Episode 328: Marnina Allis & Marisa Portanova: Empowering Communication & Collaboration at Blythedale Children's Hospital

This week, Chris interviews Marnina Allis and Marisa Portanova, two speech-language pathologists at Blythedale Children’s Hospital, the only independent specialty children’s hospital in New York State! Marnina and Marisa share about their role on the core assistive technology (AT) team, ideas for supporting AAC users and their families outside the hospital, taking a team-based approach to treatment, and more!

Before the interview, Chris and Rachel share about starting the school year and how changing school teams often bring a certain amount of new energy to school sites. Chris also shares about one of his favorite things to start the school year - donning the costume of Shadow the Dog, the mascot for his wife’s elementary school!

Key Ideas This Week:

1. Collaborative Approach to AT and AAC: Marnina and Marisa emphasize the importance of a collaborative approach at Blythedale Children’s Hospital, involving a core AT team that includes speech therapists, occupational therapists, physical therapists, and a rehab engineer. This team works together to provide comprehensive support to pediatric patients with complex needs, ensuring that assistive technology solutions are tailored to individual requirements and are integrated into the patients' everyday lives.

2. Focus on Family and Community Involvement: The interview highlights the hospital's commitment to involving families in the therapy process, empowering them to feel comfortable and capable of using assistive technology with their children. They aim to provide ongoing education and support to families, recognizing that successful communication strategies need to be practiced in all environments, including home and school.

3. Make Learning Language Fun: Marnina and Marisa discuss their implementation of group therapy sessions that focus on fun, engaging activities like games and themed literacy projects, which allow children to interact socially while working on communication goals. This creates a supportive, interactive environment that promotes skill development and community building among AAC users.

Links From This Episode:

TED Talk - Derek Shivers: How To Start a Movement

Visit talkingwithtech.org to listen to previous episodes, find new resources, and more!

Help us develop new content and keep the podcast going strong! Support our podcast at patreon.com/talkingwithtech!

Transcript of the Episode

Please Note: This transcript was generated using speech recognition & AI tools; it may contain some grammatical and/or spelling errors.

00:00:08 Rachel Madel
Welcome to Talking with Tech. I'm your host Rachel Madel, joined as always by Chris Bugaj. Hey, Chris.

00:00:14 Chris Bugaj
Hey Rachel, you know I go by Chris Bugaj, but you know what my alter ego is? You know what, when I donned the costume that I have another name that I go by.

00:00:24 Rachel Madel
I feel like you have lots of costumes, Chris. So like I'm I'm not sure which one you're referencing.

00:00:30 Chris Bugaj
Yeah, it it's the one that only comes out when the sun is out.

00:00:36 Rachel Madel
Give me another hint.

00:00:36 Chris Bugaj
Only comes out. It only comes out during specific times of the year, like the first day of school.

00:00:45 Rachel Madel
Does it have to do with an animal?

00:00:48 Chris Bugaj
It does.

00:00:49 Rachel Madel
Shadow.

00:00:51 Chris Bugaj
I am shadow. That's right. You know that for for people who are just listening, what is he talking about? So my wife, it is an assistant principal at an elementary school and I get to be the great fortune. I have the great fortune of being shadow, the school mascot occasionally, which is a black lab. So I donned this black lab costume and occasionally like at a big volleyball game or something, I might get to be Shadow or a spooky bingo, I get to be shadow. And on the first day of school, I get to be Shadow. And here we were recording today and it's the first day back for all the students. They're coming back today. And I got to get up wicked early in the morning, get into the shadow costume, go out there in front of the school, dance myself crazy in front of all the kids, getting all the pictures with all the families. And it was a great time. And I'll even see Rachel. I know we have a listener. I'll say hi to that listener right now who is a parent from that school and sent me a picture of me as Shadow with her child. Just saying, you know, this was awesome. And this my, my, my child loves when they get to see shadow. So, so that was just, you know, it was just awesome. It's just an awesome way to start the school year. The first day of school I is there's this energy and excitement and buzz around it. And at the time of this airing, when this banter recording will air, it's right there at the beginning of some. Some places won't have started yet, some will have already started. But it's that time of year when it is that fresh, exciting, new optimism. Everything is, is exciting and and I'm extra excited not just because of shadow, but I can't tell you already, already my teams is blowing up all day with teammates going, Oh, we have new speech therapists and they're already knowing about modeling and descriptive teaching and they're asking about where, how far along are we on this journey, on our AEC journey? Like they're already aware they're, they're coming with ideas like having coffee talks with parents and trying to schedule that like once a month so parents can come in the morning and have a coffee with the speech therapist or other people talk about AAC stuff. And those ideas are flowing right now. It's fresh. You know, it's not, it's not Thanksgiving time or later in the year when you're like, oh man, is it winter break yet? You know, summer, like right now is that that fresh excitement? And, and I feel it, you know, I feel that excitement. It's always great to start the year with that sort of, you know.

00:03:24 Rachel Madel
Yeah, it's, it's the buzz. Everyone's refreshed, revived, and that is always great. Like I feel like we all need a break and we all need to kind of regroup and disconnect. And yeah, it's that's the nice thing about breaks in summer and everyone comes back fresh.

00:03:44 Chris Bugaj
Well, yeah. And in public schools, you almost always have new people, right? People have moved on to go. If you're an, if you're an elementary speech therapist or teacher, someone has moved on to go to middle school or and you're getting new younger kids in that have that have come in. If you're older, like there's always this, yes, it's refreshing from the summer, like, OK, I've got, I'm revitalized, I'm ready to go. But there's also, there's changes happen with the people that you're working with, which means there's this again, this, this, this newness that is, that's, that that's, that's exciting, you know?

00:04:18 Rachel Madel
Totally. And I feel like that that newness is great, but also like, it's hard 'cause like it's like, oh, and now we have a whole new team that we need to train up. But at least we're at the beginning of the year and we have that like energy and passion and we're reminded of why we do what we do and why we chose this career. And so yeah, I'm having a lot of students that I'm like introduced to their new teachers and their new paraprofessionals and all the people. And I'm like, yay, like we get to do some more training. Some of them have the same same staff and teachers, but it's definitely a lot of turnover.

00:04:58 Chris Bugaj
Always, always. And especially in special education, some of the, some of the data there shows that it's like 4 times the, the than general Ed, four times more turnover in special Ed than general Ed. So yeah, there's always going to be new training, There's always going to be new coaching that needs to be done. But each time you do that, there's new people more people in the world now know, right? Like even if they've moved down and they've gone to something else, they still are more aware of how to interact with people who are learning language with AAC or using AAC now that they've learned language to express themselves. And so the, the awareness keeps growing. We, I got AI got a note from one of the people today that said, yeah, parent came in talking about the, the learning literacy through PRC program, like the learning literacy through Unity program on the, on the language lab. And it's like parents are aware, you know, some are aware. So it's just it all that stuff is, is exciting to me, you know, exciting.

