Season 7 Episode 4

[INTRODUCTION]

[00:00:13] 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 .1 ASHA CEUs. Now come along with us as we look closer into the many topics of 
speech-language pathology. 

Welcome to Season 7. Telepractice: It's Not Just Screen Time. 

[00:01:14] KHK: Welcome to the podcast mini-series. Telepractice: It's Not Just Screen Time. 
Presented by speechtherapypd.com. 

Thanks for joining us for our fourth episode, Accent Modification Through Telepractice. We 
would like to mention that there is a handout that accompanies this presentation available for 
download. This audio course is offered for .1 ASHA CEUs. 

I'm your host, Karin Hartunian Koukeyan. I have been a speech-language pathologist for over 
two decades and working in telepractice for the past 12 years serving in both special education 
and healthcare. 

Before we get started, we have a few items to mention. We love and encourage questions from 
our participants. You can put your questions in the chat box for our guests to answer. 

As a reminder, if your state license requires CEUs, be sure to complete all course modules, 
including the one that says quiz, before the end of today on your speechtherapypd.com 
account. 

Here are the financial and non-financial disclosures. Karin Hartunian Koukeyan is the host of 
this podcast and receives compensation from speechtherapypd.com. And she's also currently 
the Clinical Program Director at SLPTELE. Her non-financial disclosures are that she is the 
current SIG 18 Associate Coordinator for ASHA. 

Dr. Kelli Uitenham receives an honorarium from speechtherapypd.com for this episode. She is 
also the owner of Serenity Speech Therapy and Kensington Academy. She also is an 
independent contractor for Great Speech, Inc. Her non-financial disclosures are that she is a 
member of SIG 8 for telepractice. 

And now here's a little bit about our guest today. Dr. Kelli is a medical speech-language 
pathologist licensed in nine states and has been practicing for nine years. She is the owner of a 
private tele practice company, Serenity Speech Therapy; and owns Kensington Academy, a 
private consulting firm for SLPs interested in starting a private practice, getting into telepractice 
or travel therapy. 

Dr. Kelli's areas of interest include accent modification, dementia, dysphagia, aphasia, 
Parkinson's disease and fluency. She has experience working in skilled nursing, assisted living 
and independent living facilities. 

Dr. Kelli also has experience working in hospitals, home health, and as a travel therapist. She is 
a certified Compton PESL accent modification instructor, a SPEAK OUT! and SpeechEasy 
provider. 

Dr. Kelli is also an adjunct assistant professor at St. John's University North Carolina, AT&T 
State University and Shaw University. She's a public speaker and has served as a guest 
lecturer for Purdue University and Howard University. 

Welcome, Dr. Kelli. 

All right, in this episode, we will cover the following learner outcomes. By the end of the course, 
participants will be able to identify the necessary skills required to provide accent modification 
services via telepractice, identify where to locate potential clients, develop a plan for initial 
analysis and accent modification sessions. 

Before we begin, we would love to hear about how you began your journey as a speech-
language pathologist and how you came upon telepractice. 

[00:04:48] Dr. KU: Hello. Thank you for the introduction. Yes, that is a great question. I 
originally started out being a journalism major. I graduated. Did the whole starving artist thing. 
That didn't work out. And then I spoke with a speech-language pathologist that I knew and she 
encouraged me to check out speech therapy. And I was like, "What is speech therapy?" 

And so, she pointed me in the right direction. I did some research. I fell in love with the 
profession. And so, I applied to grad school. Did that. Did several of, well, all of the things that 
you listed and becoming a travel therapist. And then towards the end of that, when I stopped, I 
had all of these licenses and I had continuously heard people saying like, "Oh, I was licensed in 
the state but I let it lapse. And I wish I hadn't." And I was like, "Well, I want to keep mine. But 
what is the purpose if I'm not in the state?" And then I thought, telepractice. I can use all of my 
licenses and still do what I love. And I'd be able to hold on to them. That is how I came up with 
telepractice for myself. 

[00:05:57] KHK: Awesome. Thank you for sharing that. What made you become interested 
specifically in working with accent modification? 

[00:06:05] Dr. KU: It was really the freedom of private practice, and telepractice and just being 
able to think outside of the box. One of the great things about being a speech therapist is you 
have such a wide range of things that you can do. I knew I wanted to still practice and help 
people. 

Accent modification just kind of appeared. It seemed to be something that we could do. And I 
looked into the Compton P-ESL program, and took training and just learned even more about it. 
And that was my journey to it. 

[00:06:39] KHK: All right. And I've heard a lot of different terminology around this area, such as 
accent reduction, accent enhancement. Can you speak a little bit to these terms? Do they mean 
the same thing? And why are there different terms? 

[00:06:55] Dr. KU: Yes, they are different terms, but they mean the same thing, which is 
essentially modifying or changing the way somebody speaks or changing their accent. They 
mean the same thing. 

[00:07:07] KHK: Do you have any idea why there are different ways of expressing the same 
meaning? Why did they come up with so many different ways of saying it? 

[00:07:15] Dr. KU: I can't give a definitive answer to that. I would just have to hypothesize that 
just like specific jargon is used in different professions or different regions of the country or 
world. It could mean the same thing but it's called something different. That is my best guess. 

[00:07:31] KHK: Yeah, that's probably very true. Does the age when an individual learns 
English, make a difference in whether or not they might have an accent? 

[00:07:41] Dr. KU: Well, it depends on where they are, regionally. It depends on their 
environment. Meaning who they grew up with. The people that they spoke around in the home. I 
will say that when it comes to modifying an accent, it will matter Ð like around the age of 12 or 
13 is kind of the point of no return where that is where you're going to have the most challenging 
time after that time of modifying an accent. Before that time, it's just easier to pick up different 
accents. 

