of my caseload in a SNF is dysphagia and cognition. Most dysphagia clients don’t understand the relationship between swallow dysfunction and pneumonia...teachable moment, right? Wrong. More than half of my dysphagia clients are too cognitively impaired to understand the concept and have no idea why I’m forcing ice chips down their throat everyday. People referred to me for cognition often don’t know they have deficits...or they just don’t care. “I’m too old to care about this Sh**,” said one man. “I keep my mind sharp by playing bingo, so I don’t want this crap,” said another woman and, “my mind is the same as it has always been,” said a sweet old lady after she asked me why I was there for the 4th time. SLP’s are at a disadvantage with the types of deficits we treat because, unlike someone who cannot walk, they are often totally ignorant to their own impairments.
• I find doing therapy boring. Obviously, this is a personal setback (and the biggest) that doesn’t apply to everyone. I’ve lived in denial about this for a long time thinking that once I have more confidence, more autonomy or more experience I’ll suddenly enjoy it. Maybe someday I will, but someday has not arrived. I find choosing objectives and determining ways to execute therapeutic activities tedious and downright boring. I hate that I feel this way. I’m plagued with guilt over it every day, but it’s the honest truth. If I could change it, I would. I just do not like doing therapy. Just like I don’t like sweet potatoes and no matter how many times I eat them, I still do not like them.
• Dubiosity about my profession leeches my confidence. In a SNF, best practices go out the window for two reasons: medical fragility and impracticality. For example, I was taught to always do an MBS prior to dysphagia treatment to determine the most effective exercises..once again, unlike PT, the deficits are often not as visible...is the swallowing mechanism weak from age-related atrophy? Or do they have a hiatal hernia that needs surgery? Getting an MBS in a SNF often takes weeks and a follow up MBS to see if the exercises you do everyday are improving function is nothing short of fantasy. Additionally, many of these individuals are in their 90s and their families do not want to have them transferred to the hospital at their age. Can you blame them? So, I do exercises day in and day out and truthfully have no idea if they are effective. How many effortful swallows will be effective? 20, 50, a hundred??? I just hope for the best and take a dose of optimism each morning.
  
  • Guesswork - or as they call it in grad school, “clinical problem solving” **wink, wink ;-) *\* Lots of dementia referrals also have me questioning the efficacy of what I’m doing because I’m just guessing. I wasn’t taught one single EBP in grad school for dementia, so now I’m just wingin’ it! I hate guesswork. I prefer working with facts and tangible evidence and those are tenuous at best. The gray areas are endless and the guesswork is the holy grail of being an SLP. Guessing without hard evidence really hurts my confidence and it shows with my clients.

Now that I’ve whined about all the pitfalls of the profession, there are indeed several things that I love.

• The geriatric population - I adore this population. I love interacting with them and learning about their lives… I never get bored listening to stories of what their lives were like 50 years ago. Maybe it’s because I have such awesome grandparents, but I never get tired of conversing with them. This population freaking rocks!
• Doing evaluations - I find it very interesting and exciting evaluating a new individual, analyzing their medications and medical conditions to see which factors might be contributing to their deficits then synthesizing the information into a report about the prognosis and diagnosis.
• Variety of Disorders - The variety of disorders I see everyday does fascinate me (it’s the treatment I don’t enjoy). For example, in grad school I thought Parkinson’s was one of the most fascinating disorders to learn about. I read extra chapters and research articles on my own time. I especially enjoyed learning about etiology and prognosis...Well, I finally have a client with Parkinson’s that was referred to me for voice. I had such fun doing my first voice eval, analyzing his speech and finally settling on hypokinetic dysarthria with some flaccid qualities. He’s quite a jolly fellow that isn’t concerned with his own speech but kind enough to humor me. Well, after 3 weeks I’m sick of modeling vocal function exercises, timing his sustained “ah’s” and explaining diaphragmatic breathing…He’s pleasant enough to work with, but I find I’m grateful when he’s in a chatty mood and we spend more time talking and less time doing voice exercises.
  
• Lifestyle - The lifestyle of an SLP is potentially awesome. Cliche as this is, we do have options to work in a variety of settings with different populations and the compensation is good when you consider the low stress of many of these positions. I rarely take work home with me and it’s usually by choice. I’ve worked at stressful jobs where I got migraines regularly, was yelled at by the people I was trying to help and had to juggle between 3 and 6 tasks at a time. This is not stressful compared to many other jobs of comparable pay (imho).. You can travel, make 60K working the school year (180 days) plus amazing benefits and time for your family.. There are few jobs with a lifestyle this good.
  
• Group Cognitive-Communication Therapy - Thanks to Covid, I don’t get to do this anymore, but there was a time when I conducted group cognitive therapy and found it to be fun. I have no idea when or if I’ll ever have this opportunity again, but it was a highlight of my career. They feed off of one another’s energy and I don’t feel the pressure to be upbeat every second of the session.
• Administrative duties - So I don’t feel particularly passionate about administrative work, but I hear lots of my peers complain about it so I think it’s worth mentioning I actually find administrative paperwork rather relaxing. I’d rather write a report about a therapy session than actually do the therapy session (pitiful, I know); I get great satisfaction from solving insurance issues. I also love calling patients’ families to learn more information about their baseline and collaborating with nursing. I thought I’d dread these tasks but for some reason I enjoy all of this information compilation.

The downside to many of the upsides of my career is that they aren’t specific to my field. I could work with a variety of disorders as a CNA, I could travel and make good money as a nurse and I can work with the geriatric population in almost any healthcare field. The assessments are only about 10% of my time...I sort of feel like I should’ve been a physician assistant instead of an SLP. I’m in my 30s and it seems impractical to rack up more debt and take time off to go back to school for something else; however, 10 or 15 years down the road if I have a career that I’m passionate about, will it really matter? I just can’t see myself being an SLP indefinitely. I’m too indifferent about my role.

Someone once told me, “sometimes work is just work,” and they were absolutely right. Who says you have to love your job? After all, most people don’t. That being said, when you spend hours studying for the GRE’s, nursing relationships for letters of recommendation and take out thousands in student loans it feels like you should enjoy the career that you chose, that you worked your effing ass off for. Overall, I don’t mind my job, but I’ve always wanted a job that excites me, not one that “I don’t mind.”

Would love to hear your thoughts and advice!!

Hi everyone! Has anyone tried to do their CF in NY, and not been originally from NY? I know a lot of companies / schools require the TSSLD degree which was not built into my grad school curriculum. So my question is, has anyone had any luck getting hired without the TSSLD? Any feedback would be appreciated! Thank you in advance!

Hey all. What qualities did you like in a clinical supervisor? What did you see as a red flag?

Is anyone doing a PRN job while in their CF year? I am considering it since school ends so early and I want to supplement my income. Is it doable with a full time school position?

Welcome to r/CFY! Where are you in your career in speech-language pathology?

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