00:05:59 Rachel Madel
Yeah, I am am really excited about the new school year. I just feel like it's super great, like kind of fresh slate. Like sometimes I think by the end of the school year, like the parents that I work with, like everyone's kind of just like, like, I don't know what's happening. And there's just this kind of like trudging along. And a lot of my families are like, OK, like, we're hopeful. We think this is going to be a great year. We're excited to get started. And so I'm hoping that that motivation and excitement continues.

00:06:29 Chris Bugaj
Me too. Let's see how long it can last. Right? All right, let's talk about the interview today. So here's what we've got going on. I interviewed two people from New York City and they they talk a little bit about their work with adults, not not just kids, but with adults. And so without further ado, let me introduce who we're talking with today, and that is Marnina Ellis and Marissa Porta Nova.

00:07:06 Rachel Madel
We'd like to thank all of the wonderful Patreon supporters who make this show possible. This podcast is funded by listeners just like you who signed up at patreon.com back slash talking with tech to show their support. Because of the generosity of our amazing Patreon community, we're able to pay Luke and Michaela, our podcast producer and audio engineer, who keep the show looking and sounding great. Patreon supporters also receive bonus content such as early access to interviews, behind the scenes recordings, additional curated resources and materials, and so much more. Check it out at patreon.com\ talking with tech. Now let's head back into the episode.

00:07:50 Chris Bugaj
Welcome to the Talking with Tech podcast. My name is Chris Bougie and today I'm joined with two very special guests. The first one is Marnina. Marnina, you and I have known each other for many, many years. I think where you met, we met was at ATIA. You came to one of the pre conferences that Beth POS and I were doing called more than Core back in those days. It was like everyone wanted core vocabulary and they thought if they just had core vocabulary, all AAC would be magically solved. And we said there's more to it than that. And so you, you were in that. I often think of it like this alumni group, Marnina, because so many of them have, we've continued on this relationship like known each other since then and many of them been on the podcast. And so, so Marnina, I'm going to give you a chance to introduce yourself. And then Marissa, you're here as well because you 2 are colleagues that work here together, right? So tell us a little bit about where you well, who you are, what you do, where you work. Give us the whole thing. Marnina, you want to go first? Give us your full name then.

00:08:50 Marnina Allis
Marissa, Thanks, Marnina. Alice, you're totally right, Chris, it all goes back to that pre conference at ATIA where I feel like for me that conference was mind blowing. I have to thank you. You really changed my thinking about AEC and between you and Beth at the pre conference and you and Rachel with the podcast, I know I personally have learned so much and I know how much you do for our community and I feel like so many people learned so much. I want to start by thinking of you, thanking you. It's an honor to be here. I feel like I never thought I'd be one of the guests on the podcast as somebody who listens religiously. So this is really exciting. I'm lucky that since that pre conference, I've been at ATIA every year and we have stayed in touch and that's been so great. I'm from New York, Marissa and I work together at Blythedale Children's Hospital. Marissa will give a little more info on the hospital itself, but I'm lucky that I was one of the members of the core team, the core assistive technology team at Lifedale. And to tell you a little bit about that, we work collaboratively with OT and PT and a rehab engineer. So we have people who specialize in seating and mobility and access and our rehab engineer who can kind of think creatively. And we, Marissa and I, look at the AAC so that we all work collaboratively to give the, our patients are all Pediatrics and we give our kids the best shot they can in order to use their AAC and be successful. Personally, I've been here at Blythedale for a long time. I'm old. I've been here for more than 20 years now. And both Marissa and myself as members of the speech department, we do AT, but we also see clients all over the hospital. I'm currently assistant director of the speech Language pathology and Audiology department. So I also have some administrative responsibilities. But I think like you, the AT holds our heart. I'm so glad to still be able to do evaluations and treatments for AT and AAC specifically.

00:10:53 Chris Bugaj
Awesome, Marissa.

00:10:55 Marisa Portanova
I'm Marissa Pordinova. I've been at Blaiddell for just over four years now. I recently joined the assistive technology core team and I, I met you, Chris Marnina introduced us at ATIA 2024. So that was really exciting. So as I'm still the newbie to all of this, I feel like I've learned so much attending your sessions that talked a lot about inclusivity and just really mind blowing stuff that changed the way I look at my AT treatment therapy and the way I educate families and caregivers. So thank you for that and thank you for having Ernie and myself here today. So I'll give you a little bit about Blythedale and what we do here and why the place we work is so unique and special. So Blythedale is New York State's only independent specialty Children's Hospital and one of only 14 pediatric specialty hospitals in the United States. We serve patients from birth through age 18, and we have a combined staff with lots of expertise and resources. We have the largest pediatric therapy department in New York State to provide exceptional comprehensive care for medically complex children and support their families. So the goal is to provide as much education as we can to these families with children who are medically complex. This way they transition home seamlessly and feel empowered to take care of their child as best they can. Children are admitted here for a variety of medical conditions including respiratory, traumatic brain injury, pulmonary hypertension, feeding needs, complicated traumas, post hospitalizations. We have cancer rehabilitation, spinal cord disorders, genetic and neuromuscular disorder. So we kind of treat quite the variety. And our hospital comprises of a 96 bed inpatient unit. We also have a long term care unit with 24 beds and we have a day hospital program which is really neat. We're joined with the Mount Pleasant Blakedale School District, So what that comprises of is kids who really have intense rehab needs and can't get those needs met in their public school. They can continue their academics here at the hospital while also receiving intense therapies. So it's really nice to have them have a regular day with peers and also get their intense therapies right there. They don't have to go before school or after school. It's just built in during their day, which is really neat. Our goal here at Blakedale is to help our patients achieve their rehab goals and return to their families and communities.

00:13:28 Marnina Allis
And we're lucky that as therapists we're able to service all our units. So we have our inpatients, our day hospital, our long term care and our outpatients. And we really support the AT needs throughout all the different units in the hospital. So it doesn't matter where in the hospital and the continuum of care you are, but we can take a look at it right from the beginning and hopefully follow you all the way through, including bridging that gap. When you leave us and you go into the community, which we struggle with the same barriers that I know I hear your other guests talk about in terms of working with school districts and teachers and the turnover of staff and the children leaving. And we deal with those same struggles that everybody else deals with. We're lucky that within the hospital we might hold on to them a little bit longer, but when they go to school we are still dealing with the teachers and the pull out and the push in and the same struggles that everybody else deals with. And especially once they leave the training and making sure that there's no abandonment or lack of training when the our patients leave us here at Blithedale.

