SEASON 12 EPISODE 6

[INTRODUCTION]

[0:00:12] ANNOUNCER: Welcome to SLP Learning Series, a podcast series presented by SpeechTherapyPD.com. The SLP Learning Series explores various topics of Speech-Language Pathology. Each season dives deeper into a topic with a different host and guests who are leaders in the field. Some topics include stuttering, AAC, sports concussion, teletherapy, ethics and more. Each episode has an accompanying audio course on SpeechTherapyPD.com, and is available for 0.1 ASHA CEUs. Now come along with us as we look closer into the many topics of Speech-Language Pathology.

[INTERVIEW]

[0:01:04] SMS: All right. Hello and welcome back, everybody. Thank you for joining on this continued journey of self-discovery, self-connection and growth. I'm your host, Stephanie Michele Sweigart. I'm a licensed and practicing SLP out in Los Angeles, California. I'm a school-based SLP, and my pronouns are she, her. I also hold a certification as a teacher of mindfulness and compassion-based practices.

Thank you so much, everybody, that is here for this episode. Thank you to speechtherapypd.com for this. Just another amazing opportunity to connect with other professionals and learn and grow together and have this space for holistic self-development. We are getting ready to bring this mini-series to a close. I can't believe it. We're at our sixth episode and I really want to express my gratitude to everybody who has been a part of this journey that we've shared together.

It's really been a unique experience to be able to share in our field in this type of format. Just having your support with the listeners chiming in in the chat box, with your emails that you followed up with and your questions and concerns, it's really made this journey truly special for me. I really appreciate just knowing that the discussions have resonated with many of you. Thank you so much. Your feedback has been very valuable and immensely rewarding.

Before we get started, I do have a few things that I have to alert you to. The first one is that this podcast provides informational and educational content only. This is not a substitute for professional therapy. Discussions aim for self-discovery and it offers mindful strategies for addressing work challenges. The suggestions are not definitive solutions for your circumstances. Your choices are your responsibility. Seek professional advice for personalized support for yourself.

By listening, you do acknowledge that information is general in its nature and it may not suit your needs. That's okay. Exercise caution and consult relevant professionals before making decisions.

Let's dive in now to today's episode. I want to point out that each episode is 60 minutes. It's going to be offered for 0.1 ASHA CEUs. As far as my financial and non-financial disclosures, for financial, I am the owner of a non-public agency, Golden State Speech Pathology Services, which is a staffing agency in Southern California. I also receive an honorarium and speaking fees for professional development that I provide and for this episode for ShiftMakers. I also receive compensation for the sale of digital courses that I have available for sale. For my non-financial disclosures, I do not have any at this time.

I'm very excited, because you'll see that I do have a guest with me here today, who has so graciously offered their time and their wisdom to really share a personal challenge that they've faced in the workplace. This is Margarita De La Cruz, who was born and raised in San Fernando Valley in California. She's currently working as a bilingual SLPA in home health, the early intervention setting. She's very proud to be able to support families in her community, anything speech, or non-speech related.

Before getting her license as an SLPA, Margarita worked for a school district for over a decade, really gaining her valuable knowledge and skills when working with children, their families, and other school staff as well. Currently, she's interested in becoming much more involved in the speech world by connecting with other SLPs and SLPs such as yourself, who's listening, to really share and create resources that are going to help everybody become better therapists and just greater human beings. Her financial disclosures, do you have any to share at this time, Margarita?

[0:04:52] MDLC: Well, no. I mean, just that I was invited to speak as a guest in SpeechTherapyPD by you and yeah, I have no other non-financial disclosures.

[0:05:02] SMS: Perfect. Yeah, so for financial disclosures, then that would just be the honorarium for this podcast and no financials. Thank you so much. Maggie, is there anything that I missed that maybe you want to tell us about yourself, or something that you're currently involved in in the speech world?

[0:05:16] MDLC: I know. You've pretty much covered it all. I just am currently working in home health, early intervention, and I just find it extremely rewarding. I think that's where I'm going to stick to for a while. I don't know if you've ever done early intervention.

[0:05:31] SMS: I have not. No. Not early intervention. I will say, for my externship, actually, as I'm flashing back 17 years ago. In my externship, I'm dating myself, I worked at a clinic and we did do some home health for just a few weeks. After that, I haven't had experience once in the field.

[0:05:54] MDLC: Yeah. No, I mean, the littles are very little. They're pretty much in diapers most of the time, but I mean, they're fun. They're definitely from a different perspective. I mean, anything speech, you've got to notch it down very, very low with when it comes to anything that they relate to, I mean, even CVC words, for example, like I have to think of like, ÒHmm, pee-pee, poo-poo.Ó Something that they are used to.

[0:06:25] SMS: ThatÕs probably coming up a lot in their vocabulary, actually.

[0:06:28] MDLC: Yeah, I mean, mama, papa. Just very, very basic stuff. I mean, I love it. I mean, seeing them just progress on their own and even with the help of family and obviously, early interventionists in general, it's very rewarding to see.

[0:06:45] SMS: Well, thank you so much and thank you for all that you're contributing to our field. We can dive into today's episode. This is Voices of Change. This is Empowering Professionals Through Compassionate Communication. For those of you who are listening to this episode, I've also prepared something special for you. You can scan the QR code in the handouts, where you can download our workbook companion. This is a tool that Margarita and I are going to use as we navigate through today's topic. Grab that QR code, have the handouts and the framework ready and let's get ready to dive into this conversation that hopefully, isn't just informative, but experiential for Maggie and myself as well.

