I book my appointments in Cliniko, and it synchronises with my personal and family calendars on iCal. For privacy you can adjust the level of information displayed in iCal, choosing first name, full name or initials. It’s straightforward to book clients in for blocks of sessions and Cliniko emails the parent a reminder before each session. I’ve set it to go out 2 days before the appointment, at 10am. The email simply reminds families of the date and time of the upcoming therapy session, which parents tell me they find useful.

I write my clinical case notes using a form that I’ve customised. It’s a mix of check boxes (e.g. where the appointment was and who the child attended with) and free form text boxes for things like the session’s aims and information about how the child responded. It’s easy to look back over past sessions and see how the child is progressing.

The other features I use are invoicing and file attachments. You can upload your company logo to Cliniko and make a professional looking template for invoices. It’s quick to produce them and the system can either email the invoice to the client directly or you can save it and email it yourself. It also lets you track who has and hasn’t paid. I use the file attachment feature to upload documents to each patient’s record. I scan in the case history form and any assessment record sheets – once you’ve made a pdf, it’s a drag and drop interface to add them to a patient’s record. I also upload all the reports and letters I write so they’re in one place, secure and available whenever I need them.

There are some fun touches, like it reminds you when it’s a client’s birthday, as well as lots of features that I don’t yet use. For example it supports clients booking their own appointments directly online, via your website. You can also use it to track your business expenses.

Cliniko has allowed me to run an (almost!) paperless business. I can write and review case notes wherever I am. And the automated appointment reminders increase attendance rates. I recommend it. (I pay for my Cliniko subscription, and they don’t know I’ve written this review!)

I kept two principles in mind when deciding what I needed to buy or borrow to start my therapy business:

• Wait and see what I need and then buy it – with internet shopping lots of things are available on next day delivery.
• Buy things that can be stored easily and used for multiple purposes – as I’d need to store everything at home and then carry it to therapy sessions.

Assessment materials

I bought two standardised assessments, my most expensive purchase. I’m happy with the two I chose and how many times I’ve used them. The publishers have displays at industry conferences or events and offer discounts, so if you’re planning on going to an event and need to buy assessments check and see if the timing works out.

I also use informal measures like Language For Thinking and sequencing pictures from Black Sheep Press. Some observation schedules are available for free online, like the Modified Checklist for Autism in Toddlers – so I use these.

Toys and books

My colleagues in the NHS asked what I’d like as a leaving gift, so my toy collection started with a tea set, a train set and Mr Potato Head! I bought toy animals, food and a fishing game. My parents still have toys from when my sisters and I were little so I “borrowed” soft toys and books from them. (Check the content of books, I love There’s a Hippopotamus on Our Roof Eating Cake but in my original copy, the character gets a smack: I skip this page.)

I’ve found some great bargains at charity shops and bought things to motivate particular clients. Homemade toys often go down well too, I still have the sparkly tube I made back in 2008 and still get strange looks carrying it to work on the bus!

Technology

I use my iPad in therapy. I record and watch back videos in Parent Child Interaction therapy, with a small set of speakers to boost the audio. I also use it to play games such as my favourites from Toca Boca. When I made a snakes and ladders style game to work on speech sounds, I realised I didn’t have dice, so I downloaded a free app (I think it’s for poker!)

We already had a colour printer and scanner at home, and I use both regularly. I bought a laminator and I use it for making visual timetables and other resources. I’ve written before about Lessonpix – the online product I use to make my visuals (and bingo games!) Finally, I use Cliniko to manage my appointments, write my case notes and send invoices. I’ll write more about how I use it in the next post.

Other bits and pieces

I bought two folding child sized tables and four chairs which I used for every session in my original therapy rooms and currently don’t use at all.

And my secret weapon? A box of tissues. I’ve finally realised that if I bring the tissues, I’m much less likely to get sneezed on!

This blog post is part of a series, read the previous posts here.

I don’t have space to see clients at my flat. I needed to decide if I’d go and visit people, or rent a therapy room and have clients come to me. When I calculated how much time I’d spend travelling from family to family, I realised I’d only be able to see 4 or 5 clients in a day. It made more sense for me to rent a room, I’m able to book in between 6 and 8 clients a day.

There are of course advantages to seeing clients in their own home or educational setting. There are also advantages to seeing people in a distraction free, neutral space where both children and their parents can focus on the therapy session.

I work part time, so I looked for rooms I could rent by the hour or day. I’ve used 5 different therapy rooms and learnt what’s important to me, here are some things to consider.

Where is the room?

I look for somewhere close to public transport. One of my current rooms has a car park which is a bonus. Families have also commented that they enjoying coming somewhere close to cafes and shops. I decided not to work from one practice that looked gorgeous during the day, but felt isolated at night, I didn’t think I’d feel safe.

Is it accessible?

Think about the access. If you work with pre-schoolers like I do, they may arrive in pushchairs. My first therapy room was up 3 flights of stairs. They may also be in the process of toilet training, how far away is the toilet?!

