The Bolivia Project
Bolivia 2008
The Bolivia Project
Bolivia 2008
Catherine (Cate) Crowley, Director
Miriam Baigorri, Clinical Director and Clinical Supervisor
Elizabeth Ijalba, Bilingual Literacy Research Specialist and Clinical Supervisor
Lorena Diaz, Schools Specialist and Clinical Supervisor
Overview
- For 3 ½ weeks (May 28 to June 20, 2008) eighteen
students in the graduate program of speech language pathology at
Teachers College offered free speech, language, and
dysphagia services to children in Bolivia.
The Teachers College students worked in three different sites and were
supervised by three ASHA-certified native Spanish speaking clinical
supervisors, and the project director.
- At least 5 television programs and many radio broadcasts and
newspapers carried information about the services offered by the
Teachers College SLP Bolivian Project.
The
Chief Cabinet Minister of Evo Morales, the President of Bolivia, sent a
letter to Cate Crowley acknowledging the work of the TC SLP students in
Bolivia.
- Each
student accumulated an average of 54 clinically supervised hours that
will go to meet their ASHA certification requirements.
-
Together the students provided a total of
over 920 hours of free speech and language services to Bolivian
children with disabilities and their families.
-
Students
gave 11 different talks on a variety of topics related to children with
disabilities at the national hospital for children and a school for the
deaf in La Paz,
and a school for children with developmental disabilities in El Alto.
These charlas were attended by approximately 335 teachers,
parents, medical professionals, and administrators.
-
Clinical supervisors gave direct
supervision at all three sites and provided daily feedback to the
TC student about how to improve their work. They met as a group at
least once a week.
-
Ten students--the non-native
Spanish speakers--arrived early for 5 days of intensive Spanish classes
for 4 hours a day in groups of 2 or 3.
-
Two times a week all met for a
seminar on Bolivian language, cultures, politics, and educational
systems. Articles came from a variety of fields including anthropology,
U.S. congressional reports, comparative education, educational
anthropology, linguistics, and sociolinguistics. The readings and
discussions gave students insights into Bolivia that enhanced the
quality of services they provided.
-
On weekends students traveled throughout Bolivia to learn more about the country and its people.
The Media Blitz about our Campaña
Our work in Bolivia
this year was marked by a great deal of media coverage. Dr. Christian
Fuentes, Director of the Hospital del Niño, and Catherine
Crowley appeared on several television programs. In addition, the media
department of the Hospital del Niño arranged for publicity on a
number of radio stations and in the newspapers. 
This
coverage was picked up and disseminated throughout the country. In
response to this media coverage parents brought their children from all
over Bolivia to receive the free speech, language, and feeding services we offered.
Virtually all of these people brought their children to the
Hospital del Niño where the students and supervisors worked
diligently to meet the demand. Lorena Diaz was our clinical supervisor
in the morning at the hospital along with six students. In the
afternoons usually two of the supervisors went with a group of six to
eight students.
Every child was evaluated first through a parent
interview
and then through clinical diagnostic methodology. During that very
first first session, the students would begin with parent training on
what the parents could do to stimulate language and communication in
the homes. Virtually all children were scheduled for several additional
therapy sessions where the families could learn more strategies
and techniques.
Most of the children who came to the hospital for services had
never seen a speech language pathologist (or fonoaudiologist) before.
Many of the children came from very long distances. Some flew in from Santa Cruz, Sucre,
and the jungle regions. Others came on 18 to 30 hour bus rides just to
have the opportunity of receiving the services of a speech language
pathologist.
One set of grandparents flew from Santa Cruz
with their 8 year old grandson who had all the marks of a child with
severe autism, but who had never received any services and had no
diagnosis. The grandparents, in fact, had never heard of autism before.
Our students began developing a communication system and a behavior
modification system for this non-verbal, somewhat aggressive boy. The
grandparents came to the charla on autism and then came to every charla
that the students gave for the week they were in La Paz so they could learn as much as possible for when they returned to Santa Cruz.
Another 4 year old girl was also nonverbal but only because she had moderate to severe cerebral
palsy.
She understood everything and her mother knew this and was searching
for some help for her daughter. The students developed an expandable
communication board for this girl that she began using almost
immediately. For the first time in her life, she told her mother what
she wanted by using the communication board.
For some children, their language delays improved quickly and
remarkably with parent education on how to stimulate language. Some
parents learned by watching our students use communication temptations
to draw the children into a communicative mode. One mother was in tears
as her son uttered his first words during a therapy session with our
students.