The first objective that we're really looking at that we're going to touch on is understanding ethical challenges that SLPs, SLPAs, I'm sure many helping professionals in the field face and the impact it has in our roles. I think that some of the ones that really jump out at me, there are many challenges that we have in this profession. Some of them are all too common. I think, confidentiality is one of the biggest ones that has really come up, because it's balancing this need for information sharing, right? We have to maintain the privacy of our clients, but we also have to figure out how are we going to collaborate, because we do collaborate with other health professionals and educators and family members, but respecting their privacy as well.

Informed consent is a big one. We've got lots of documentation to support us in making sure that we have permission before we proceed and perform tests. There can be ethical challenges that can arise, especially if we're working with clients who maybe have limited decision-making capacity, right? We need to consider when we're working with minors, we're working in the school systems and home health and clinics.

Also, thinking about how can we ensure that the families, or the caregivers understand what we're asking and we are getting that proper consent? Cultural competence is definitely a piece that comes up. Making sure that we've got a lot of professional development in this field now around culturally competent care. It is crucial and I think as speech therapists, we can say that we face a lot of challenges in just understanding and respecting diverse cultural practices and beliefs and communication styles. We might be touching on that a bit later today as well.

Really, just ensuring that therapy is culturally sensitive, it is inclusive when we are working with our clients and our families. Conflicts of interest can come up. This is a big one. This is where our professional judgment might be swayed, or shifted a little bit, or influenced by personal interests, or maybe financial interests. Avoiding these is going to be really important. Avoiding these conflicts of interest and remaining neutral, when we talk about staying objective, this neutral language, removing our evaluations from it will be really key in the decision-making process.

When we think about our scope of practice, this comes up a lot. I don't know about for you, Maggie, but just in understanding our role, we talked about this a little bit on the phone, understanding roles and responsibilities. It's like, okay, so I'm being asked to do something, but that's not in my scope of practice. It doesn't fall under my scope of practice, so what's going on here? I think we're going to be touching on that a little bit more in this episode as well.

There are so many different things to consider. I mean, when it comes down to continuing education, being ethical with that, with when we're advocating for our clients, when we're looking at our billing and our reimbursement processes, right? These are all things, maintaining professional boundaries. There are a lot of ethics that come up with just establishing and being able to maintain like, what's appropriate? This boundary, professional boundaries between yourself and myself, or with myself and the clients, or myself and the families. This is going to be really important.  Technology with COVID. I know technology has really Ð do you use technology, Maggie, at all? Because I know you're in the homes, but Ð

[0:10:47] MDLC: Yeah. The company I work for, we get tablets, like iPad tablets to take with us for notes purposes and then signatures to collect toward.

[0:11:00] SMS: Yes. Yeah. So very important, right? The information that we're putting on there and the signatures. Yeah, all of this in telepractice and online communication. We have to really protect and make sure that we are handling all of this electronic health information responsibly. Lots of different challenges and ethical considerations when we are reflecting on our career.

Today, Maggie is going to share with us an ethical challenge that has come up for her. We asked her in a questionnaire that went out via email, what is your situational conflict, or challenge, current or past, and how has it affected your well-being, your stress, worry, your emotions? Include necessary details, but not names. I'd like to start there. If you want to give us just a little snapshot of your story, the one that you submitted to us on your questionnaire.

[0:11:54] MDLC: Yeah. This agency that I worked for in the past, not currently with the menu longer, we had a certain developmental reports that we had to do, I think, I would say, quarterly. Those were pretty lengthy. They followed the DRTP outline, for those that are familiar with the DRTPs. That goes into things that are outside of speech. Like immediately, we have physical skills, gross motor, fine motor, cognitive skills, which some of these things do overlap with speech, obviously. But there was a lot of that being placed on us to report on.

By us, I mean, speech therapists, and as well as the other Ð there was another position as well. They were called early childhood teachers. They were also asked to do the same report. Immediately, just I noticed there was the same responsibilities for both positions and that made me question a little. I was like, ÒWell, okay.Ó Also, it was just outside of speech. I was a little curious over how that was going to work out. But I'm pretty open-minded and it's a new job and I figured like, ÒYou know what? I'm excited. This is a preschool setting, and preschool students.Ó I'm all for learning and figuring it out and seeing how I can help.

Yeah, it just became, eventually, a little bit un, unattainable or just in general, a little Ð not a little, a lot overwhelming, because besides these reports, your daily responsibilities, your daily admin tasks, which is session notes. When it comes to school settings, a lot of us usually do groups. It's about four max. But even that number got pushed near the end of the year, just because students are being identified with these needs of speech, of needing speech services throughout the year. Our caseload just gets higher and higher and then we don't have those caseloads caps. That's where it gets a little bit crazy.

[0:14:10] SMS: I'm hearing the craziness. I'm hearing that you are overwhelmed. Also, if you could share with us, you mentioned that when you were not able to get to all of the reports, who completed the reports for your students? I mean, in general.

[0:14:26] MDLC: Yeah, that was the other very important part. These reports were supposed to be completed by us. If not, the admin team would help us fill in the missing gaps, which was interesting, because I don't recall the admin team going to see these children, or service them directly. Yeah, so that was a little questionable.

[0:14:49] SMS: That sounds like a big ethical dilemma, right, they're facing. Like, okay, I've got all of these demands in my role that I have to do. I have these comprehensive developmental reports for my students that maybe the admin team doesn't know. There was maybe some pressure coming from the admin team to complete these, to get these done, right? It was impacting your direct therapy time. You're talking about these bigger group sizes, four or five kids. Lots of kiddos in a group.

[0:15:17] MDLC: It's six max. 

[0:15:22] SMS: I took a breath just thinking about that. I'm like, especially that age group.

[0:15:27] MDLC:  Yeah, six, four-year-olds. Just like therapy, group therapy for 45 minutes.