Is there space for your clients to wait if they arrive early? Are there any resources you can borrow, such as child sized furniture or musical instruments? Is the room suitably furnished, or will you need to remove fragile things before getting started each day? How often is it cleaned? Is there any storage you can use?

What are the rental terms?

The places I’ve worked from have varied hugely in terms of the admin, and payment terms. Two places required me to sign a contract, provide my insurance information, and give notice if I wanted to stop using the room. Others have been more flexible. When I was gradually returning to work after maternity leave, I chose a room I could book on an ad hoc basis to minimise the risk of paying for a room I wasn’t using. Then when it wasn’t available on the days I needed, I found a room where I book 6 sessions at a time, but don’t need to sign a contract. I was surprised that when I asked for a discount, one place was happy to give me one.

What’s not essential but nice to have?

I like the idea of having access to a kitchen, but in 18 months I’ve only made myself 1 cup of tea! I do use the sink to fill and empty buckets for water play though. I thought wireless internet access would be useful, but on the rare occasions I’ve needed my iPad online, I’ve tethered it to my phone.

Referrals and other benefits

It might be worth thinking about what other businesses or services work at any location you’re considering, as they may be able to refer people to you. Some venues offer other incentives: when I rented a room in a wellness centre, I was considered a “teacher” and could go to yoga classes for £1!

Each time I need to look for a new therapy room I feel overwhelmed, something always comes up though! If you have questions about finding a therapy room leave a comment or email me.

This post is part of a series, I wrote about how I advertise my service and how clients contact me in previous posts. Coming next pricing, billing and all things money.

Last week I had what I thought was a winning therapy idea, when it didn’t pan out I had to improvise.

Two of my kiddies are working on verbs and we’d been practising “cutting.” I’m targeting /sn/ clusters (“snip!”) with another child. I was inspired by some recycled packing materials to try a hair cutting activity.

I drew faces on paper and taped wavy, strings of cardboard packing stuff on for hair, it looked great. I handed a pair of children’s scissors to the girl working on “snip” and she gave it a good go. But the scissors were too small and not sharp enough to cut the “hair” – oh dear. We started snipping other bits of paper, and then rapidly moved on to sticking things on to a picture of a “snail.” For the two boys working on “cutting” it was Toca Hair Salon to the rescue – phew.

Therapy is all about improvising: therapy sessions rarely go exactly to plan. We can’t follow a recipe, instead we spontaneously make communication opportunities from whatever is available, and teach parents to do the same.

The team at Little Bee Speech kindly gave me their new Articulation Test Center to try out and review. I haven’t used an app to assess a child before, so I was intrigued to see how it would go. 

I used the Test Center with a 4 and a half year old girl, who I know well. I watched the comprehensive video tutorial of how the app works before I began. Read this post on the Little Bee Speech Blog for a detailed description of how to use the app and all its features.

Useful features

I found it straight forward to get started and record how my client produced each word. She enjoyed completing the assessment, was keen to swipe on to the next picture and motivated to finish it in one sitting (which is not always the case with traditional, paper based assessments.) The prompt questions worked well to elicit words she didn’t know and the clear photographs were easily recognisable.

When you’re finished testing, the report the app produces is very detailed and I used parts of it in my clinical case notes. I really like how easy it is to compare a child’s performance over time, and therefore monitor progress in therapy. It’s wonderful to have everything you need in the one app so no schlepping of heavy test materials or hunting through papers to find past tests.

Feedback for the authors

My client and I both accidentally set off the voice prompt while swiping on to the next picture. And there are a few words that British young children are unlikely to know (for example ‘skunk’ and ‘pretzel.’) However, my worry with this app is the way that sounds are marked as incorrect – they are changed from green to red. Young children are amazingly switched on to this right / wrong distinction and I felt uncomfortable marking this so clearly for my client to see. As she is beginning to read, she was confused when I dragged her error sound on to the word in place of the correct sound. 

I wonder if there’s a way to make this scoring more subtle. Would it be feasible to pair an iPad and iPhone, and have the pictures on the iPad and the scoring on the iPhone? If you have any clever ways of scoring this type of assessment discretely, please let me know!

Overall I was impressed by this app, it would be a useful addition to a speech and language therapy toolkit, and from Tuesday 12th August until Thursday 14th August it’s on sale, at 30% off (details on the Little Bee Speech Facebook page.)

I came across LessonPix, it’s an online product, there’s no software to install or CD to lose, and I can use it on any computer that has an internet connection. The cost is $36 (USD) per year for an individual subscription, which converted to £22.62 when I paid online with my credit card. It’s less than £2 a month, and as there’s no CD to receive by post you can get started straight away.

I’ve used this resource every week since I bought it, and I recently renewed my subscription for a second year. I’ve made all the usual things, such as symbols for visual timetables using the picture cards template. I’ve also tried out new materials, my clients have enjoyed the games like dominos and board games. I even made a bingo game with s cluster words for a client’s birthday!

To make a resource you simply search for the pictures you want to use and drag each one into your “tray.” You then choose what materials (picture cards, now and next board etc) you want to make, and the site produces a PDF. You can save your trays to easily make different resources with the same pictures later on. As the finished resource is a PDF you can print it from any computer, you don’t need to be signed into the site. I store all my resources in Dropbox, so if I forget to print them, I can always pull them up during sessions on my iPad.