A
number of other parents brought 3 and 4 year olds whose speech was
unclear. Our students used developmental guidelines to advise the
parents on whether their child’s speech was delayed or acceptable for
the child’s chronological age. Many of these parents simply did not
have the information to know what normal development sounded like. A
number of these parents were in tears when they learned that their
children were doing fine and were likely to develop normal speech just
in the process of growing older.
These and many, many other stories allowed our students to
understand the value of their work as speech language pathologists. It
was moving to watch our Teachers College students work with their first
“clients” and make such extraordinary contributions to the lives of the
children and parents they touched.
Sustainability
One
of the most important goals of the Bolivia Project is that our work
continue after we leave. Over this past year we were able to stay in
contact with all of our sites through the internet. In this way,
we identified what particular topics the placement sites wanted for the
student talks and learned of any significant changes in the sites.
The internet also facilitated a closer relationship with the people who
work in the sites so when we we arrived in May 2008 we
were prepared to get to work.
Sustainability through parent education and training
Parents were always included in the speech and language sessions. At first parents watched while
the
TC students modeled what they were expected to do. The TC students
talked to the parents about what they were doing and seeing. As soon as
possible the parents were encouraged to take the lead in the therapy
sessions, with the TC student providing
support and shaping the parents' skills.
Most of these parents also attended the charlas (see below) where
the TC students provided information on how to facilitate communication
for a particular disability.
Sustainability of individual therapies
Our work was focused on training parents, teachers, medical professionals, and administrators on how
to
continue
on with the work when we returned to New York. We wanted to establish a
level of understanding on what we were doing; what our goals were for
individual clients; and what methodologies would be most effective in
meeting the needs of the children.
Students spent many late nights in the hotel creating therapy
materials for the children. Parents attended therapy sessions and the
TC students modeled how to use the materials effectively. They also
showed parents how to create, expand and adapt the materials as the
children's communication skills improved.
Many parents were given packets of materials to use when we left.
One example is the shown at left. where Linden created all these
materials for the boy she worked most closely with in Bolivia. The
materials are designed to be used at home and in his classroom.
One 15-year-old boy with cerebral palsy at CEREFE had taught
himself to read but could not communicate verbally in a way that could
be understood. Natalia, at right, took him as her client and
created his first communication book. Most of the entries were written
words. She took him out with his classroom teacher, and he used his
communication book to order lunch. The TC student and his teacher
collaborated on this book. In doing so the teacher developed her
own skills so that she can support him in expanding his
communication capacity.
Sustainability in the classrooms
At both school placements--Camino de Sordos and CEREFE--the TC
students spent about half their time in the classrooms. There they
worked with the teachers to incorporate language-based activities that
would stimulate language development
for the children in the class.
At CEREFE the TC students selected on one or two classrooms to focus on
for
the month. In one of the classrooms most of the students needed some
form of Augmentative and Alternative Communication (AAC). The TC
students created classroom activities that incorporated a strong
AAC component, such as when the students had to make choices, state
their preferences, or make decisions on what would happen next. The TC
students created the activities for the classroom, demonstrated to the
teacher how to do it, incorporated her suggestions, and then stepped
aside so the teacher could develop full mastery of the activity (photo
at left). Over the month the teacher saw the benefits to her
students and learned the skills needed to continue to use AAC
effectively in her classroom as a communication bridge for many of her
students (photo above right).
One of the classrooms in particular was very small with about 10
children who were mostly diagnosed with moderately-severe autism or
Down Syndrome. One woman was in charge of this classroom. Few of the
teachers that the TC students worked with had any teacher education
preparation, and even fewer had any coursework on special education.
Yet, even with good training and several teacher assistants this would
have been a very challenging classroom.
The TC students worked in that classroom every day modeling
language- and literacy-based activities. The teacher was always present
and always participated. To support the group activities the TC
students generally did pull-out therapy sessions with many of the
children. This created a teachable environment in the
classroom.
Before they left, the TC students created theme-based folders,
each centered around a particular book. Each folder contained a number
of different activities that the teachers could do with the children in
her classroom (photo above right). After the month in Bolivia, the TC
students had a good sense of what the children liked and what activity
level would be appropriate for that class. They also
collaborated with the teacher to make sure they were
creating materials that she would feel comfortable using.
Sustainability of Literacy activities: The Magic of Books--And Musicals!
Literacy-based activities were not apparent in most of the
classrooms. The TC group had brought approximately 60 books in Spanish.
Throughout the month, the TC students read books to the children and
created many literacy-based activities that expanded upon the stories
moving into vocabulary development, development of syntax and
morphology, story grammar, character development, and learning reading and writing skills.