00:14:39 Chris Bugaj
Martina and Marissa, would it be I what something I heard you say in that description is how closely you work with the family. So that's a particularly that's a important goal is to make sure that they leave aware, like they're learning along and then when the time ends with you that they have built a number of skills and that, I don't know, in the schools. I think that's something we're continuing to learn, right? Is that, oh, we do direct therapy 95%. I'm just throwing a number out like 95% of the time. And yeah, we talk to you every once in a while. You know, we maybe send a, a thing home in a, in a composition notebook or maybe an e-mail. But it sounds like you have a deeper, maybe more robust relationship with the family, but I don't know. So is that fair or or or not?

00:15:27 Marisa Portanova
Yeah, we definitely, we definitely pride ourselves off of working closely with the families. We want them to feel empowered to use the child's device, not be scared of it 'cause, you know, these families might get this brand new piece of equipment. They're like, well, I don't know what to do with us and you know, it's just going to sit there and grow dust. So we want them to feel like they know what they're doing to best help their child. So ongoing education for us might look like whatever is convenient for the family, whether that's a virtual telehealth session because it's hard for them to get to the hospital, or if we can get them in person, obviously that's ideal. But we kind of want to meet the family where they're at. So how do they best want to communicate with us? Whether it be through writing in a communication notebook, talking through e-mail, talking on the phone. It's really key for our kids because we want their goals to be addressed here, of course, 1st in school, of course, but also at home, because we all know that children learn best when they're using their devices with a variety of communication partners in all environments. If if they're using their device in an isolated setting with one person, you know it's, it's not, it won't seem functional to them. It won't seem empowering. But if multiple people are using their device with them and, and they're getting their needs and wants and requests met or engaging socially with other people in their life, it's, it's just so much more powerful. So we definitely think it's, it's important and we're lucky enough to be able to do that here. So I feel like school is, is still the place that we're struggling. So it's nice to have these conversations and discuss what what's working, what's not working like if you have any tips so.

00:17:03 Chris Bugaj
Well, I mean, I, I right now what I would say is that I empathize with you about the turnover rates and that I hope is a catalyst for shifting everywhere to more parents centered trainings and experiences. You know, I feel like we were closer to that in the school districts during the pandemic because it was like, we kind of know the students not going to be working on the screen with us, but you're sitting right next to them. So let me teach you them some stuff. And that sort of has drifted. So I empathize you through that turnover rate because you spend all year getting a teacher up to speed and then they leave because they're going to. And OK, it's one thing if they leave and they're going to Buffalo, right? OK, great, we still helping New York State. But if they're out and they're like, I'm going to go work at Starbucks for a while, I'll see you right then. Yes, that still helps a little bit. But they're the, they're not as frequently implementing those skills that you spend so much time building up. Fair.

00:18:02 Marnina Allis
Sorry, I was going to add something that makes us unique is these families come to us often following a traumatic event or a surgery or some big change in their dynamic. And if the family is able to be here, they can be at bedside when they're in patients 24/7. So we try to tap in to the families and to the assistive technology as early as possible because we know that once they go to school, it's going to be a different game altogether. They're not going to be here. They're not like it's, we're a regular school. You can't hang out all day like you do when we're inpatients. So it's like we're really trying to maximize on that inpatient time as soon as we can because you just, you can tap into the parents in a different way than you can when they're in school.

00:18:48 Chris Bugaj
Totally. That totally makes sense to me, Marnina. I know there's a number of students in our school district and beyond that get speech only services. And what that means is, especially for the very young children, they'll come and like the preschool children that only get speech, speech only services. And they will, the speech therapist will meet the family in the office and they'll take the kids hand and we'll go back to their room and they'll do speech therapy while the parent just sits there for an hour, you know, Yeah, flipping through their phone or maybe reading a book or something. It's like, wait a second. That would be an awesome time to take like, hey, why don't you come with me? Why don't I teach you this stuff, which sounds like exactly what you're doing? Like, hey, the, the parents here, why don't we learn some stuff while you're here, Right. Is that what that's what you're you're describing? Awesome. All right. Now, Marni or some Marissa or Marni, I can't remember which one of you said it. You use this term core team or core AT team. That makes me think there's two teams, but or is there just one team? Tell me about the Blythdale Assisted Technology team in general and how it all works.

00:19:51 Marnina Allis
Sure. So we have this core team which is comprised of a physical therapist, 2 occupational therapist, the physical therapist and one of the O TS do the seating and mobility. The other OT does access Marissa and I. So there are two SLPS. We do AAC and we have our rehab engineer and the way we work, we're the core team that does the outpatient evaluations, but all of our staff has some familiarity with AT. So other people might be treating cases as well, but they can also come to us to consults that I have this AT kid, we're working on XY and Z, the OT and I have tried this and we're kind of struggling. Can we all come together? And that's also where the AT court team comes in. So not only are we the court team that's doing the outpatient evaluations, we're also serving as consultants to our huge team of OTSPTS and speech therapist. We're all also doing assistive technology services through their regular therapy sessions. Because we are the core team, we're also the main ones doing trainings to our large team of OTSPTS and speech therapists about assistive technology, about our collaborative process. We train them on our new devices. We offer happy hours when we've got learns about some new apps and we want to teach people about those. We kind of try to keep our, I keep saying large, but we're probably 70 to 75 PTOT and speech therapist combined. So we're really trying to at least give everybody some level of knowledge and what we have, what we do, how we can help and where they can go, what resources we can offer. So when we say the core team, it's the small group of us who really do the intense education and learning and ordering and getting new devices and providing training to our large group of therapists who are all great about working together and wanting to learn. And I saw you were trying this with this other patient. Can we try it with this patient? And we really do our best to kind of be available for the school staff, the therapists, keep the doctors in the loop of what we do so that we can really have everybody using assistive technology across the spectrum as much as possible.

00:22:12 Chris Bugaj
Marnina, can I dig into that a little bit? Because again, the, the, the connections are with the school district and how our services are provided, at least the services in my school district are provided are very similar, right? We have a, a small number of assistive technology team. In my case, it's 9 plus me, so 10 with occupational therapists and people with transition backgrounds and some speech therapists, right. So this similar like core unit that then goes out to the larger related services and educators beyond that to provide educational services and help them brainstorm through what they're doing. And that sounds, you know, what they might put in place and what implementation might look like. And that sounds exactly similar to what you're doing for all the the extended family at Glythale, right? Is that is that fair?

00:22:58 Marnina Allis
Yeah, the advantage is it gives the staff a point of contact, so when you're struggling, you know who to reach out to. And then if it's not, you know, maybe that's more of an OT issue and I'm not the right person. Or maybe I can work with the treating therapist and the teacher, or maybe the private duty nurse or the aide, the aide in the classroom. So kind of figure it out together and train those few people. Exactly. That's what I always say. Like, we might work in a hospital, but at the end of the day, it feels like we're all working in a similar situation with similar barriers, similar, you know, wins and strengths and similar frameworks.