[00:08:13] KHK: And can you define what is an accent? How is an accent different than a 
dialect? 

[00:08:18] Dr. KU: Okay. And this is in the handout. ASHA defines an accent as the unique way 
that groups of people who speak the same language sound. An accent is more of how you 
sound or how your speech sounds. A dialect is more of specific words or language that is used 
for a particular language or people.

[00:08:43] KHK: And can you give some examples of regional accents or national origin 
accents? 

[00:08:48] Dr. KU: Sure. Regional accents, that would be kind of what we have here in the 
United States. If you're in the south, then you may have more of a drawl and you could sound 
like this. But if you're out in California, then you may have more of ÔUpÕ speak. But again, 
regionally. It depends on where you are in California. 

Northern regions, they have more of a Ôquick talkÕ. And that's more of like a New Yorker or 
something from New Jersey. And in the Midwest, that is pretty much where the general 
American English accent comes from. And that is regional. So, out in California, the South, 
Northern regions, those are all within the United States. 

But if you look outside of the United States as a country Ð and there are different accents in 
Canada. Common characteristic of Canadians is the way that they say sorry is more closed lips. 
They say ÔsorryÕ. Sorry. In Russia, there are different characteristics. And so, when you look at it 
globally, that's where you have more of national accents. 

[00:09:56] KHK: National would be more about the country outside of the US. And regional as 
within the country of the United States of America.

[00:10:04] Dr. KU: Yes. 

[00:10:05] KHK: All right. And there was a question regarding the handout I did want to say that 
the handouts were uploaded right at the start of this podcast. For those that may not see it, they 
may want to log out and log back in. But it will be there for those listening to the recorded 
version of this podcast. 

All right. Let's talk a little bit about client-specific differences in sounds and some of the common 
patterns that cause some miscommunications or challenges in this area. 

[00:10:39] Dr. KU: I did write down a few. Excuse me for looking. There are, of course, several 
languages that we can go through. I will pick out a few. If you are working with a client who is 
from China and they speak Mandarin, then R and L, those are two sounds that can be 
confused. And so, that is going to be a sound that you'll want to target when you're in session 
with them. An example would be producing wa instead of wall. 

Another example would be for persons who are from India or speak any of the languages from 
India, the sound eh and ah can be confused or used interchangeably when I'm speaking 
English. And so, for example, ÔbetÕ and ÔbatÕ. Those could be confused. 

And we'll do two more. Spanish. The sounds ÔshÕ and ÔchÕ can be confused or used 
interchangeably. ÔChooseÕ instead of ÔshoesÕ. Or ÔshareÕ instead of ÔchairÕ. And Russian, which is 
a lot of my caseload right now. And we'll talk about that later. I call it the Russian I. 

And so, that is produced more like ÔeÕ in the American English accent. And so, that change can 
change. ÔFeetÕ from ÔfitÕ. And also, the final, the ÔyÕ vowel is a challenging sound as well. Actually, 
the ÔeÕ is a challenging sound. And so, they'll produce ÔactualleÕ instead of ÔeÕ. Those are some 
common occurrences with those different languages or patterns I should say. 

[00:12:32] KHK: It seems that the short vowel sounds are a little bit more challenging. Is that 
correct? 

[00:12:37] Dr. KU: Yes. 

[00:12:38] KHK: Okay. Got it. Interesting. Let's talk about the shua and some consonants and 
vowels that occur only in English and what kind of challenges they produce or provide for the 
folks that are trying to speak more of the general American dialect. 

[00:12:56] Dr. KU: Okay. The consonant sound that other languages tend to not have that the 
English language does have is ÔthÕ. Voiced and voiceless. That is a sound that is either 
unintentionally deleted, or lack of a better term, or substituted with something completely 
different. 

[00:13:21] KHK: All right. And how about with shua? Do you have any comments on that and 
how that presents any issues? 

[00:13:27] Dr. KU: I don't have any in my notes or that I can think of off the top of my head. 

[00:13:33] KHK: Okay. I apologize. Thank you. What are three things Ð let's kind of dig into the 
nitty-gritty of the accent modification services. What are three things needed to provide accent 
modification services? 

[00:13:46] Dr. KU: I would say excellent knowledge of speech science. It's very important to 
know the different positions of your articulators. As I'm sure everybody listening is a speech 
therapist. But for those who may not know, it's the parts of your mouth and face that help to 
make and shape sound. And so, that's how we can shape our accents. And you as clinicians, 
that's how you will be teaching your clients to make and shape those sounds that you want 
them to make when you're in session. 

Knowing the phonetic alphabet is going to be a big plus if you want to work with clients with 
accent modification. Non-English speakers. Almost all of the clients that I have worked with who 
were born in other countries, went to school in other countries, almost all of them know the 
phonetic alphabet. And so, that helps quite a bit. It's important for you to be proficient in the 
phonetic alphabet as well. Yeah, those are three things. 

[00:14:45] KHK: Very good. What are the average number of sessions that you've found that 
you need to provide before you see any improvement in your clients? 

[00:14:54] Dr. KU: Good question. That really varies. It depends on the client. It depends on 
when they learned English. How long they've been in the country if they are in America? 
Sometimes clients want accent modification services before they come to the United States as a 
way to assimilate. 

But it's hard to pound down a number to get an actual number because some people may want 
accent modification services to change how they sound at work. And if it's somebody who is 
already an English-speaking native, somebody who's from America, they may need a couple of 
months versus someone who just arrived in the country and they will need possibly a year of 
services. It really varies. 

My goal is to make sure that the client is comfortable and happy with how they sound. And this 
is something that the clients will ask too. How long until I see results? But I have to take the time 
to basically teach them how to be little mini SLPs so that they can learn the different intricacies 
of how your tongue should be positioned or what to do with your lips. And then that way, they 
learn how to self-assess and self-correct in session and out of session. Because of that, it's so 
hard to get a number. 