It is so quick to use that it’s easy to personalise the resources for each child, simply putting their name in the title is a detail they appreciate. You can upload your own pictures and photos to the site and then use them to make resources in the same way. If you’re using words with the pictures, you can replace any of the existing labels with your own words – which means the USA / UK English differences aren’t a problem; just search for ‘faucet,’ choose which picture of a ‘tap’ you want, and change the label!

The only thing I’d advise you to watch out for is getting signed out of the site. If I sign in and start filling my tray to build a resource, then get distracted and come back later, the site sometimes automatically signs me out. If I don’t notice I’ve been signed out and finish making the resource, and produce the PDF (when I’m not signed in) the PDF has large watermarks on it and I have to re-do it.

The service was designed and built by Lori and Bill Binko, a husband and wife team in Florida. Bill is an active Twitter user, where he responds to therapists’ queries and lets people know about special offers. It appeals to me that they promote their service by providing useful information and responding to feedback. The gorgeous pictures of Florida sunshine (on Twitter) can be hard to take during winter here in London though! The site has a friendly feel, for example, if you can’t find the picture you need, simply click ‘request an image’ and let them know what you think is missing.

I wasn’t asked to write about LessonPix, (I paid for both of my annual subscriptions) I’m choosing to spread the word about a product I find useful. My subscription to LessonPix has met my needs; I can produce engaging, personalised, visual materials quickly and easily. It’s so affordable and easy to use that I feel happy recommending it to parents. Check it out!

When the team at London Speech Therapy tweeted a request for bloggers to review their Colourful Semantics app I volunteered. I was given a complimentary copy of the app in order to review it.

The principle of Colourful Semantics appeals to me, as I’m a fan of clear structure, but the hundreds of small pieces of coloured paper always put me off! Watch Helen Blatchford explain how Colourful Semantics works.

This app removes the need for lots of printing, cutting and laminating, it’s all there ready to go. The app is loaded with a set of photos and the corresponding sentences. You can work at various levels: who, what doing, what, where and describe – which are all colour coded. When you start the game, a photo is presented and the child is asked a set of questions, for example: “who is in the picture?” The child responds by selecting the correct symbol from a choice of four and is given feedback as well as an opportunity to practise saying the sentence after the model.

What I like about the app

• It can collect data about a child’s performance, the app tracks how a child is doing – what a time saver.
• The app is visually motivating for children, and I think they’d find it fun and engaging.
• There is a clear structure, so children would quickly learn what they’re expected to do.
• The voice that says each sentence is a lovely clear British accent!
• The app is customisable; you can turn the music off (I’m easily distracted,) turn the praise off (see my view on praise here) and mute the rather directive: “your turn to say it.”

Things I think could be improved

• It seems to present the pictures in the same order each time you play, which becomes repetitive.
• The app presents the whole sentence (the cat is eating food outside) when you’re on the simplest level and the child is practising ‘who’ – which is confusing.
• It’s wonderful that you can add your own photos to the app, however the procedure is currently time consuming and some of the options (e.g. symbols) I required when I tried to add a picture of myself eating a bowl of soup weren’t available.

Mirla Gaz uses this helpful heuristic when reviewing apps:

“In order for me to recommend a therapy app, I need to feel that it can simplify the life of the therapist and will be a fun learning experience for children.”

This app will be a fun learning experience for children. When I compare this version of colourful semantics to the paper based one, it absolutely simplifies life for the SLT. However, in its current form, adding your own photos is not yet simple enough for me to justify the £27.99 price tag.

A recent experience gave me a powerful reminder that the children we work with need to feel calm in order to learn and develop their communication skills.

We were about to fly to South America on an evening flight. I’d planned to come home from work and travel to the airport with my partner. But for some technical reason, we couldn’t check in online. Panic! Suddenly the plan needed to change.

When my partner suggested a new plan—going directly from work to the airport—I started mumbling incomprehensibly about not having the right shoes on and my ID badge. I said it was impossible and insisted that the original plan was better. The more anxious and angry I got, the harder it was to think rationally.

Looking back, I realise I needed a visual timetable! If my partner had used symbols to talk me through the sequence of events, it would have reduced both my anxiety and my difficult behaviour. I would have been able to think more clearly, see that the steps were logical, and realise they allowed me to reach my goal: getting to the airport on time.

The same principle applies to the children we work with: they need to feel calm in order to learn and develop their communication skills. We should take the time to prepare a visual timetable for each session, to minimise anxiety and create the right conditions for learning.

In one of her workshops, Gina Davies reminded me that visual support can be quick to produce and low-tech. She demonstrated using an A4 sized whiteboard to produce a “now” and “next” style timetable in front of the children. This can also support the development of early literacy skills if you hold the board so the children can see you drawing and writing.

At the other end of the technology scale there must be visual timetable style apps on the iPhone or iPad. Have you used any? I’d love some recommendations.