[0:15:32] SMS: Wow, okay. Yes. I'm hearing a lot of things that have raised valid ethical concerns for you. It sounded like, in this process, you decided to prioritize a healthy work-life balance. You were like, ÒI have my boundaries. I am not going to be able to complete these reports.Ó I want to say that that's very commendable, because there's a lot of people that don't know their boundaries, or know how to speak up for their boundaries.

It's unfortunate that the administration didn't understand, or see the ethical concerns with what was happening in the environment, right? I think, leaving that situation is what you mentioned you decided to do?

[0:16:14] MDLC: I did question, just returning at a supervision role for the next school year's providers. They were willing to talk about that and give me that opportunity to assume a supervisory role, because they got so much great feedback from all the school sites that I serviced, all the school staff, teachers, site supervisors included were just praising me and throwing my name out there like, ÒI love how she works.Ó I mean, they obviously wanted to keep me and I felt motivated by all the praise that I was like, ÒI would like to help others go manage everything that I managed and create boundaries where they need to create boundaries.Ó

In the end, it was too big of a monster for me to battle alone. I felt like, there was an honesty key missing between those above me and myself that I felt like, it didn't start off in an honest way and it didn't continue in an honest way. I just didn't trust that they would support me in a supervisory role in the following year, so I decided to not return.

[0:17:31] SMS: Right. Yes. I'm hearing, because your need for honesty, your need for trust, dependability, or an ethical work environment, professionalism, you just couldn't check those boxes. At that point, you had to make a decision that was best for you and say goodbye and move forward. We asked you, how do you typically handle conflicts, or disagreements in your personal, professional relationships? You mentioned that you tend to evaluate your conflicts on your own first before bringing them up, because you want to make sure that it's a problem that you can solve independently on your own first.

I want to dive into that just a bit and talk about Ð it sounds like, you might have a process, right, a process for handling challenges. I'm wondering if you can just share, shed a little light on that process a little bit for our listeners, when these things come up.

[0:18:26] MDLC: Yeah. It sounded a little therapeutic the way you put it. Yeah. I mean, definitely, I definitely do Ð I have trouble asking for help, I guess. That comes from me just taking a lot of responsibility for the challenges that I face. That's not always fair to me, because there's challenges and things that I really don't have complete control of. I should be asking for more help than trying to fix these things on my own.

Usually, when I do face a problem, I think about how what things I can actually Ð like, what things I have control, versus what I don't have control of. I don't have control of other people. I don't have control of their thoughts, their feelings. Even if there was an action that I felt they purposely did this, because we just had a conversation about this, and now I'm getting these reminders that I need to be more on top of my, let's say, admin tasks, or something and I feel defensive, I immediately just tell myself, ÒWait. Hold on. What? Can you control yourself?Ó Okay, let's control myself first. Then I tell myself like, okay, now we do not control others. We do not control others. We do not control others, but what would we like from the other person? What is something that you really need from that person right now?

If it's support, I just straight up ask for support. I say, ÒYou know what? This is my problem. Unfortunately, this is what I'm facing. And you can help me in this way.Ó Even if it's your boss, your supervisor, it can obviously feel very intimidating for people that are not used to speaking up for themselves. People that are used to dealing with things themselves like I am, it can be very intimidating. It takes a lot of practice, but maybe that Ð

[0:20:26] SMS: I love you sharing this. I know you said it sounds therapeutic, but it's like, let's get our coffee and sit down and have that chat, because there are so many people Ð and I'm not a therapist. That's why I gave the disclosure in the beginning. But I think it's important for people just to know that it's so common, and just to normalize that we all have fears. We all have fears to show up at times and to advocate on our own behalf and to say the things that need to be said for the change to happen. I really appreciated how you shared like, what is in my control? What isn't in my control? What do I have the power to do?

You mentioned something like, ÒI know I need to call myself down first.Ó I think all of these strategies are so very important. I'm really excited for your openness and your vulnerability to share this, because I think it is something that many people who are listening can relate to. I know, I can relate to, that we all have those situations that it's just like, what's going to happen if I speak up? Is there going to be retaliation? Am I going to lose my job? Am I just going to be viewed as a complainer? We talked about this on episode three in this podcast. We were talking about habitual ways of responding to conflict, which I had sourced from Oren Jay SoferÕs book, and it's called, Say What You Mean. I love this book. The four different ways, or common ways, not an end all be all, but was conflict avoidance, right? I just, I don't want to deal with it. I'm out of here. That was me many years ago.

I was, when things hit the fan, I hit the streets. I was gone. I was like, ÒNope, done.Ó Conflict confrontational is that like, I'm up in your face. I might get louder. My tone might change. It's like, I'm going to put my needs as the priority, with a lot of maybe more demand type of language. Then we've got passivity, which is, ÒOkay, I'll do it.Ó Meanwhile, you're thinking, ÒI really didn't want to, but I'm a people pleaser. I just want to keep the peace and harmony. But I'm forgetting my own needs.Ó Like you said. You're like, ÒI realized I'm forgetting about myself, when we're doing what others want us to do, if it doesn't align with our desires.Ó

Then the passive-aggressive is that individual who goes ahead and says, ÒYeah, I'll do it.Ó Then meanwhile, behind your back, they're saying things that are negative, or not doing the full assignment, or maybe not doing the best job with it as their retaliation. For those people who are listening, maybe you identify with one of those, maybe you don't relate to any of those. I mean, there are people that can, that do have processes, like Maggie shared. Like processes that I have, or ways that you can communicate in your own way. There's many different communication styles out there where you can have open and honest dialogue, where you can sit down, where strategies can be formed and collaboration can feel more like a breeze. There's those people that can just, they just, they do it. They're doing that thing and it comes easily for them.