But I can say we'll do a range between three months in a year or more. Because after they see 
improvement, a lot of times they will want to continue. And I will say, "You sound great. How are 
you feeling?" And they may want to tweak something else or fix something else. Well, not fix. 
But just change something else. Or at least kind of do it as a maintenance kind of thing. And of 
course, with insurance not being involved, and we'll talk about that later, that makes it easier to 
do that. 

[00:16:48] KHK: I'm curious. When you said three months, are they coming an average of 
every week or every other week? Do you know? Is there a pattern? 

[00:16:55] Dr. KU: Also varying. Also varying. Okay. I'll share kind of a case study I suppose. 
There was a young lady who was in her late 20s, maybe early 30s. She was from Mississippi. 
And she moved to Texas. And she worked in a call center. And her Mississippi accent made her 
quite unintelligible to several of the people that she had to speak with on a daily basis. And she 
really just got tired of having people say, "What did you say?" Or, "Can you repeat yourself?" 
Or, "Can I speak with somebody else?" And so, she is from America, Mississippi accent. She 
was probably seen Ð I saw her twice a week for five months. And that was it. 

[00:17:44] KHK: And you work with them for 30 minutes usually, or 45, or an hour? That also 
probably varies I'm sure. 

[00:17:51] Dr. KU: Varies.

[00:17:54] KHK: No magic formula, Dr. Kelli, is there? 

[00:17:56] Dr. KU: No magic formula. No magic formula. The shortest length in session that I 
will do is 30 minutes. And then I added a 45-minute option just for those who feel like 30 
minutes isn't enough but they don't need an hour. And then I also offer an hour.

[00:18:11] KHK: All right. Sounds good. Sounds like it's not a one size fits all. It makes perfect 
sense. 

Let's talk a little bit about the different components of accent modification. If you could kind of 
highlight what are the different areas that you work on? 

[00:18:27] Dr. KU: You mean like the different levels? Like how it progresses? 

[00:18:30] KHK: Yeah. What are you working on specifically where Ð is it just the consonants? 
Or do you also work on other things? 

[00:18:39] Dr. KU: I work on everything with them. If you think about artic, like doing artic 
therapy with kiddos or adults, you start with a sound. During the evaluation, I will listen to the 
clients and I will document what it is that I'm hearing. I'll document any patterns that I'm noticing 
that align with their native language along with any other characteristics that they may have 
picked up. 

A lot of my clients speak multiple languages. Have lived in multiple countries. A lot of them are 
businessmen and women that means that they can pick up accents and characteristics of other 
languages. And so, that's an extra joy and an extra challenge for me as a clinician. 

But I will document what the patterns that I'm noticing and then I will start teaching them about 
the articulators. And then I will also teach them about the different levels of speech. I'm saying 
we'll start with the sound level. Then we'll go phrase level. And so on and so forth. And I share, 
the difference in all of those is your rate of speech. 

And so, that is to encourage them to be patient with themselves. Because if we're starting at 
word and phrase level and they sound really good, when they go back into a meeting for work, 
they have their accents that is not the American accent that they're working towards. And that 
can be frustrating for some. 

But I do explain the different levels to them. And so, it will depend on the sound. For example, 
with my Russian clients, I mentioned earlier the I sound. Them producing e for that short I and 
the American accent, it takes time. And so, we do repetition and muscle memory exercises to 
just keep producing it. 

I will go through the different levels. We'll do it in the initial position, medial, final. And it's so 
intricate. And each one is so different. And it could be a consonant. It could be vowels. It's really 
what they're presenting to me and how I tailor the sessions for them. 

[00:20:48] KHK: Sounds really good. Do you need to be a speech-language pathologist to 
provide accent modification services? And what other professionals might work on this area? 

[00:20:59] Dr. KU: You do not have to be a licensed speech-language pathologist to be an 
accent modification coach, or teacher, or therapist, or Ð well, I suppose, therapist. But however, 
you'd like to label it, you don't have to be a speech therapist to do it. It is just easier for speech 
therapists to do it because we have so much background and knowledge of the intricacies of 
speech and how our articulators work. And so, that we can teach people where to move their 
tongue. Or if you need to get a particular sound out of them, how to kind of change the word but 
keep the sound the same. And we have those skills. And it's easier for us to do it. 

But other professionals who can provide accent modification services include speech coaches. 
Or you may see accent coaching or persons who work with. And it can be a speech therapist. 
But people who work with voice for acting or singing. 

[00:22:04] KHK: Like a dialect coach? I think I've heard this too. Yeah. Okay. Now what if you 
have a client who might have an articulation disorder in addition to an accent? And is that even 
possible? 

[00:22:17] Dr. KU: That is possible. I have a client who is from Russia. He moved here four 
months ago, five months ago. And he always had a challenging time with his r's. It just so 
happens that, with the Russian accent, they traditionally have a challenging time with r's 
anyway. 

While I am working on his accent, I simultaneously will help with the production of the r so that 
the accent is transitioning how he would like it to or being modified how he would like it to be 
modified. 

[00:22:58] KHK: I'm wondering if he has a harder time because of his articulation disorder. 

[00:23:03] Dr. KU: Yes. Thank you. I would say that because of his language, and it being his 
native language being Russia, he would have had to have had the challenges with r anyway. 
And because in the Russian language, the r's, when they are speaking English with their 
Russian accent, the r's are derhoticized anyway. He would have needed strengthening anyway. 
The carryover from artic, it would not be considered articulation therapy because the overall 
goal is targeting the accent.

[00:23:35] KHK: Interesting. A lot of shades of gray, I'm hearing. 