At Camino de Sordos the TC students focused on
developing literacy and language skills using a Big Book
version of El Pez Arco Iris (The Rainbow Fish). They first read
the book to the children with one student
reading the Spanish, another signing the
story,
and a third acting it out as it was being read. At the end, when
the Rainbow Fish gives his beautiful scales away, the
student acting out the story gave each child a brightly
colored paper in the shape of a scale. The TC students knew that
these children really understood this book about sharing and community
when the children spontaneously stood up and with huge smiles on their
faces made a giant "group hug" that they made sure included everyone in
the classroom!
The Rainbow Fish story was told and acted out in
different ways several times over the next week--a fish was created
which the children decorated, the students drew pictures about it,
and they talked about sharing things they loved. The children
also drew chalk outlines of themselves and showed where their clothes
would go, similar to where the scales would go on the fish. At the
end of this--the only literacy activity the students observed in the
school during the month--the TC students gave the school The Rainbow
Fish Big Book, several other Big Books, and a variety of other books
that would lend themselves to this type of literacy exploration
and fun.
The TC students at CEREFE incorporated literacy in a different way. Ever the New Yorkers, these students
brought
Broadway to El Alto and turned the book Donde Viven Los Monstros (Where
the Wild Things Are) into a musical! They created masks for costumes, a
boat, a sea, monsters, the mother, and Max. There was even a starring
role for "the warm smell!" They spent two weeks rehearsing
the play with the CEREFE students. The TC students created
songs, with input from the CEREFE students, that the entire
cast sang. These songs incorporated and emphasized main plot
developments.. The cast included a class of teenagers with
developmental disabilities and autism, the TC students and their
supervisor, a mother, and the classroom teacher.
After two weeks of rehearsal, they performed the musical
for for the CEFERE community--parents, fellow students, teachers,
and
administrators.
Before the TC students returned to New York, they gave this and
many books to the teacher that would lend themselves to dramatic
adaptations. The teacher enthusiastically accepted this gift, ready to
create new musicals with her class.
Clinical Supervision and Clinical Hours
The Clinical Supervision
All three clinical supervisors were ASHA certified, native-Spanish speakers with their New York State license and bilingual extension certificate, and with many years of clinical experience.
Miriam Baigorri, MS, CCC-SLP, is the Clinical Director of the
Bolivia Project and Clinical Supervisor of CEREFE. Miriam works at
Bellevue Hospital as a Bilingual Speech language pathologist. She graduated from Teachers
College
SLP program. She is on the faculty of the Bilingual Extension Institute
at TC and co-teaches the cleft palate course there. Miriam is of
Spanish descent.
Elizabeth Ijalba, Ph.D., CCC-SLP,
Bilingual Literacy Research Specialist and Clinical Supervisor at
Camino de Sordos, recently completed her doctorate focusing on
bilingual literacy at
CUNY Graduate Center. She is an Assistant Professor at
Queens College and is on the faculty of the Bilingual Extension Institute.
Elizabeth is originally from
Uruguay.
Lorena
Diaz, MS, CCC-SLP, Schools Specialist and Clinical Supervisor at the
Hospital del Niño, is a bilingual speech language clinician in the New
York City Department of Education. Prior to joining the NYCDOE two
years ago, Lorena worked for YAI’s Grammercy Preschool. Lorena is of
Puerto Rican descent.
At each site there was at least one clinical supervisor present at
all times. The supervisors provided direct supervision--they
answered questions, gave suggestions, and any additional support that
the students needed. In the evenings at the hotel, students prepared
materials for their therapy sessions. Even there, the supervisors were
available for questions, suggestions, and feedback.
The supervisors provided daily feedback to the students. The
supervisors were to build upon the students’ strengths and constructive
criticism was provided. At least once a week the group met for a larger
session when students spoke about the work they were doing with their
clients. These larger group sessions were very useful to share
innovative approaches that could then be replicated at other sites or
with other clients.
Students were required to write goals and S.O.A.P. notes for
one client that they followed throughout the month. Here again, the
supervisors gave feedback on the quality of the written work which the
students incorporated into their next submission of the written work.
Students developed goals and prepared sessions for all the clients they
saw on a regular basis, but they only had to write goals for one client
that they saw everyday or two or three times a week.
On average students accumulated 54 clinical hours that can be
attributed towards their supervised clinical hours needed for ASHA
certification. Over the 3 ½ weeks, the TC students provided over 920
hours of services to Bolivian children with disabilities and their
families.