For anybody that's listening, if you want to dive a little deeper into the type of conflict, a habitual way of responding to conflict that you might have, that is on episode three. Another thing that's really challenging, too, I think for people is specific emotions that come up in those challenges. Because I'm a very emotional, sensitive individual. People used to say that I Ð what was the expression? I wore my emotions on my sleeve, right? You would know how I was feeling. I'm wondering for you, do you think when these challenges are coming up in a professional setting, are there any type of emotions that are a little harder for you to find a way to express, or be in open dialogue with?

[0:24:08] MDLC: Yeah. I mean, there were moments where as a provider in this preschool setting, I would deal with a lot of, you know what? Oh, that already sounds bad the way we're doing it. I didn't deal with people. I had conversations with people, or I would get maybe some feedback, or I would Ð I think a lot of people would be confused as to who I was half the time. Because I was a traveling SLPA from different sites. It would take a while for people to know what I was doing there, who I was.

Then I think there's a lot of like, when it comes to adults, there's this hierarchy of titles, or something going on sometimes, where they feel, I don't know if it's threatened by my expertise, or my wanting to come help support in their classroom when it comes to speech and language. I'm not the most consistent person there, because I have all these other sites to support. Of course, these direct teachers, or site supervisors are the ones really carrying the difference there of the carry on with its students. They're the ones practicing daily, seeing them, feeling like they're probably making more progress with the students than I am, which completely understandable.

There was moments where I would not only feel it, but I would get maybe comments here and there of like, ÒOh, you know, who are you again? What are you doing here?Ó IÕm like, ÒOh.Ó I took it without the tone. I took it without the face. I took the words, not their attitude. I was like, ÒOh, Margarita De La Cruz. IÕm the speech therapist. I'm here to see so and so. And so, is this a good time? If not, when can I start? Where can I sit? Where can I work?Ó There was a lot of having to dodge, pick your battles. Pick your battles.

[0:26:08] SMS: Yes. I'm hearing that you maybe, you had to navigate some of your own frustrations with that and those encounters.

[0:26:17] MDLC: Yeah. It's hard, because sometimes I would just not be having one of those days where I had the patience. If this person gives me attitude one more time, I don't know how I'm going to react. That's okay. We're not always a 100%. We're not always in that state of mind where we can be dodging these things. Sometimes we can't deal. There were times where I just had to say, ÒGive me a secondÓ, and pretend I got a call from my supervisor or something and just take a deep breath, come back in.

[0:26:55] SMS: Self-care. Yes. You saw that moment and you took self-care, because I'm thinking about when I used to Ð when I told you, I used to just, when things hit the fan, I was, right? Anger was a big thing that came from me. I'd be very angry and holding on to these feelings, where I had all this blaming and judging. I focused on what I thought people were doing wrong in the environment. In doing that, it created more of this anger in my mind, because I was like Ð and it's like you say, pick your battles.

I was choosing to focus on these things that were making me so upset. Anger was hard for me to be able to come out and say what's on my mind. I know this is something that comes up for people in my team. I know this is something that we've talked about in another episode, that when we're angry, people think, ÒOh, I shouldn't be angry. I shouldn't share anger in this way.Ó You've even mentioned in the questionnaire that if you're experiencing anger, you tend to keep it to yourself, that you don't think that it's helpful to express it.

I thought it was important just to touch on real quickly before we move on to our next part of our episode is really just this idea that seeing anger in a way is energy. Not good, or not bad. It's this energy. It's this wisdom that is rising up in us. It's like fuel, if you will, right? That's going to give us what we need to get to a place that we need to be. At that point, it's our decision on, well, do I want to use up all this fuel, all these precious resources that I've got from this wisdom, right? This fuel, spending it judging and blaming and complaining and telling everybody who will listen, how awful these people are and what I'm going through.

Or, do I want to use that fuel, that energy that is coming up in anger at different levels, and use it to now connect back to what's going on for me? What am I feeling right now? What am I needing? What are my unmet needs that's causing so much anger right now? So, that I can begin to advocate for myself. So, I can get clear on what boundaries I need to set, or what steps I need to take to get my needs met, or what I need to do to create Ð we always say, be the change you want to see in the world, right? It's like, I can use this now to start to create the things that need to happen. Sometimes that's just leaving, walking out the door when you've tried different things and it's not working out. Sometimes that's the safer, or the better option.

It's really this stopping and connecting with our breath and realizing, ÒI've got all these judgmental thoughts that are happening. But let's come back to myself for a minute.Ó Like you said, you stepped outside and you're like, ÒI had to take a breath, right?Ó We self-connect. That self-connection is a very important strategy that you mentioned that I hope all the listeners are grabbing onto right now, because that self-connection to just stop, going down the rabbit hole, stop the train dead in its tracks. Notice what's going on for you, notice what you're needing, and then learning a framework for advocating, if that's your choice to do so.

We'll talk about, you don't have to advocate. I mean, again, there's different communication styles. But being able to now find a framework to say what's going on, in a way that people are going to listen. Their ears are going to open. They're not going to be thrown onto the defense as soon as you come in, because you are relating it back to I statements, you're connecting to your feelings, your unmet needs. Then you're willing to have that open space to collaborate for strategies.

I wanted to jump into that framework. I know you are familiar with it, because you've been in another podcast. You've mentioned, you also have downloaded the workbook. I know you've got some questions about that framework, so we're going to use the Q&A to dive into those questions in just a little bit closer towards the end of this episode.