[00:23:38] Dr. KU: Yes. Lots of shades of gray. 

[00:23:40] KHK: Yeah, definitely. Definitely. All right. I do agree with what you said. I think it 
would be best if everyone checks the licensure rules for states and also other countries. And 
just make sure that if you are working on a lot of areas that cross into communication disorders, 
that you are licensed appropriately. 

[00:24:01] Dr. KU: And with the pandemic and everything, make sure that you're checking 
updates as well.

[00:24:06] KHK: Definitely. All right. We've got articulation therapy. I mean, speaking of which, 
it seems to be so similar and mimics accent modification. How is it similar or different than 
accent modification? How do you compare and contrast those two and kind of separate them 
out? 

[00:24:27] Dr. KU: In my opinion, they are very, very similar. And I am hoping that that gives 
confidence and that other clinicians that are listening will take the skills of articulation and apply 
them to accent modification. A lot of what we do in our accent modification sessions are the 
same things that you'll do when you're working with an artic client. 

I will say that the differences come when you're not just working on one specific sound and you 
have to apply that to their language. And so, functional phrases are used. And we'll talk more 
about that later. But there is gray area but very much similar to articulation.

[00:25:12] KHK: Very good. All right. What are some reasons why an individual would want to 
seek out accent modification? What brings them to you for your services?

[00:25:22] Dr. KU: Assimilation is a huge reason and professional purposes. I have clients that 
do public speaking. And for the same reason as the young lady I spoke about from Mississippi, 
they don't want to be asked over and over again. What did you say? They're supposed to be 
having an impactful moment or really connecting with the audience. That can be challenging if 
the audience is thinking Ôwhat are they saying?Õ. 

Professional purposes is a big reason. Persons who teach therapists. People who are 
consultants. A lot of professionals are people who have to talk for a living. 

[00:26:05] KHK: All right. Let's see. What are some examples of professionals that might seek 
out accent modifications? 

[00:26:13] Dr. KU: Teachers or professors, consultants, attorneys, politicians. Politicians have 
to speak a lot. Actors. And so, that was where the dialect coach comes in. Religious 
professionals. Pastors, rabbis. Anyone who has to speak to a congregation. Anyone who gives 
presentations professionally. Even people who are in small companies who have to speak to 
staff that work for them or people who are employed in small companies and have a lot of 
responsibility that include speaking to people. It could be a receptionist who has to help make 
appointments and greet people who are coming in. And accent modification maybe something 
that they're looking for. 

[00:27:02] KHK: All right. It sounds like there's a lot of people that probably can benefit from 
this. I'm going to actually take a question from the listeners at this time. What assessment do 
you use, or screening tool, or evaluation tools you use? 

[00:27:18] Dr. KU: I use the Compton P-ESL. They have Ð when you take the class, they will 
provide you with materials. But as you get more seasoned in it Ð I really just started using the 
screen, and that is a list of words that you will have the client to repeat. I will place it on the 
screen so that my client can read it versus hearing me say it. Because then they kind of have a 
model, and it can modify how they're saying it or trying to say it. After they read that, I make my 
notes, and I document where I'm seeing a pattern. And then, I develop the plan of care for them. 

There also have been times where I will kind of just elicit conversational speech, and I can also 
determine patterns that way. And the client feels like we're just chatting and I'm getting to know 
them. But I'm actually working and assessing how their speech is. That was a really vision. 

[00:28:11] KHK: Let's talk a little bit about treatment. And I'm curious if you can tell us the top 
three things clients can do today or tomorrow to improve their speech? What are some things 
that you tell Ð strategies or tips that you could give our listeners about that? 

[00:28:30] Dr. KU: Functional phrases are your friend. I use functional phrases to get the clients 
to write out at least 10 Ñ itÕs like pulling teeth sometimes Ñ but 10 phrases or sentences that 
they know they're going to say every day. If it's, "Honey, I made dinner,Ó or, "can you grab the 
mail?" or, "Hey, guys, let's go ahead and get started,Ó or, "Thank you for attending this 
meeting.Ó. Any of those phrases that people know they're going to say either in their 
professional or personal settings, I have them write those down. 

And once we get out of the early sessions, early, early sessions, maybe like the first two or 
three sessions, we're really working on our articulators and knowing what those are going. 
Through the vowels and kind of building out to where the more challenging work will be. But it 
gives them an idea of how intricate everything is. And then they're kind of like, this could take a 
little while once they see how much goes into it. 

But the functional phrases are helpful because they can use those for practice. And you have 
additional muscle memory and carryover. And they can use it when they're practicing over and 
over again when they are in that moment and they're like, "Oh, I need to ask if my significant 
other will get the mail." Then they can go and practice it. They can also practice it through video 
recording, which is part of their homework, which we can talk about later.

Changing for work and not home. An important tip is going to be finding out where they want 
their accent modification to be. In what setting? Because sometimes I'm essentially teaching 
code-switching to clients because they only really want to assimilate and sound like they have 
an American English accent when they're at work. But then when they're at home, they're 
speaking with their loved ones or their friends and they're hanging out, and they don't really 
need to assimilate. Finding out where they would like to speak in their new accent is important. 

And then the third thing is giving one specific sound for them to work on and just helping them to 
develop that muscle memory. it could be building it from the initial sounds. I like to start with the 
initial sound. And then just repeating it at word level. Single syllable at first so that they can build 
confidence. And then go to the medial position in the final position. And that essentially helps to 
build a strong foundation for them to use those skills and those sounds when it's longer and 
more challenging speech productions. 

[00:31:08] KHK: What I really like about the functional phrases, you could probably focus on 
different aspects each week, right? They may not necessarily get it all right the first, or second, 
or third time. But over time, as you're saying, you're building that muscle memory and you're 
bringing awareness to all those different things or different aspects of the word. I really like that. 