At the hospital student clinical hours were divided primarily
among autism, developmental disabilities, cerebral palsy, and language
delays under 4 years old. In addition, about 5% to 10% of the cases at
the hospital were fluency and cleft palate. At CEREFE most of the
clinical hours were for children and adolescents with autism,
developmental disabilities, and cerebral palsy. All the children at
Camino de Sordos were either deaf or severely hearing impaired,
although a few had a secondary diagnosis.
Spanish language skills
At
the hotel and in the clinical placements the students were immersed in
Spanish. Students who were not native Spanish speakers studied Spanish
at Instituto Exclusivo in La Paz.
In groups of two or three they received 4 hours a day of intensive
Spanish for five days before they began the clinical placements.
All students were required to participate in the charlas (talks). So every student had to learn some
Spanish
that they could use during the part of their charla where they
presented. This meant that all students had to work on their Spanish
skills to be at a level where they could communicate and be understood
by parents, teachers, medical professionals, and administrators.
At the clinical placements, students who had weak skills in
Spanish paired with a strong Spanish speaker. Each student had a
different client they followed and wrote goals on. This teamwork
allowed the students with weaker Spanish skills to learn more Spanish
and to give students direct services. Those with weaker Spanish skills
had to learn enough Spanish so they could work with their identified
client. Students with weaker Spanish skills generally chose children
who needed AAC so that the TC student could provide services to them.
The Charlas (The Talks)
Prior to coming to Bolivia, students worked in small groups to research and understand current thought in the U.S.
on the topic of their charla. They needed this background on
identification, causation, prevention, and treatment on their charla
topic so they could have enough expertise to answer questions from
parents and professionals. (At least one supervisor went to each charla
to support the students if they had trouble answering any of the
questions.) Also students had prepared powerpoint presentations in
Spanish for parents, teachers, and other professionals on their charla
topics.
In developing their charlas, the TC students worked to
ensure that their charlas were interactive and they
planned significant time for questions and answers. In addition to
the
powerpoint
presentation, students prepared handouts that the audience members
could bring home and could implement with a child with that disability.
For example, the Down Syndrome charla presenters prepared a handout
describing various communication methodologies that have been effective
for children with Down Syndrome. The handout for the charla on children
under 4 years old with language delays included a simple chart of
normal language development and examples of how to stimulate language
in various situations.
Altogether, the students prepared and gave 11 charlas on 7
different topics. Most of the charlas were given twice—at the Hospital
del Niño in
La Paz
and at CEREFE in El Alto. Approximately 335 parents, teachers,
administrators, medical professionals, and others attended the 11
charlas. The following is a list of the charla topics and the numbers
of people who attended:
- Literacy and the Deaf
- Autism. Attendees: 1) 60; 2) 15
- Hearing aid benefits. Attendees: 36
- AAC. Attendees: 1) 15; 2) 45
- Lang Delays for children under 4 years old. Attendees: 1) 60; 2) 30
- Down Syndrome. Attendees: 1) 20; 2) 30
-
Dysphagia (Feeding). Attendees: 25.
Future Plans
Hearing Aids for the Children in Camino de Sordos
One major project that we have committed to is to provide
hearing aids and follow-up aural habilitation therapy for the children
at Camino de Sordos (some are pictured above). Melissa Innis, Au.D., a
dually certified bilingual SLP and Audiologist, plans to go to
Bolivia in September 2008 to test the hearing of all the children in
Camino to determine which children will benefit from hearing aids and
to make mold impressions for those children. Melissa is currently
working to secure donations of the hearing aids and molds.
To benefit from these hearing aids, the children need aural
habilitation to learn how to 1) make sense of the amplified sounds they
will hear with the hearing aids and 2) produce these new sounds in oral
communication. Ray Diaz, husband of Lorena Diaz and technology expert,
spent time at Camino de Sordos in June 2008 to see what was needed
to set up telepractice between the TC clinic in the school in La Paz.
We are working with Ray so that the computers are in place when the
Camino students get their hearing aids.
We can use lots of help
on this project. Any donations or support for this project will be very
welcome. We hope to have the hearings aids and telepractice set up
before we return to Bolivia in May 2009.
The Bolivia 2008 TC Students
CEREFE -- Jenny Brown, Ingrid Curniffe, Natalia Martinez, Ileana Perez, Linden Prickett, Jamy Rodriguez.
Camino de Sordos -- Jules Csillag, Elina Eydlin, Dora Katsnelson, Chris Lebron, Diana Posadas, Courtney VanBuskirk.
Hospital del Nino -- Emily Bernath, Cate Bradford,
Sara Carmody, Mahreen Daruwala, Angie Livingston, Natalie Eisenberg,
and Caitlin Ruderman (honorary).