00:23:40 Chris Bugaj
Can I ask? I want to ask another follow up question about that. And that is how do they approach you if they need your assistance? Like I think this kid needs to get something and I need that means that my pathway is through you or I'm I don't know what to do. So I'm going to come to you. Is and is that all over the map? Like, well, some people have built their own capacity. Thank you Marnina, Marissa and core team. I have learned what I needed to learn. I'll come to you and like you've built capacity in them. Is it all of that? Like how do they know to come to you?

00:24:10 Marnina Allis
So that's a good question. Within the hospital side, I think there's an understanding of who the core team is and what we do. We do trainings at the beginning of the school year to Orient the new staff and the continuing staff that we're still here. Here's how to contact us. We are fortunate and that we have an AT coordinator Tracy, who you can always contact Tracy and say I need some help. Can you put me in touch with the right person? But we're lucky that many of our therapists OT speech therapist, certainly the PTS when it comes to seating and mobility have a level of comfort on their own. And we're lucky that we have a loner fleet of devices. I mean, every the speech department there is 2 speech therapist for office and every office has an iPad with a variety of AC apps. We have a bunch of fully integrated communication devices, Toby's accents, other brands with I gaze or you know, a head mouse or able to use switches more easily than with an iPad. So therapists are free to go and help themselves and use what they think is appropriate and get started, but they should always hopefully feel like we're here. So when they're feeling stuck or if they need help that they can say, can you come to the session? Can we bring the team together to take a look? What are your thoughts like, here's what I'm thinking, What are you thinking? And I, I think one of the things that our therapists love about being here is that collaboration and is that knowing that we're here to support each other. And you know, if you think you can run with it, great. We're not going to stop and tell you, no, wait, don't please run with it. But if you're feeling like you're stuck, know that we're here to support you and help you problem solve it.

00:25:58 Chris Bugaj
Yeah, that support is key. I'm just going to make some assumptions here that maybe your turnover rate is a little less than the school districts, right? Because if they are existing in in a supporting environment, they don't want to leave. Like the grass is rarely greener, right? When you peek over the fence, it's like, man, I have these tour, I have these awesome AT team. I have awesome colleagues that I work with. I feel like supported. I don't feel bad when I don't know something. I feel like, OK, that's an opportunity for me to learn what that sounds like. Just a great place to work.

00:26:30 Marisa Portanova
We always encourage questions. Curiosity is is how you grow your mind. So always asking questions. So it's nice to be in an environment where we're all supporting one another and also across disciplines. So it's nice that we can even just contact like someone in another discipline to take a second look to or get their lens on something.

00:26:48 Chris Bugaj
OK. Let me ask you this sort of again, a follow up question is you were mentioning like the number of beds, which means like the number of people you can service in one setting, right? But then you have the other other settings. Is it fair to say that most, again, by making an assumption here, so you'd be like, Chris, this is wrong or this is generally right that I would make the assumption that the vast majority of your patients do use some assistive technology, but maybe it's low tech, maybe it's high tech, but it's, you know, a vast majority of them. Is that a fair assumption to make or no?

00:27:23 Marisa Portanova
Yes, yeah, definitely a large variety of our children do use some type of assistive technology, whether it's for mobility, communication, environmental access. That's a fair assumption.

00:27:35 Chris Bugaj
Gotcha. So in that case, it's sort of like you had to use a build a capacity model because it couldn't be like do an evaluation for every single kid. It's like you there would be some where they're struggling and we need some help, but otherwise we've been doing this for a while. We know what resources, we know what to put in place. Is that fair?

00:27:56 Marisa Portanova
Yeah.

00:27:57 Marnina Allis
Yeah, agreed.

00:27:59 Chris Bugaj
Awesome.

00:28:00 Marnina Allis
One of our larger units is our infant toddler unit. So obviously with those guys, PT IS and OT are looking at adaptive strollers and some of them stay a while. So we might be starting to look at early AAC, but outside of the infants, I agree with Marissa, really everybody has been looked at in terms of do they need an adaptive chair, do they need a different way to play, Do they need some kind of early communication? I've heard you talk about like the tier one support and the Tier 2 support. So we haven't really gone into that model just because our kids are all so different. I think we as therapists are trying to think about that more just in terms of the AEI mean, the seating and mobility. I think they think about that for sure, but also in terms of the AEC and the giving them access to play just as soon and as early as we can. Let's tap into what we can and give them as much ability as possible.

00:28:59 Chris Bugaj
Awesome, awesome. Well, OK, you brought up the AEC. What does that implementation look like? Do you have groups where you get kids together? Because AAC is like a social thing where you're communicating with other people, but you wouldn't be just working directly with one client alone. Maybe. I don't know, tell me how does it all work?

00:29:17 Marisa Portanova
Yeah. So one day as a department, we all sat down and we're like, let's get some group started within our within our department because we have lots of children with speech goals, a lot of children with feeding goals and why not make it a social experience? So we kind of put our heads together, made lists of children on our caseload that we felt like have a similar goals that we could target in a social setting. And it gives them more of an opportunity to interact and learn from their appeals while targeting their goals. So instead of it being such an isolated, structured setting, let's, let's unstructure it. Let's just teach them within a regular context. So we came up with groups of two to four children based on interests, therapy, goals. We grouped them on level of functioning regardless of age, gender, AC device or grade. So even if they had an AC device, it didn't matter what hardware, it didn't matter what software, didn't matter what access method. Just putting kids together in a group was a great way to motivate them. Target core language literacy, play games, have fun, just built community. Talk about how was your weekend like Get them to interact with one another in a different way and outside of a structured academic setting. So our weekly groups were so successful that we wanted to give children more opportunity to still work on goals and reduce risk of regression. So we also created these one week intensive groups that occurred during school breaks. So it was just, it's really nice. We our weekly groups will be one time a week. The kids get together, each child will have a therapist with them. And if we can, if we have an extra set of hands, one clinician will lead the group. So this way everyone has someone supporting them. And then there's someone who's kind of just like running, like leading what's happening or like leading the conversation. So I'll let Marnina talk more about like the structure of our groups and our treatment plans. But it's been a really fun thing that we've been implemented and we're happy to be sharing that today with everyone.

00:31:20 Chris Bugaj
Marissa, you said the magic word to me, which is this. You were grouping kids based on interests and then fun, right? You use the word fun. So if you were to think back in the last couple of months of being in these groups, what's the most funnest? Everyone was laughing. What's the thing that like, jumps into your mind is like, oh, this is what we did. That was just so cool.

00:31:42 Marisa Portanova
Headbands our, our, our kids. We have this one group of children. We have an elementary age child, a high school age child, and they just all really like playing headbands. It's like the one thing they all agree on doing in addition to talking about their weekends or school breaks, they all love telling each other what they did, who they were with, sharing something new about themselves. Like hey, check it out. I have a new private duty nurse with me. This is her name. I miss my old one. Just like having that casual conversation they really like. But headbands has been fun. They'll tease each other. They'll decide who goes first. It's just like a really nice opportunity for them to choose what they want to do and they enjoy doing it with one another. So yeah, that's that's been the fun game that we play.