There is a really applicable question right now. How do you prioritize which sounds you target 
first? Any research on complexity theory with accent modification? Interesting question.

[00:31:40] Dr. KU: Interesting question. Good question. It's a mix. Sometimes I will initially 
target what I know is going to be most challenging and what's going to take the longest. And 
then I will also ask the client if they have a particular sound. Or like once they learn, then I start 
to mold them into little mini SLPs. 

I will ask them, "Is there a particular sound that you're interested in working on? Or do you have 
any questions about any word, sentence, phrase, what have you, that you've heard or that 
you've been saying or repeatedly asking you, "What are you saying?" It's a mix between what 
I'm noticing and assessing and what they are experiencing. 

Because again, I want them to be comfortable. And so, if they're constantly being asked by their 
boss or someone on their team, "What is it that you're saying?" If I can help them in a session to 
improve that, then it's a win. 

[00:32:38] KHK: I love it. I love it. And do you use auditory discrimination or auditory skills at all 
when you're working on accent modification? 

[00:32:47] Dr. KU: I do use auditory discrimination. Again, this varies and kind of depends. 
Some clients have a very difficult time with hearing themselves. And so, when I was in grad 
school, they would turn off all the lights and have us either close our eyes or just be in complete 
darkness. But they would play sounds that sounded identical. And we had to decipher which 
sound it was. 

With that kind of training, I have a very sharp ear. But clients are not going to have that same 
kind of training. And so, if they have a difficult time, I will isolate the sound but I will have them 
do the same thing. I'll say close your eyes. And then I will ask them, "Can you hear a 
difference?" Shockingly, sometimes they cannot. But depending upon the word and the sound, 
they get it. Yes, I do use those.

[00:33:38] KHK: Excellent. What are some specific Ð I believe you've kind of mentioned this. If 
you want to kind of summarize once again. Any other specific exercises that you might have 
missed initially that you use? 

[00:33:51] Dr. KU: I definitely build on what they've done. If it's the sound level, then we're 
going to repeat that sound. And that can be very boring. But I will include Ð when we get to the 
reading level, then I will ask them to provide something that's jargony, if that's a word, for them. 

It could be something from their profession. Of course, all things that are safe and appropriate 
that they can share and read to someone who is not in their profession. I have them self-record. 
And that's an exercise that helps them with self-assessing and self-correcting. Because the goal 
is for them to not need me forever for them to graduate and have these skills that they can use 
independently. 

Self-recording on video is huge. I will also offer an option to record the entire session. And that 
way, they can go back and see my lips and see all the things that I'm doing. 

There are times when I'll lean in very close to the camera and shine a light in my mouth so they 
can see what my tongue is doing. They'll have that to go back and reference. It's also a great 
option for when they progress and they're doing great. And then they go back and listen to or 
watch themselves on the video and they can see like, "Oh, my goodness. I can't believe this 
was me at the beginning." But it also shows their progress. Those are always fun moments. But 
those are good exercises. 

[00:35:13] KHK: Can they differentiate or hear differences between how you say it and how 
they're saying it once they start doing that? 

[00:35:22] Dr. KU: Yes. Yes, they can. 

[00:35:23] KHK: That's exciting. Yeah, that was actually one of the questions that our listeners 
were asking as well regarding recording. Thank you for sharing. You did mention, I know. This is 
so much like articulation, the drills. And we've all done this. And it does get you know a little bit 
mundane after a while. I'm curious if you have any tips for how you keep it engaging and 
interesting? And we all know that that helps the dynamic of learning too, right? If they're really 
like interested in it and focused on it.

[00:35:51] Dr. KU: Funny enough, pictures. My clients seem to really enjoy when I bring out a 
picture activity. I will have them look at something. And it could be like a problem-solving picture 
from one of my [inaudible 00:36:04] clients who's needing problem-solving assistance. 

And I may show them the picture and I'll say, "Can you tell me what you see in this picture using 
your best American accent?" And they'll start describing it. And then it kind of becomes a 
conversation. And I'll say, "Well, can you tell me what's wrong with it? Or what would you do in 
this situation?" And those kinds of activities can kind of spiral into sort of a conversational 
exercise. And I like to use those for when we get to conversational level. 

And let's see. Pictures are always fun. Videos can be fun. If you either send them a video ahead 
of time. Or if you show it when you share your screen. And you can talk about it. 

I also really like to talk about their culture and their country because a lot of times it's very 
different from what I experience here in America. And so, you get to kind of expand. And then 
they have fun because they're teaching you. And sometimes I'll have them teach me a word in 
their language. That's fun interaction for them. Because it's about connection in your client and 
wanting them to be happy and feeling welcome. I really like talking about their culture. Pictures 
are good. Videos. And then I mentioned before, having them read things that are specific to 
their profession. 

[00:37:26] KHK: Love it. Let's talk a little bit about accent modification specifically provided 
through tele practice. What are some of the key components or things that we need to have in 
order to provide good quality services through telepractice for accent modification? 

[00:37:44] Dr. KU: Strong Wi-Fi. Strong Wi-Fi. I recommend this to Ð anytime that I do a talk, 
you want to get a Wi-Fi mesh. And what that is essentially a force field around you, and your 
router and your Wi-Fi signal. And that basically makes it ironclad. And that kind of covers your 
behind as a clinician. Because if a connection is a little shaky, or the call keeps dropping, or you 
get that signal mishap, you know that it's not you. And that way you can help the client figure out 
what is happening on their end and hopefully things work out. But the Wi-Fi mesh is very 
important. 