[MESSAGE]

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[INTERVIEW CONTINUED]

[0:31:25] SMS: For those listening, if this is your first time on the episode, if you haven't downloaded the downloadable workbook and your handouts, this is a framework that is non-violent communication that is developed by Dr. Marshall Rosenberg. You can learn more about him at cnvc.org, the Center for Non-Violent Communication.org. It is a framework that if it works for you, can really be applied to address challenges, or conflict, or ethical dilemmas that you are having in the workplace. I thought I would just start by bullet pointing those for our listeners. The first one is just observation. We're removing any evaluation from what we're seeing. We're just clearly and objectively describing a behavior that we see, right?

We're sticking to the facts, right? We're just sticking to the facts without putting in as best as we can our interpretations for personal judgments. Maggie, I don't know if you want to play along for this or not. If you've got the handouts ready, I'm wondering if you want to maybe take a stab at your situation. Maybe together, we could work through this, like a little workshop here on figuring out maybe one to two sentences, like summarizing what you have told me. Let's see if we can call one or two sentences about your situation that led to your ethical dilemma. I want to invite you to Ð and already am I listening, I'm hearing you have a lot of neutral language, so I'm thinking this will be high note for you.

I heard that self-correction, too, that awareness, which is so beautiful to have that awareness when we speak and to hear that. I want to invite you to try to just use one or two sentences that are free from judgment and blame and put it into neutral statements to come up with one or two sentences about the dilemma as it involves those assessment reports. We'll needle right in the assessment reports and your situation around who was doing those.

[0:33:21] MDLC: Okay. Am I speaking to, let's say, a co-worker friend about this? Or am I speaking directly with supervisor about the dilemma?

[0:33:31] SMS: Yeah, good question. Who do you want to speak to? I mean, I can be that person. We can role play. Do you want to? I mean, if you were going to approach this in the school setting, who would you approach?

[0:33:42] MDLC: I guess, I wasn't directly working for the schools that I was visiting. I was under an agency. I'd probably talk to my co-worker about it before Ð

[0:33:52] SMS: Yeah. Okay.

[0:33:54] MDLC: Before going to talk about it with the higher up.

[0:33:57] SMS: Perfect. What we're going to do is, I'll give you a little sentence starter. This is for anybody that's listening to when you're doing this exercise. We as a speech therapist, we have our sentence starters that we use with our kiddos. I'm going to give you guys a sentence starter. When I observe, or when I see, or when I hear, or when I notice. We're going to start with that, but we're not going to go into the I feel. Okay, just fill in that phrase now. When I see, when I observe, or when I hear and then create a little sentence about that. We know that the sentence isn't going to end, because we're going to move on to feelings next and we're going to keep building on with this exercise.

[0:34:35] MDLC: Okay. No, that's a great sentence starter. I feel like, I've probably already used that before, actually. When I see an email reminder from the administration team about completing my notes on a daily basis, I feel Ð

[0:34:53] SMS: Okay, so we'll stop there. We're going to go with the observation. This is great. No, this is great. We're going to go with the observation of, and that was very neutral. When I see an email, you told me very clearly it's an email. It's coming from administration about your notes needing to be done daily. Very neutral, very clear. The second step is connecting to a feeling now. This is really trying to identify and express the universal feelings for you. In that workbook, there's universal feelings and universal words. Is there, for the purpose of this exercise, we'll stick to the universal feeling words within the chart. Are there one, two, three, maybe that come up for you from that situation?

[0:35:37] MDLC: Yes. There's annoyed.

[0:35:40] SMS: Annoyed, uh-huh.

[0:35:42] MDLC: I feel frustrated and irritated. That's those are the Ð

[0:35:49] SMS: I'm taking notes, because somebody once said, a short pencil is better than a long memory. I've held on to that, because I need all the help I can get with remembering things. There we are. Okay. I've got irritation, annoyed, frustration. Very good. Okay Ð

[0:36:06] MDLC: You know that theyÕre all pretty similar, but Ð

[0:36:09] SMS: But that's okay. It's interesting, because we're building our vocabulary now, our emotional vocabulary. Some people might not be able to, and that's okay. If you're listening and you're like, ÒI don't really know what I'm feeling.Ó I can't connect it to. I can only sense it and I can't come up with a word for it. That's okay, too. But this vocabulary bank, the purpose of this is to just like an observation where we pulled out the evaluation to stay neutral, so we went from staying away from evaluation to just observations. With our feelings, we're staying away from opinions and we're sticking to universal feeling words.

What I mean by that is if we used a feeling word such as abandoned, if I said, ÒMaggie, you abandoned me. I feel abandoned.Ó Or just, ÒMaggie, I feel abandoned,Ó there could be some defensiveness. I mean, if somebody told me I abandoned them, I might go on the defense with that, because that abandon is a feeling word that insinuates you did something to me. With universal feeling words, we're trying to express the same message, but we're using the feeling words that will connect us more with others.

When I was in the disagreement with my co-worker and you left the room, I felt alone. There, when I say alone, maybe I can express to you the same idea. You weren't there. I wanted you there. Abandoned could be off-putting, right? It could throw you into this fight, flight, freeze, a stress response. Whereas, if I say, I feel alone, or I feel lonely, maybe we're diffusing that conflict a little bit. That's why, I think, these universal words that he's Ð Marshall shares are so important, because they really spend a lot of time looking at those words and separating out.

Or, if we said something like, I feel like you just up and left me in that situation. I feel like, you just up and left me. We talk like that all the time. We say, I feel like, and anytime we say like, it's an opinion, versus a feeling. We want to remove that and get back to those universal feelings. Irritation, annoyed, frustration, we got it. These are great.