00:32:27 Chris Bugaj
And, and headbands is so great for cognition and for communication because it's sort of like descriptive teaching. Like, OK, this person has Taylor Swift as their card. What can I say that describes Taylor Swift, Right. So they're you're digging into all these aspects and then you're laughing about it afterwards when you either got it or didn't get it right. And congratulate each other. Oh, that sounds great. Yeah. All right, Marnina, tell us about the structure of these.

00:32:52 Marnina Allis
Sure. I just want to start by saying, you know how the therapist skip board the headbands never gets old for the kids? Never. We're always like, look, we brought something different and they're like, no, no headbands, you know, And it's a classic. It's a classic. I also just wanted to add to what Marissa was saying. All of the kids who come to our groups also have individual therapy over the course of the week. So we try to structure it so that whatever we're doing in Group can be carried over and taught in a more focused way during those individual sessions. So we're definitely trying to kind of interface the two. So in terms of our weekly groups, we're very like everybody in AAC is right now. We're very core word based, so we will often over the course of a month focus on a book and within the book the core and fringe vocabulary associated with it. So we will, like Marissa said, we have two to three kids, variety of ages, and then over the course of the month we break it down into reading the book, discussing the book and then activities related to the core vocabulary in the book. So whether we're doing sensory activities or literacy based activities, we're definitely trying to integrate, you know, literacy and as much, you know, sight word and literacy and sounds letter correspondence. Just trying to really focus on that stuff as well with our younger kids and with the older kids doing whether it's predictive chart writing or you know, writing their own books. But we definitely over the course of the month focus on activities related to that book. And then whatever we do, whether it's an arts and crafts activity or a game or some kind of interactive activity, whether it's a treasure hunt or something more interactive like that, we'll definitely cue hopefully the individual therapists are there and can carry over those things into additional related or even the same activities again. So kind of carry over all the learning and the knowledge over the course of the month as much as we can. We also try to tie in with the classroom teachers. If there's a way that especially with our preschool rooms, what kind of things are they doing over the course of the month? How can we work together so that we know that that same vocabulary and the same lessons are being carried over there as well? So as Marissa mentions, once this was going well and we kind of had a structure for a month of activities and kind of put everything together in a box so a therapist could kind of grab it and oh, here's the book. Here are the core words, here are some activities. I know we did this in Group. Let me try to do the related arts and crafts activity today. We started to think about those school breaks, those vacations where the kids are at home and how can we tap into the families and the children for a week. So while our regular groups might be 1/2 hour and you do a different activity over the course of a month, we basically took that idea and merged it into our intensives where the kids will come over a school break for 3-4 or five days for a few hours each day, so maybe 2 1/2 hours. And basically in the course of a day, we're doing those same activities, but just more intensely in a, you know, longer time frame. And usually because we're doing that, we might do two or three different books with related vocabulary and overlapping themes over the course of the week and try to end it off Friday where they're writing their own book. And based on things we've done over the course of the week, maybe with each book we've targeted on something different in the book that they could, we could do a predictive chart rating activity, They could write a page And then at the end of the week, put the books together so that they have something to go home. And there's a perfect way to carry over the language, the vocabulary, the concepts with their family members. Generally the way it works because we're hospital based, when you're just coming in for like our intensives or you're in school and being pulled for therapy, the parents are not here. So every day during the intensives, we would print out a sheet of here's what we worked on, here's what we did, here's some things that they enjoyed, here's what you could do at home. And then taking the book home with that at the end of the week, we could show the parents a pick up, like look what they did. What a great way for you guys to talk about what happens over the course of the week and continue using that vocabulary and those materials over the course of time being at home.

00:37:29 Marisa Portanova
And to add to that, if, if a child didn't have that experience, we would bring the experience to them. So you could pull up like say the book was about giraffes. We'd pull up like a YouTube live video of giraffes at the zoo or say it was a book that we had that maybe the family didn't have access to at home. We'd provide them with like the QR code link to the ebook so they could listen to it online. Just making sure that we were trying to encourage carry over as best as possible and me and simplify it for the family.

00:37:58 Chris Bugaj
When you're talking about books, do you, are you talking about like, well, I guess maybe it, it relates to the, the developmental level of the students. So maybe they're working. So when you said draft books, my mind went to drafts. Can't dance. Oh, poor Harold. Do you, is that the sort of thing you're thinking of, or is it also no? And we do an animal book that is much larger and it's a we're doing research around giraffes and that kind of stuff. Like is it or is it typically we're working with the storybooks?

00:38:31 Marisa Portanova
We work with the storybook, so Giraffes Can't Dance was one of the books that we read. So we'll have like a theme for those intensive weeks, whether it's like animals, food, and we'll pick the five books based on that theme. That's where we've had the most success. Cause groups can be scary, it can be intimidating. It's like where do I get started? What do I pick? But picking a theme and then choosing like activities, concepts, books surrounding that theme has been the easiest to just like run with.

00:39:01 Chris Bugaj
That certainly aligns with, I think what most schools do as well as they pick some sort of theme, then they find supporting materials that go with that theme. They model the core vocabulary, they do writing experiences, they do literate other literacy experiences where they're finding words and that kind of stuff, Right. I'm curious what your thoughts are, if you've ever considered this and said, no, we're not going to do it that way. It's sort of flipping it and saying, OK, here's where our kids are language wise and this is the next skill that they're going to need. Here's some more words that they're going to use. Like have you noticed they're not using any the Ings or Ed? Why don't we pick books that are all written in past tense, you know, and we'll do structured around that. I'm curious, have you ever done anything like that? Because I think some people are, well, I'm starting for the last 15 years, some people started to dabble in that. But it's been such a swimming upstream, like, yeah, but every teacher knows how to do a theme. We don't start with the theme of the language. So tell me what your thoughts are on that.

00:40:05 Marisa Portanova
So Marnina actually just gave an education. We do like focus groups within our department and we'll have like weekly topics that we discuss just for that ongoing education and collaboration and continuing to give everyone the knowledge that they can feel free, feel empowered to treat their caseload. And something Marina talked about was implementing grammar in AAC therapy because it's, it's one of those like things that I personally even wasn't doing in my therapy. And if that's where, if that's the next level where the child's at language wise, like why not just start modeling and why start talking about things in the past tense, like let's do it. And it's just something that maybe didn't come 2nd ager to me. But after hearing that, I now have started implementing that into my therapy. So when a child is talking about something even of interest to them, like I will add in that grammar, like maybe it's something related to their week. And oh, you did that in the past. And then I'll add that past tense grammar or we're counting. I have a child who really likes to count, so we'll then once there's multiples of something, we'll add the SN. So just like going off of what they like and then implementing the associated grammar. It's definitely something that I've just recently learned to incorporate into my therapy. You want to touch more on?