Making sure that you have a HIPAA-compliant platform. And ring lights. You definitely want to 
make sure you have a good-quality ring light. I have two. I'm sure you can see this here. I like 
the ones that can change colors. You've got the daylight setting. You have amber setting. 
There's one that's like a mix of the two. But you can find those on Amazon. Check the reviews. 
That's how I select them. And if you choose to reach out or ask a question, I'm happy to send 
the ring lights that I have. They're great quality and they last. 

And then the last thing I would say is to make sure that you have a high-quality microphone. 
Because you really want to make sure that you are heard especially when you're working on 
different sounds that sound similar. You want to make sure that they can hear you. 

Some speech therapists like to use a microphone and headset combination. That works too. It's 
really just personal preference. And, of course, if there are hearing complications for the 
clinician, then other things should be taken into consideration. But those are my top 
recommendations.

[00:39:42] KHK: I don't know if you have any tips regarding settings in the platform that people 
might be using anything to be aware of so that audio comes across accurately.

[00:39:53] Dr. KU: I would check the platform that you're using. Each platform should have a 
way to do like a mic check and for you to be able to hear. They may play like a tone or 
something so you can hear what the sound is going to be like. And then you'll be able to see 
visually how your microphone is doing. If it's too hot, it's very loud, you'll see it's stretching the 
sound signals, stretching all the way to the end. And that can be uncomfortable. 

And also consider that your clients very well may have headphones in their ear. You may not 
want to squeal for joy when they are successful with the sound, which I have done and 
apologize for. 

[00:40:39] KHK: Oh, my. I am curious. I guess that kind of segues into the next question. If 
you've done accent modification in person, do you have Ð or if you haven't, maybe you can 
share what are some things that are markedly different from doing it online versus doing it in 
person? And that might be actually one of the examples that you just shared.

[00:41:00] Dr. KU: Yes. Count that as one of my examples. I actually have not provided accent 
modification services in-person. My practice is completely telepractice. Outside of me going into 
the office for SpeechEasy evaluations. 

But I would Ð from working with clients in-person, the difference would essentially be just the 
connection. You can't pass a tissue if someone has a rough day, that sort of a thing. But there 
are studies and research that have proven that telepractice versus in-person yield the same 
results.

[00:41:38] KHK: And I'm also curious if you've done accent modification groups. I've heard of 
some programs that incorporate groups as well as individual sessions. Could you kind of 
comment on those setups? Have you done any like that? I haven't done any group. I did learn 
about it. I am trained to provide group accent modification services. 

I choose not to just because of how detailed and intricate each different languages, accent, 
dialect. One, it could be somebody from the same country who speaks the same language. But 
one has you know a difficult time with producing r's and they just have the tongue strength that 
needs to be built up. Well, they're going to be working on all different things. And I just prefer to 
give that one-on-one time for the client and not have to be concerned about dividing my time. 

[00:42:33] KHK: All right. And how do you provide feedback to the clients to approximate 
productions? How do you do that online? Just curious. 

[00:42:42] Dr. KU: In session? 

[00:42:42] KHK: Yes. 

[00:42:44] Dr. KU: I develop a list of target words. When I'm speaking with them and asking 
how's their day? What did they do this weekend? And all of that. Again, they feel like they're 
shooting the breeze. But I am analyzing and I'm making notes. 

Depending upon the client, I will look down and make the notes. Some clients are very much 
like, "What are you writing? What did I say?" And so, sometimes you have to write while you're 
still looking at them so that they don't get distracted. 

But I will write a list of target words and then I will um kind of segue into Ð because, of course, 
they feel like we're just talking. I will segue into, "Well, let's go ahead and take a look at this list." 
I've got a list of words. And then I will go through each one. I will say the word for them with the 
American accent depending upon if they've heard it several times and they know how to fix it. If 
they don't and they haven't heard it enough, then I will model how they sounded with their 
accent so that they can hear that difference. There's the auditory piece. 

And I'll go through each one. If we're doing a reading exercise, then I will have them re-read 
what they just read and see how many of those words can get produced with the American 
accent. And then lots of verbal praise initially to help build confidence. I will also make a second 
list of all of the successful productions. 

Once they get into it and they're feeling more confident, they don't really need the successful 
production list. But that is one of the ways. And then the video recording is another way.

[00:44:28] KHK: All right. And is there anything else that may not be related to technology that 
you would suggest to conduct accent modification services? Anything at all? 

[00:44:39] Dr. KU: Only what's up here! Yeah, paying attention to the different cultural Ð I don't 
want to say rules. But just paying attention to different cultures. If you do choose to provide 
accent modification services in person, then you would want to know Ð if you're a female who's 
providing services, you may want to know that in some cultures you are not to touch the hand of 
a male of that culture or a particular hand to touch or avoid. Ways to greet people. Topics to 
avoid. What's appropriate? What's not appropriate? And just making sure that you are 
knowledgeable about the different cultures so that everybody is comfortable and nobody walks 
away feeling negative in any way. 

[00:45:27] KHK: Definitely. And what are some resources for homework that you provide for 
your clients? Is that something that we might be able to find in your handout? 

[00:45:36] Dr. KU: Yes. In my handout, I have this book. This is a great resource if you're 
interested in getting into accent modification. This will tell you Ð you'll get more examples of the 
different sounds that are commonly a challenge for different languages. They'll talk about 
different rules. And it really will just help Ð especially if you are just getting into accent 
modification, it can kind of serve as a guide.

[00:46:06] KHK: And would you mind reading the title and the author of the book for those 
listening to the recording? 

[00:46:11] Dr. KU: It's called Mastering the American Accent. And it is by Lisa Mojsin. Lisa, and 
it's spelled M-O-J-S-I-N. 

[00:46:26] KHK: Oh, thank you so much. 

[00:46:29] Dr. KU: Yes. The second edition. You can find that definitely on Amazon.