Let's go to needs. You have the universal needs box. With needs, what we're separating now, again, separating evaluation, separating out opinions. With needs, we're separating out strategies, because there are many strategies to meeting the same need. When we get so hung up on it has to be this way, and our communication partner is like, ÒNo,Ó and were like, ÒNo, it has to be this way,Ó and they're like, ÒStill no,Ó and we get really upset, we are not opening up to all of the different possibilities that could be out there, or diverse perspectives, unique perspectives that could be out there. We're moving away from strategies and we're connecting to needs.

For the purpose of this exercise, let's look at that needs box. When you think about you've got this email, it's coming in from admin, they're asking you to do daily notes, feeling irritated, youÕre feeling annoyed, youÕre feeling frustrated, what are you meeting right in that moment, do you think?

[0:39:15] MDLC: I'm needing a check-in. Like, how do you think I'm feeling right now? Let's check in with me first. ÒHey, Margrita. I noticed you haven't been submitting your notes daily. Is there something that I can support you?Ó That's from my [inaudible 0:39:15].

[0:39:32] SMS: Okay. Let's go down to this need box and let's see if check-in, check-in, or Ð

[0:39:38] MDLC: Maybe something close to check-in. Let's see.

[0:39:40] SMS: Yeah. It sounds like, you're needing some communication with admin, right? I'm sorry. Yes. Well, yeah, because you're talking about a check in with admin, or a check in with your agency. I'm sorry.

[0:39:51] MDLC: Yeah. Like, a check in with admin. Well, yeah. They're, I guess, synonymous with part of agency team.

[0:39:59] SMS: Let's go a little higher. What do you think the need is that that check in supports? If you got that check in from them, what does that give you? Does it give you clarity? Does it give you closeness? Does it give you a feeling of the communication that you wanted? Does it give you more peace in your life?

[0:40:17] MDLC: It gives me closeness. It gives me trust. They trust me to do my job adequately and timely, but they know something might be going on that I may Ð maybe I'm not asking for help when I could.

[0:40:34] SMS: Okay. I like that. Closeness, trust. Is there one more that you just mentioned? Closeness and trust. Those are good.

[0:40:41] MDLC: Yeah. Support, I guess. There's a support in there.

[0:40:44] SMS: There's support in that. Yes. By them checking in, that meets your needs for support. That meets your needs for trust. That meets your needs for closeness. Do you see now how a check-in is a strategy? It's a strategy that's meeting a need. Great. Now, we've got our observation. We know how we're feeling. We know that our feeling comes from this unmet need. It sounds like, my needs for trust, my needs for closeness, my needs for support are not being met and I'm getting further irritated and I'm getting further annoyed and I'm getting more and more frustrated, right? That brings us in now to our request. This is the fourth step. Observation, feelings, needs, request.

We want to make a request. If this is something you're needing from admin, I would think the request would be with admin, right? We're going to formulate. Now we're going to put all these pieces together. When we think about a request, we want something that is clear. When we ask it, they know what it is we're asking, because when it's not transparent, when it's vague and it leaves room for interpretations, they might think they're doing something, but it's not what you wanted them to do, so it's not going to meet your need. The point is we want to meet your needs. We want to have the trust, the closeness and the support.

We think about that, okay, what strategies can I propose? Because we want it to be actionable. We want to be clear. Want to be positive, right? Because when we're making requests, we don't want to make a request that would be at the expense of somebody else's well-being. We want to consider that. We want it to be a positive request and we want to be actionable. I heard in your talking this check-in. Let's talk about that a little bit more. Let's go with the check-in and how can we make a check-in really clear? Because there's a difference between me saying to an SLPA I'm working with, ÒHey, I want you to check in with me next week.Ó Versus me saying, ÒLet's connect on Wednesday between 12 and two for about 20 minutes on the phone.Ó

We just want to be really clear and give as much information as we can to set the person up to understand what it is that we're asking to see, if it's something that is possible for them. What is a check? How could we be clear, positive and actionable with your check-in? Well, what would that look like? Describe the check-in.

[0:43:14] MDLC: You know what? Hearing you talk about these actionable steps, actually reminded me of one of the staff on the admin team. Actually, I feel like, I learned this from her. She was quite well at communicating, compared to other people that I've worked with in the past when it comes to admin and providers. I feel like, we had similar ways of communicating. One of them was she would offer her support and she would ask how I would need that support in time. As in, I need more admin time to get these notes done. She would be very direct like, ÒOh, yeah. For sure. How much time would you need?Ó That was fair for her to ask, because if I need more time, how much time am I talking, so that she can schedule me some time and my day?

This is something that I realized like, oh, this is something I picked up while working with this agency. It wasn't all bad. I mean, I've got some good co-workers. I have some good communication there every now and then. You know that I learned from her and I realized, okay, next time I have this conversation, or multiple times that I emailed with admin before, I would be prepared ahead of time to calculate how long I think I would need to get these things done based on child, based on my previous number of like, I already knew how quickly I could get certain notes done within X amount of time. I would tell them, ÒYou know what? I unfortunately, I don't have time for that in my schedule. I haven't had time for that in my schedule as of lately on a daily basis. But if you would give me so and so amount of time this week, I will get those done.Ó Those are some actionable steps that I took over.

[0:45:08] SMS: I love that. It sounds like, the communication, the dynamics between you two was very positive.

[0:45:14] MDLC: Yeah.

[0:45:15] SMS: And more effective than, probably, in the work that you were doing together.

[0:45:19] MDLC: I mean, I wouldn't have known what to ask for either. It's like, for anyone who's listening, it's not Ð sometimes at your job, you don't know what the actionable step might be, but that's where you can have that conversation and see your admin team, or your supervisors can help you help support in those actionable steps and create those actionable steps with you.