00:41:21 Marnina Allis
Yeah, I was going to say I went to Eddie Tia, actually I went to Amanda Sopers and something on grammar instruction and it really brought thoughts to that. And I on my case will personally have a 10 year old who's very smart boy and has really picked up on using his device. It's brand new really quickly. And I've really with him been spending the time he can produce sentences and working on that grammar and learning to use like within the app, the little, you know, quick buttons that help you do those things and trying to work more on that. I think as we try to move, as we try to work more on literacy and the writing, I think it's only natural that some of that grammar and some of those, you know, that, yeah, grammar and that that would come next, that that's something we would want to work on. So I think that's definitely a way we need to go. Agreed. I think they're getting it in school, but I think having it explicitly taught how to do it on their devices is not something they're getting in school. And I think if that's something we can do to make their academics easier and make their communication more understandable and efficient, that's something we should do.

00:42:41 Chris Bugaj
Awesome, awesome. All right. So you already mentioned some of the barriers that you've been facing, you know, like the the turnover rate of of of teachers and you do the training. Is there anything specific to just working in a hospital setting that is different or any other barriers that you face, challenges that you're you're working to overcome?

00:43:04 Marisa Portanova
Yeah. So with being in hospital, you can with our group specifically, not every child can attend the group. So you might get stuck then without a group setting and now it just turns into an individual setting. So that sometimes happens like your goal and your treatment plan for that day can be really great. You're excited for the group and then maybe not every child is present or can come. So that's definitely a barrier also just, but if we didn't plan. So within our intensive groups, we found out that's a lot. There wasn't enough movement breaks for our kiddos. There wasn't enough time for that non structure. We had so much structure planned initially that we had to build in those like movement breaks, Those sensory breaks take some of the structure out of it because we would lose their interest if it was too structured. So it was all trial and error, like after the first intensive group we did, we all met and said what worked, what didn't work, like what can we add in next time, what can we change? We started incorporating music therapy that we would have like a featured, oh, music therapy is coming this day of the week. And that was really neat because it just added another element of a sensory experience for those children to tie in some of the language we were working on and expose it to them in a new way, give them another way to access that language. And we would incorporate some art, some food. We had to incorporate snack breaks, like all things we didn't really think about initially. And then with time figured it out, like, how can we make this more exciting for our kids? How can we engage them? So really just a lot of trial and error and then meeting afterwards and debriefing about it instead of just being like, all right, well, that was that didn't work. And not talking about like meeting, talking and having a game plan for next time is so important.

00:44:46 Chris Bugaj
I just want to, you can see it, but the listeners can't see the giant smile on my face because I think a lot of people do plan. And then if it doesn't go well or they don't take the moment to reflect on it, or if it doesn't go well, something well, the kids were broken. Like, hey, they weren't attending or they were sick or like, no, let's reflect on what we can do and build differently because the kids are kids. So that's just awesome that your team was already aware of that and is again, sounds like a really supportive place. Like, OK, let's figure out how we can make this better for next time. So cool. Something else to think about Marissa is in the planning phase and then the reflection phase of this experience design is you mentioned like, oh, we need to more have more movement breaks or more snack breaks, right. I think it's something that I would invite you to think about as as a team as what if it was the other way around? What if it was well, OK, what we need is a sitting break or a stationary break or a seat where break. How does that change the design when we're thinking about how we're going to have this kinesthetic movement as the most most of the time and the OK and I sit at my work as the small, small part of the time. So just, I don't know, something to think about is flipping the flipping it in your in our mind that way.

00:46:07 Marisa Portanova
Yeah, I like that.

00:46:08 Marnina Allis
Me too. Can I add just two quick things. One, a lot of our kids have complex bodies. They are the complex communication needs kids who don't get the time out of their chairs and are hard to manage out of their chairs using AAC. So I think that's a barrier, but not a barrier because we're lucky and that we can work with OT and PT and really tapping into them and being like, how can we make this more engaging? How can we make this different? How can we make them feel more involved, you know, than just sitting in their wheelchair? And I think and a shout out to our whole team, not just we're lucky that when we plan these things with speech, the speech therapist, they're as excited to get involved and be a part of it and problem solve and plan. And we have a great team in that respect. And then like Marissa said afterwards to be like, wait, that didn't work, That did work. And everybody's so great. We're really lucky. We have a great team of therapists who are so willing to like, let's figure it out, let's work it out together, let's pick each other's brains. But also a shout out to our OT and PT departments who are also so willing to, can I come, can I take a look? How can I help? How can I support? And trying to work on more collaboration because I think that's what makes it work so well for our kids.

00:47:33 Marisa Portanova
Yeah. And you're, you're my brain is now like thinking maybe even inviting those other disciplines to help with the group. So like giving the children like that time where they can, but with the support of PT and OT because we're so lucky to have that resource. Like because they could support the access while the child is outside of their chair. And then we can then reduce the time that they're in their chair. So just like now I'm starting to think what else we could do with our group. Yeah.

00:48:00 Marnina Allis
I guess it was before your time, Marissa. When we first, first started with our AAC groups, once a week in OT would come and they would lead the group. So we were sure to incorporate that sensory experience or like look at that kids motor skills. How can they be act direct, selecting easier position? What should we be thinking? And I feel like it's making this conversation is making me think maybe we go back to that even if it's scheduling as hard, if we can do it once a month just to get that input from some of our OT and PT buddies.

00:48:33 Marisa Portanova
Because we do that a lot in our individual group. So then now doing it again with our our larger groups.

00:48:39 Marnina Allis
Nice, but.

00:48:40 Chris Bugaj
Are there any other barriers or challenges I.

00:48:45 Marnina Allis
Mean, I think time is always a barrier, the time to plan, the time to communicate. But we're lucky, you know, we don't, we try not to let that stop us. We try to just kind of move ahead.

00:49:01 Marisa Portanova
You know, I wish our groups could be hours long cuz the time it takes to get there, set all the kids up and then get them back to where they need to be. You know you wish you had more time in the day so.

00:49:12 Marnina Allis
Right, when you ask some of our a bunch, most, a lot of our AAC users are also learning how to drive a power chair. And once they're in that power chair and they can be in it all day, we're going to encourage that. But probably we need to drive a little slower and getting from the school to the speech department just might take a little longer. But hey, being able to drive your power chair and having that independence is important to us as well. So I agree we have to like pick and choose. Like it might be a few minutes less of AAC, but like carrying over that skill of driving that power chair and being able to come to group and say to their friends, like I drove here myself, this is the first time or you know, look, now my device is mounted on my chair. Like to be able to do those things is exciting for the kids as well. So I feel like you got to just roll with it.