[00:46:32] KHK: Wonderful. Thank you for that. We're going to switch gears now. And I know 
that our audience has anxiously been waiting for some answers to the following questions. I 
think this is the big question they've been anxious to hear about. How do you find accent 
modification clients? 

[00:46:52] Dr. KU: Yes. Excellent question. You can find clients definitely through the corporate 
route. I would recommend contacting HR, HR departments. They'll be able to connect you to the 
appropriate departments. If it's not HR, they'll be able to put you in the right direction. That is 
one. Searching for companies that do a lot of international business. Companies that do a lot of 
consulting. And a lot of consulting can be international. 

And then word of mouth is a huge piece of that. And it's kind of like once you get into it, they're 
going to speak with someone and they're going to say, "How did you change your accent? How 
did you sound like that?" And then they're going to say, "Oh, I work with this speech therapist." 
And they'll share your information. 

Also, you can tell your clients, "Please spread the word if you know of anybody else." Family 
members. I've worked with a lot of married couples. And that's great because then they can 
practice together. And that's homework. 

Let's see. Google is great. Depending upon if you own a private practice or not, you can have a 
company to kind of boost your name so that you can appear at the top of Google searches. And 
then you will be the one that comes up when someone in your area is searching for accent 
services. 

Also, know that clients typically are not going to be using the term accent modification because 
they don't know it. Perhaps accent in an estate that you are in or that you're licensed in. 

And let's see. They said Google. I actually asked some of my clients how they started searching 
for accent modification services. And so, some of these are their gems. But this one is mine. 
Toastmasters. Toastmasters is a great option as well. 

[00:48:53] KHK: Wonderful. I love the tips that you're giving on the Google searches. Basically 
they would put in the word accent and then the state that they were located in to find you. Okay. 
Interesting. 

[00:49:06] KHK: Or accent coach. Coaching is a big word. Coaching, that of course says to me 
not speech therapy. But because you are a speech therapist and you can provide accent 
modification services, you can market yourself as a coach if you would like to.

[00:49:24] KHK: Definitely. Definitely. And how did you make initial connections with these 
individuals yourself personally? Was it through a corporation, or Toastmasters, or anything 
else? 

[00:49:35] Dr. KU: No. The first one I had was someone who found me actually. And then that 
person ended up being a word-of-mouth person for myself.

[00:49:45] KHK: All right. Very good. There's an interesting question that just came through I'd 
like to highlight. Somebody is asking what are some things to not do when you're providing 
accent modification services? I guess what would you want to avoid? 

[00:50:00] Dr. KU: You want to avoid topics Ð this is culturally. You want to avoid topics that 
could be offensive. If you're not sure Ð and when you start developing these working 
relationships with your clients, it's very easy to feel like friends. And they may have thoughts 
and views that you don't agree with. But you don't want to say something and then accidentally 
offend somebody. That is a huge one. 

And with the accents, you are working with a range of people from different cultures, and 
different countries, different languages. You don't know who they know. And so, that is a huge 
one culturally.

As far as the actual service, I would say you don't want to be too negative. You do want to have 
an aspect of it where you're building their confidence. You don't want to just keep saying like, 
"No, you're not doing it right. You're not doing it right. You're not doing it right." 

A lot of modeling is good. You don't want to only describe. You don't want to give I guess 2D or 
surface examples. A lot of times the clients enjoy when you're sharing how they sounded. I'm 
not saying practice your accents. But see how you do with manipulating your articulators to see 
if you can get yourself to sound how they sound. 

A lot of times when I'm in session, I may close my eyes because that's kind of like simulating 
this from grad school, where they turn the lights off. But that just isolates another sense, so I'm 
not taking in more stimuli. But I may repeat exactly what it is that they said so that I can feel 
what they're doing. So I can tell them what not to do. 

But as far as what not to do in that regard, don't be too negative towards them. Don't beat them 
up. Because a lot of times, they're going to be beating themselves up because they're going to 
be thinking, "I've been doing this for months, and I'm like right here at this level. And I just can't 
get this word, or this sound, or whatever it may be." They're going to be harder on themselves 
than you are. That's what I would say not to do.

[00:52:11] KHK: Definitely. And I think that multicultural sensitivity is going to be huge because 
that could cross over into all the activities you do, and the homework and everything. I think that 
was a very good tip that you gave. 

Somebody's asking if they should invest in malpractice insurance if they're working with accent 
modification. Do you know much about that? I know you do more than that in your practice. 

[00:52:35] Dr. KU: I would say yes. I would say you want malpractice insurance regardless of 
which area you are specializing in. With accent modification, just like if someone were to stutter, 
you wouldn't want anyone coming back and saying like, "Oh, you made me sound worse," or 
say something like. That you've got malpractice insurance that can help with that. 

But I would check if malpractice insurance covers that. You're still working with someone on a 
specific goal. But because it's not a treatment, I don't know if that would be malpractice. That's a 
good question. That's something to look into. 

[00:53:19] KHK: Yeah, definitely. And I know if you have your own business, there's separate 
rules around that too for protecting your business. And those also vary by state. Our state 
licensure, very complex. 

[00:53:31] Dr. KU: All clinicians should have malpractice insurance is my belief even if you 
work for a company. Their insurance is to protect them. Maybe some of the people that work for 
them. But having your own is the best bet. And if you are paying for it as an independent 
person, not as someone who owns a practice, I think it's like maybe $49. Maybe $54 or 
something like that for the year.

[00:53:55] KHK: That's not too bad at all. Speaking of charges, we didn't get to talk about 
reimbursement. Does insurance reimburse for these services? And if not, how do you do your 
payment plans and all of that? 