[0:45:42] SMS: That's it. You nailed it. If you don't know that Ð I mean, and you can make a list, because, again, we talked about there's so many different strategies to meeting a need. If your check-in is one strategy to meeting closeness, trust, or support, but admin's like, ÒI don't have the time to check in this many days, this much time, or whatever, because of everything else we have going on.Ó It's like, you could also say Ð well, that brings us into Ð Let's roll through this now, because that brings us into the request. Like what you're sharing, is we could request to strategize together on how to increase that trust, that support, that closeness.

When we're putting this all together, this NBC framework, you want to express your observations, your feelings, your needs, your request, but you want to do so in a way that it's going to support connection with one another. It's going to support understanding. It's also understanding where the other person is coming from, when we are collaborating. It doesn't mean agreeing. It just means understanding their perspective, putting yourself in their shoes to understand it, because this is going to help possibly, not always, maybe bring a resolution, maybe diffuse conflict, or make the changes necessary for those ethical dilemmas in your workplace.

If we were to run through this, then using the taglines, this would look like, ÒWhen I receive an email from admin asking for my daily notes, I feel irritated, because I have a need for trust. It also sparks some annoyance, because I'm needing support right now in this role with my current caseload and workload. I'm feeling frustrated, because my need for closeness with the team is not met as I'm doing this by myself at the site.Ó Would it be possible? This is where the request comes in, where we request now to the admin, ÒWould it be possible to meet sometime next week for an hour to strategize ways?Ó Then these are the ways for you to Ð obviously, we want to alleviate your irritation, your annoyance and your frustration, and we want to build more support and trust and that closeness. ÒWould it be possible to meet one day next week for an hour on Zoom, or on the telephone, whatever is very clear for you that you would like to do to strategize ways that I might be able to receive support from admin, or other staff to help me with the daily notes?Ó Or whatever it is that is coming up.

Again, we can strategize together. That leaves it collaborative. Now we're opening up. Do you want to try one on your own on how that might sound for you using those phrases in the four-step process, or what might make more sense for you?

[0:48:49] MDLC: Yeah. Actually, while you were saying that Ð while you were doing, you're formulating that sentence, or whatever, I just was reminded of another scenario, the same agency that I went through. It was asking for support from admin for a group that I had that included a kiddo that was very mobile, very active, wouldn't stay in one area, and he was also autistic. There was a lot of needs for that particular student and I didn't feel comfortable restraining him into a section, keeping him, because it's like, that's not the way I do therapy.

I'm supposed to be Ð I'm not even a consistent person. When I show up there, I don't want to stress the children out. Like, ÒOh, this person's going to come and make me sit again.Ó Especially sensory-wise, that's just not the way I do things. I'm not going to keep a child from Ð theyÕre preschoolers, okay. They need to move. I asked for support and splitting up the group, because they would group them, split them up sometimes, even though they were the same classroom. I reached out to admin once about this particular student saying, ÒI would love it if you guys can Ð I don't know if it's possible to split up.Ó

I explained the situation with the student that needed support. I wasn't able to support him in the current setting. I gave them two options. One, can you split the group for me so that I can better help? ItÕd be smaller numbers, so two on two, instead of the four all together. Or, could you send down someone to help, so I can shadow them, like a supervisor? One of the supervisors. Can they come down, observe me, or observe the student, so I can shadow how they would do it, how they would do group session with the student who's very active, because I'm very curious to see how the higher-ups would handle this situation.

Yeah, the response was they were not able to split the group for me. They didn't know when they could come down to help show me an alternative way. Eventually, they just quietly split the group. In the end, I did get that support. I did get what I asked for, even though the initial response was, ÒNo, we canÕt do either of those things.Ó But eventually, they did. It was a little strange, but I didnÕt give it up.

[0:51:27] SMS: I'm hearing that you are prioritizing the well-being, the care, the respect for your pre-K kiddo, who is active, who you said is autistic, who you said has unique needs. The group size was not supporting your need to support him. You've had these unmet needs to really provide that quality care. When I hear that, so yes, it's this moment where we have to advocate, we have to go and say, we have to state the facts. When I see four kids and one of my students likes to move about the room and go over to whatever, and you describe the neutral observations. I'm not able to provide the level of care for that student. It's important that that student has the freedom to move about and express themselves in their own individual way to promote the best communicative environment and opportunities.

I'm feeling really overwhelmed, or I'm feeling extremely worried, or I'm feeling concerned that that student is not getting the quality care that they deserve. We advocate. I need to strategize. I need to strategize how we can collaborate, how we can come together and figure out a way to put our students first and to look at their unique needs. I mean, that's why we have IEPs, right? Every child is an individual and very unique. We need to sit down and I would like you to maybe share Ð maybe we could meet next week and talk for an hour, because I'd like to know what you're hearing me say when I say this. I want to make sure that you're understanding my perspective, but I also want to hear from you. I want to hear how you're feeling, or what you're thinking when I say these things.

When I'm not getting that support, I'm wondering why. I'm wondering if maybe you could share for me what you were needing in that moment, what needs of yours that you had to meet when you said no. Because I advocate to saying no to all of this extra work, right? Because when we say no to one thing, we're saying yes to something else, so are other people. Not making it right. Just saying, I want to connect with you. I want to understand your thought process on this. I want to sit down and have this heart-to-heart for us to truly understand what's going on. I want to hear your needs. I don't want to hear my needs. Now, when I know I can hear both of those, maybe this will spark even new ideas we hadn't even thought of, right? Because that's innovation.