00:50:04 Chris Bugaj
I see what you did there, Marnina. OK it.

00:50:08 Marnina Allis
Wasn't even deliberate.

00:50:12 Chris Bugaj
Let me ask you this, if this is a barrier or a challenger, maybe, maybe you're like, not so much for us, Chris, but something that I know Rachel and I hear quite a bit when we do presentations, it's a common question that that pops up is this concept of presuming potential like, yeah, the kid won't be able to do that. And and maybe some misnomer from people who have not attended your trainings, you know, that have that work at the hospital, but for some whatever reason, they didn't, they're not there. They weren't part of the the the larger group that had had capacity has been built yet or. And so they might have these sort of different assumptions about, you know, AAC, you know, like, like the like the classic myth that it's going to steal their language or steal their speech or something like that. Do you feel like you are wrestling with the presuming potential? And in helping people embrace the notion that's yeah, well, we're going to teach them to do all the things right? We're going to give them all. We're going to teach them how to do all of it does. Is that a thing for you or not so much?

00:51:11 Marnina Allis
Oh yeah, I'm yeah, I mean, I think like any, you know, our, our therapists I think are all so positive and open minded, but I think getting the carry over other places until you they can see the success and we have the buy in. We deal with the same barriers in addition to the other barriers of they get back from school back to the unit when they're in patients and then they're in bed and the device doesn't get set up. You know, and I feel like, yeah, we 100% deal with the same barriers that everybody else is dealing with.

00:51:51 Chris Bugaj
Just a quick oh, go ahead.

00:51:53 Marisa Portanova
I'm just thinking about one of my kiddos in preschool. Who is I using? I gaze to access her AC device, but her classroom really hasn't seen it yet because we're having trouble figuring out like where are we going to mount this device that's ideal in this classroom setting where there's lots of kids and minimal table space and lots going on. And you know, I'll just push in once a week and, and just show them during circle time. Like this is a device. This is how I model I'm going to presume competence and and assume that this child can learn the months of the year. So I'm going to model the months of the year. And then once I saw like some aides like tuning in on what I was doing and, and seeing that she was accessing the device independently to to label the colors that they were talking about during morning circle, like just their eyes lit up and they're like, she could do that. So just kind of like showing, I think and, and teaching is, is really important. I think sometimes like they just, they just don't know. So they just don't know where to start or so just showing them and and showing them what the child is capable of or just presuming confidence and showing that if you do that, look how much more the child can be successful the child can be if we do that for them.

00:53:05 Chris Bugaj
Does does the? Does the, does the experience kick off based on a doctor, like a doctor's order, I'm ordering physical therapy, I'm ordering occupational therapy? Or is that sort of the default like everybody kind of gets screened and then we say who like, hey, I want to pick this up because the screening and I need to do a deeper evaluation for those related services. Or does it start with a doctor? How does that, how does it initiate when someone needs a therapy and then by extension AAC?

00:53:37 Marnina Allis
So we are a medical model. So all of our children when they come in will have orders written by the doctors. But we're lucky that we communicate openly with the doctors. So it will sometimes happen that an order was not written and we'll say, wait, could you add XY and Z? And then when it comes to, we will do evaluations for them to get a personal device through insurance. We're lucky that the doctors are there to help fill out the prescriptions, come to sessions to be sure to include in their session notes what we're doing with the AEC and the successes that they've seen to help make the process easier for writing the evaluations and completing the funding packets.

00:54:23 Chris Bugaj
Awesome, awesome. That to me screams that who needs to be educated the most is the doctors. Because if it doesn't, right, that we need to teach them what to look for and who to order so that the, that the, the dominoes start, right. The first domino gets knocked out and knocked down. So it eventually lands in the other domino. And a great way I would imagine to do that is when they've seen a positive outcome. Remember when you knocked on that domino And this kid now has this And we taught them that with this device. Do that for all the other kids, right? So can you share some stories of some positive outcomes like what are we seeing this, the weekly groups, the intensives and this whole dynamic? How? Tell us some stories of what the awesomeness that has come out of it.

00:55:08 Marnina Allis
Sure. I mean, I think we see the same positive stories that all the clinicians out there who are doing ACCI mean, we see them come out of their shells. I mean, we really see them start to interact. We see, you know, the classroom staff and the doctors and the nurses, like, widen their eyes when they can see what's getting done. We see the kids more interested in school and therapy and socialization. I mean, I think like we know that one mode of communication facilitates other. We've seen an increase in verbalizations. I'm always happy to tell a parent you don't need that device. You bring it back and we'll put it to use for somebody else. Like our ultimate goal is communication in whatever way is easiest for them. So we've definitely seen kids who become more verbal and have taken off with their verbal speech. We've seen a lot of nice positive interactions between staff. Like everybody gets excited the first time, you know, the kid is putting it all together in their power chair, going over to somebody, using their device to communicate. I think we all see the the great work that we do and it's that pat on the back and it's that look what we can do and look what else we can do with all the other kids. We're lucky that we've definitely seen the AC us carry over to other settings. It always starts with us. But we're lucky that doing the groups, pushing in, really working on all of these together as a team has helped us see everybody more willing to learn and do and participate and be a part of it. I mean, the day that we have a special activity and everybody's involved and everyone's using their devices and can go back to the classroom and continue to talk about it. You know, the teachers are happy to have a way to have the kids be involved, but also then use the AC for other activities. With doing more literacy in our individual sessions, we've seen more carryover of literacy into the classroom into home. So we've really just seen it's, I really don't think we can say there's been any, there's been only positive reactions between seeing the kids make gains, seeing the buy in that we get from everybody, seeing the more interest in working together, seeing the families get excited. It just drives all of us to keep doing what we're doing and, you know, motivates us all to keep up on the most current devices and what else is out there and what else can we do to support our kids. And we're lucky that administration supports our learning and our getting new devices and are working together and are spending the time because having the time to do that is what helps us also do what's best for our patients.

00:57:55 Chris Bugaj
Marnina, you keep using that word lucky. And I know that's, that is part of it. Like you might not get to influence the administration that's here, but maybe you did get to influence the, the the interview panel and they're looking for somebody that already understands AAC. And so I want to say in the same way that you were very complimentary of the work way back then, I want to say Marina. Marina, you've been there for what did you say 20 years, right? And I would just imagine that it has evolved over the last 20 years because you're the sort of person that is modeling and, and pushing modeling that open mindedness and, and that eagerness to learn, right? And going after your own professional learning and then turning that into weekly groups, intensives and, and, and helping it all come together. So yes, I think it's maybe 10 or 20% luck, but that's 80 or 90% your hard work, your blood, sweat and tears. And I just wanted to give you credit for it.