[00:54:07] Dr. KU: Insurance will not cover accent modification because an accent is not a 
disorder or something to treat. And so, there can't be like a doctor's order for it or anything like 
that. And so, insurance won't cover it because it's not something to heal or treat. 

That means out-of-pocket cost is where you will be receiving your money. The clients will pay 
you directly. You set your price. I say know your worth. Check your competition if you will. 
Check dialect coaches that are in your area or other SLPs that are providing services. And take 
into account your experience, your degrees, and set a price, and go from there. 

But you can also do a payment plan and do packages. You could have 10 sessions for a lump 
sum and then have them pay it that way. It really just depends on what's going to work best for 
your business model and how you intake your payments. 

[00:55:11] KHK: All right. Thank you. I did want to kind of go back and talk about some 
common words or word pairs that you have noticed through different languages that might be 
difficult to understand. Is there anything in particular that you do notice that folks with accents 
have difficulty and that you work on? 

[00:55:33] Dr. KU: With my experience specifically, I'll speak a lot about Russian right now. 
Quickly for the listeners, because of the war in Russia, or the war between Russia and Ukraine, 
a lot of American companies offered their Russian and Ukrainian clients who were working in 
those business offices there, they offered them the option of bringing them and their family 
safely to America. 

And because of that, a lot of them wanted to assimilate. And so, they understand that there is a 
stigma with media in America. If you think about the movies that are shown, a lot of it is about 
being a spy or something negative. And so, they don't want to appear similar to what Americans 
associate with Russians. A lot of them wanted to have their accents modified. And through that, 
my caseload for our client for Russia increased quite a bit. 

I will speak to what I have noticed with my Russian clients. I did mention the I. That feet to fit, 
exactly. There's that e again instead of ÔexactleÕ. Exactly. V and W seem to get confused. If they 
say over, they won't Ð their lips won't relax enough or be open enough. They will tuck their 
bottom lip over their bottom teeth. And then that muffles the sound. And they're already in that 
V. They just haven't made the connection. Instead of over, it sounds like over. And listeners, 
you can kind of do what I described. You're tucking your lip over your bottom teeth. Over. And 
so, you have to teach them about opening up their mouths. I call it the big American mouth. 

Something that I did notice sound-wise is that almost every other language or dialect speaks 
with a very still position of their mandible. And so, that means that sounds are coming out 
through a very narrow passageway. And so, that changes. 

With American accents, our mouths are open. We're loud. We talk. And we've got our vowels 
that are shaped beautifully and robustly. But in other languages, the jaw doesn't move as much. 
And so, to get them to open up their mouths to produce a word. Instead of possibly, someone 
from Russia or another Eastern European country is likely going to say possibly. Possibly. 
Possibly. And a challenge is getting the mandible to drop and to open wide enough so that the 
sounds can be produced with the accent that they want. 

And sometimes their muscles, the mandible muscles, are so tight from being in position all of 
their lives that their actual muscle exercises that I'll encourage them to do just to help them 
open up. Definitely, the open-mouth position is huge for sound. We talked about V, W. I'm trying 
to think of another really good one. 

[00:59:03] KHK: Also, one of the things I've noticed is certain numbers. If you're, for example, 
exchanging money at the grocery store or there's a question about time, there are certain words 
that kind of get confusing. 

[00:59:18] Dr. KU: Yes. I actually had one this week, and it was fifty and fifteen. At the end of 
fifty, if they don't produce the e, and it's ÔehÕ, ÔfifteÕ. And Russians have a tendency to voice after 
the word is completed. And so, if you're saying five zero with a relaxed Y vowel at the end, then 
it can sound like you're almost saying fifteen. So, ÔfifteÕ. And that can sound like fifteen 
especially if your communication partner isn't listening that well. 

And fifteen, if they say it that way, if they don't make a strong connection with their tongues, 
their hard palate for that strong n sound at the end, fifteen can sound like fifty. Same thing with 
outside of numbers, church, and George. Those two can sound very similar because Russians 
have a pattern where their tongue kind of rolls when they're saying that particular sound. 
George. Instead of church, where your tongue is pretty still and stiff almost, theirs is relaxed and 
in a flow. George. But they're actually saying church. 

[01:00:40] KHK: Right. Thank you again. We truly appreciate your research, education, and 
expertise you provided about accent modification through telepractice. 

As a reminder, if your state license requires CEUs, be sure to complete all course modules, 
including the one that says quiz, before the end of today on your speechtherapypd.com 
account. 

Please be sure to join us for our next episode in this series, episode 5: Empowering Parents Via 
Teletherapy Early Intervention to School-Age Children. Have a great evening. 

[OUTRO]

[01:01:14] ANNOUNCER: Thank you for joining us for tonight's course. To complete the 
course, you must log into your account and complete the quiz and the survey. If you have 
indicated that you're part of the ASHA registry and entered both your ASHA number and a 
complete mailing address in your account profile prior to the course completion, we will submit 
earn CEUs to ASHA. Please allow one to two months from the completion date for your CEUs 
to be reflected on your ASHA transcript. Please note that if this information is missing, we 
cannot submit to ASHA on your behalf. 

Thanks again for joining us. We hope to see you next time. 

Thanks for joining us at SLP Learning Series. Remember to go to speechtherapypd.com to 
learn more about earning ASHA CEUs. We appreciate your positive reviews and support and 
would love for you to write a quick review and subscribe. If you'd like this and want to hear 
more, we are offering an audio course subscription special coupon code to listeners of this 
podcast. Type the word SLP LEARN for $20 off. With hundreds of audio courses on demand 
and new courses released weekly, it's only $59 per year with the code. Visit 
speechtherapypd.com and start earning ASHA CEUs today. 

[END]
SLPL S7E4		Transcript
	© 2023 SLP Learning Series	1