When different people with different ideas, you don't want everybody all with the same view and same idea sitting down. You want different views, ideas, and diverse perspectives. That's innovation. Yeah, so it's a matter of also understanding, bringing that empathy piece. Again, empathy is not acceptance, but empathy is saying, ÒWell, I just want to know, how does that land for you? What do you hear when I say that?Ó

If there is a moment where they're not hearing something in a way that you wanted to communicate, that opens up the dialogue for clarification. Now, we can clarify, right? We're getting to that more Ð the more that transparency. ÒAh, I hear where you might have thought I was feeling this way, but let me clarify. I'm actually feeling this way, or this is actually what I'm needing. I didn't need ÐÓ It gives that opportunity for us to collaborate and strategize together. I always say, it takes seven noÕs, until I'll get my yes. I mean, I keep going, right? I keep going, because I'm like, okay, it doesn't have to be the way I say it's going to happen, but maybe we could sit down and find a bunch of ways that it could happen. Then, you know what? Maybe still, you never get your need met. That happens, too. That happens.

[0:55:17] MDLC: I do want to add on that communication with your administration and all that. Isn't the only thing that actually helped that situation now that I think about it. I was always constantly communicating with teachers about their concerns, as well as my concerns. I mean, they're the ones directly present during sessions. I feel like, theyÕre very protective of the students, especially when outside providers come and provide services. I built a lot of rapport with them since the beginning. I think I gained enough of their trust with keeping them in the loop of what was happening.

When I noticed it, they noticed it. They noticed my child wasn't sitting with me when they were supposed to be having speech. They weren't trying to constrain him either, because it's like, well, they were probably curious how I would deal with that. I would take some time near the end, or during to bring my group over to where he was. But then, he didn't like having so many people following him around.

[0:56:22] SMS: He was needing space.

[0:56:24] MDLC: Yeah. We would let him be for the first half. Then the second half, I'd go and follow him around, model language for him, specifically on what he was interested in going and what he was doing. I mean, they noticed my efforts in trying to bring some quality care for him, meeting his needs where he was at, but I also communicated my concerns of the limits of what I could do as a provider, but that doesn't have support from the admin. I let them know. I requested for help. My admin team hasn't gotten back to me yet or, hey, you know what? They got back to me, and they actually, now that they think about it, they mentioned to ask teacher for support and keeping him on the table; at the table of the therapy table, or whatever.

[0:57:12] SMS: That strategy wasn't going to meet the needs for everybody.

[0:57:16] MDLC: No. Also, teachers are already so short-staffed. It was quite impossible to get anybody to come help support me, when the classrooms themselves are in desperate need of support from others. Once the teachers noticed this, they felt that I was communicating my struggles with them. They understood, they communicated with their higher-ups at the sites. The people at the sites, site supervisors contacted my agency. I feel like, that's when the change happened, because they realized, ÒOh, the site supervisors are not happy about this current setting, even though provider already mentioned it to them.Ó

It took a higher voice, I guess, or something for it to reach the ears, to actually cause some change. My admin team, that's when they split the group and they realized, ÒOkay, this is a problem.Ó It wasn't like, I was taddling. I wasn't trying to get them in trouble and get my way. It was genuine concern. Me having this relationship with teachers, with the school, with the sites that I visit. It's all genuine, even though it feels like, it could have been like, ÒOh, she did it to get back at us, or something.Ó I mean, I didn't feel that. I didn't feel that animosity at all. They did what I asked for. It took them some time, but I feel communication with just your agency, or whoever you're working for, it's not always effective, but open communication with others as well. Like, whoever else you're working with directly can help make that change rate.

[0:58:55] SMS: Yes. I think, it's interesting how you talk about the power differentials, too. There's always that, that piece is really important to think about. I commend you on talking with different professionals and getting their opinions and their thoughts and insights from different staff. It sounds like, you stuck to it and you were open to hearing from different people and eventually, admin was able to make it more of a win-win for everybody. A win to respect the student's unique needs, a win for you to have more relief in the care that you provide and making sure that you're respecting your clients and meeting your need to support them.

It sounds like the teacher's needs were also met too in that moment. That built more trust between you and the teachers and more communication. That is a win, when we are Ð if we're just saying Ð if admin's just saying, put the student at the table and have them sit there, that might be a win for admin to meet their need of not dealing with this. ItÕs not a win for you. ItÕs not a win for the teachers. ItÕs not a win for the student. We really need to strategize, okay, figure out what the main need is. Now we realize, it doesn't just have to be that admin. That doesn't have to be the only answer. There can be a lot of other strategies, because that's not the answer, to supporting everybody that's involved.

We have met our time. What I'm doing is I'm going to thank you so much, Maggie, for being a part of this learning experience, for being open and transparent. I don't know if there was any vulnerability in that for you. Just thank you for practicing and going through the process and being open to try that and also for the questions you brought. I'm so grateful. It's been nice having somebody to talk to on this episode.

[1:00:45] MDLC: Yeah. No, thank you for having me. I really appreciate the time and just the patience on your end, too, because I've been a little swamped on my end to get back to you with a few things. I appreciate the openness as well and the communication.

[1:00:58] SMS: Thank you. If anybody wants to find out more about you or your resources, is there anywhere that you want to share?

[1:01:04] MDLC: Yeah, I have an Instagram. It's @magsdelacruz. That's just no spaces, nothing. Just like that. @magsdelacruz. It's mostly my personal. I don't have a speech presence yet, but that is on the cards for me. I'm thinking about making a speech page. Follow me on my personal account and I'll pull you back. If you have any questions, you could reach out. Yeah, anything speech, not speech.

[1:01:27] SMS: Perfect. Well, thank you so much, everybody. We hope you have a great night. Take care.

[END OF INTERVIEW]

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SLPL S12E6		Transcript

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