00:58:53 Marnina Allis
I appreciate that. That means a lot, especially coming from you. I do. Who knows all that it takes. But I also, I couldn't do it without the team that we have here and people who are so therapists who are so eager to learn and eager to do what's best and willing to spend the time and the effort and the hard work to make it happen. Because without a doubt, we couldn't do it without that.

00:59:17 Marisa Portanova
And I have to say, Marnina leads by example, and she's a great advocate for her patients and all the staff within her department. And it reminds me of the lecture I attended at Atia Chris, where you played this really fun Ted talk about how it really just takes one person to to start a movement and then next thing you know, the crowd will follow. So kudos to Marnina for being that one person.

00:59:41 Chris Bugaj
Thank you. Shout out to Mike Morata. He showed that to me. I was first follower. That's the we'll we'll link the video in the in the show notes for everybody. It's Sivers is the name of the the person that does that Ted Talk. But yeah, awesome, awesome. All right, So what do you think comes next? I mean, you've built these the AAC groups, you started the intensives. What's the next on the horizon?

01:00:09 Marnina Allis
I would love to see more parent involvement for our kids who are on our day hospital program. I see we run a there's a classroom that is overseen by the speech department for kids with feeding issues. And I've seen some of the parents really connect over having their children going through the same thing and working on the same things. And it's really families who would never otherwise have anything to do with one another have really connected. And I really would love to see more of that for our AC users. I feel like so often they feel like they're the only one or you know how to get more involved in doing this in the community. And I think connecting our parents and connecting our families not only would be great from a training level, but I think for them on a personal level, I think would make them feel not so alone and make them feel the same way. We therapists see each other's successes. I want them to see, you know, as parents and as caregivers. I want them to see each other's successes and learn from that as well. And I would love to kind of that be our next step. Some, I don't know if it's late afternoon or evening groups to kind of bring these parents and these families together to learn and grow and just be a resource for each other.

01:01:29 Marisa Portanova
Build a community outside of Blakeville. Something I thought about while we were talking throughout this podcast is like having maybe like a buddy, AAC user buddy. So within our groups, because we have children in different grades, different ages, we definitely see the younger ones looking up to the older ones, especially kids who just got new equipment that maybe aren't familiar are a little timid by it or or some who are even like embarrassed because what what they see a lot of at Blightdale, they may not see outside of here. Like our part time users who communicate verbally mostly outside of Blightdale, but when they're here use their AAC devices a lot to communicate because their speech intelligibility is reduced. So when those part time users see the full time users who just got like a power wheelchair mount for their AC device, they're more empowered. Like, oh, cool. Like I'm more confident because that that kids using it and they're using it and it looks cool. So maybe just having a buddy, like a role model, like Marnina is my mentor. Why not give these these kiddos their own peer mentor to look up to?

01:02:34 Marnina Allis
I also feel like I hate saying this but we still get kids who come in who are too old to never had access to a communication system. So we're so lucky that we educate with them. But the more education we can do outside of here cuz we all want to see the kids having access to robust AC younger and younger. And we're lucky that a lot of our kids who are coming in for outpatient evals are have been 234. And it's amazing because we didn't used to get those referrals. But it still hurts when like that nine year old comes in and it's like, oh, well, you know, they tried some pictures. I use your phrase all the time that you and Rachel use. Like the reason we don't use Paxus because you've never met an adult who says this system works great for me. Like let's move away from the pictures and let's move into other things. And I think unfortunately as far as the fields has come, we still have work to do to get at these older kids access to AAC younger sooner.

01:03:40 Chris Bugaj
Yeah, all well said. I love these next steps. I just to reflect a second on the community aspect. I know that's something in the schools that has started as well, like I know speech therapist that have started like AAC coffee talk, you know, So once a month or maybe every every other week, you can come in a little bit early and we'll sit around and we'll have coffee and we'll talk about a particular topic. And sometimes we'll repeat topics again, repeat with variety, you know. And so that sounds like, again, another parallel between what you're doing and what's happening in the schools. But like, that's the next thing, right? That that becomes the thing. Yeah. And that buddy program, of course, that is happening in some schools, but not wide enough. So again, that that kind of idea, I just love it, love it, love it. All right, let me ask you one final thing. The way I like to end these interviews is, you know, we talked about your own professional learning and how you have to be constantly curious and learning about new things. What's on your mind? What are you questing after? What do you want to learn more about? What sort of got you excited for the future that you want to go in and digest in some way?

01:04:51 Marnina Allis
I think it's the technology changes, just excited with all. I mean, we recently got our hands on the Toby TD pilot, so the iPad with I gaze. So I just for me just, I mean, we see the way AI is changing. We see the way all of our technology is changing. Just excited. So I hope and I think it's only going to get easier for our kids with the complex bodies to communicate. And I think that's I'm excited to see as the technology evolves and changes and improves, what else is out there.

01:05:26 Chris Bugaj
Awesome, Marissa.

01:05:28 Marisa Portanova
Agreed. I'm glad you brought up AI because that's some, that's a new territory that I have yet to dive into and want to learn more about how I can learn more about AI to help my kiddos out. But also like I started listening to a podcast of yours today about Gestalt language processors. That's something I want to learn a lot more about how to help children who learn language differently and how I can support their learning of AAC based on how they're processing language. And again, how to help support children with varying access methods. So how to build bridges from the low tech, mid tech to high tech. So I have some users who weren't exposed to AAC at a young age. So I'm some older, like high schoolers who I'm the first person who's trying things with them and restarted off low tech and just trying to bridge them to get to that high tech and also have the parents buy in and see how successful they can be with the high tech. Although it's intimidating all the but it's different like where can we go with this and just maximize on their potential and presume confidence so.

01:06:33 Chris Bugaj
Yeah, as that community grows, that would help with that, right. Those fears go away when you see more people being successful. Fantastic stuff. All right, well, thank you so much for being here today. Thank you for sharing all about Blydale and your awesome work and how your how we're so similar. Schools and and hospitals are really not that dissimilar. One of the goals that Rachel and I had for this sort of, I don't know, I'll put it in season. I don't know when the starting maybe year 7 when this air was realizing we didn't have enough people who are working in hospitals. But now that we've had more conversations with people working in hospitals, we're starting to realize that we are actually very aligned in in the work that we do. So that's exciting for me to learn and to hear.

01:07:19 Marnina Allis
No thank you. This has been great. You give us some great ideas that hopefully can help us continue and improve our practice.

01:07:26 Marisa Portanova
Yes, thank you so much for the conversations they led to lots of light bulbs.

01:07:32 Chris Bugaj
Awesome. All right. Well, thank you and let's stay in touch. I'll see you in future, ATIAS.

01:07:37 Marnina Allis
Sounds good.

01:07:37 Marisa Portanova
Sounds great. Thanks, Chris.

01:07:38 Chris Bugaj
All right, Thanks. Bye. Bye take.

01:07:40 Marnina Allis
Care.