HOFSTRAhorizons SPRING 2010
Research and Scholarship Promoting Excellence in Teaching at Hofstra University
his spring 2010 issue of Hofstra Horizons highlights the unique professional services, education and research carried out at the Joan and Arnold Saltzman Community Services Center at Hofstra. I am pleased to introduce this issue and its focus on the Saltzman Center, as it underscores the core educational principles of Hofstra University.
In 1991 the Saltzman Center launched its clinics and opened the doors of its child care facility. Since then, each clinic – Psychological Evaluation, Research and Counseling Clinic; Marriage and Family Therapy Clinic; Speech-LanguageHearing Clinic; and Reading/Writing Learning Clinic – as well as the Diane Lindner-Goldberg Child Care Institute (CCI), has earned a high level of respect and recognition with the help of the excellent services of its directors, staff and doctoral students. But the conception of the Saltzman Center was due to the vision and generosity of Joan and Arnold Saltzman as well as Robert Goldberg, who, through the Fay J. Lindner Foundation, made the child care institute possible. Each of the four Saltzman Center clinics offers our students vital clinical experience with supervision by Hofstra’s respected faculty and licensed professionals, and well prepares our students for their future careers. In addition to student preparation, I am pleased that our professionals can reach out to Hofstra’s surrounding communities to offer various clinical and educational services. The CCI is open to the public, maintains a highly trained staff, and is accredited by the National Association for the Education of Young Children (NAEYC). I thank the directors and staff of the Saltzman Center for their continued dedication to teaching, counseling, research, and education, as well as their significant contributions to their respective fields. Please join me in congratulating them on their fine work. Sincerely,
Stuart Rabinowitz President
HOFSTRAhorizons RESEARCH AND SCHOLARSHIP AT HOFSTRA UNIVERSIT Y
table of contents 5 Psychological Evaluation, Research and Counseling Clinic Photo courtesy of thinkstock.com.
10 Reading/Writing Learning Clinic: Building Connections One Community at a Time
16 Diane LindnerGoldberg Child Care Institute
HOFSTRA HORIZONS is published semiannually in the fall and spring by the Office for Research and Sponsored Programs, 144 Hofstra University, Hempstead, New York 11549-1440. Each issue describes in lay language some of the many research and creative activities conducted at Hofstra. The conclusions and opinions expressed by the investigators and writers are their own and do not necessarily reflect University policy. ©2010 by Hofstra University in the United States. All rights reserved. No part of this publication may be reproduced without the consent of Hofstra University. Inquiries and requests for permission to reprint material should be addressed to: Editor, HOFSTRA HORIZONS, Office for Research and Sponsored Programs, 144 Hofstra University, Hempstead, New York 11549-1440. Telephone: (516) 463-6810.
very issue of Hofstra Horizons presents an opportunity to gain greater insight into the scholarship and research accomplishments of our faculty. This issue is no exception. However, this spring 2010 issue of Horizons also spotlights the exceptional professional services provided by the directors and staff of the Joan and Arnold Saltzman Community Services Center.
Marriage and Family Therapy Clinic
28 Speech-LanguageHearing Clinic: Social Participation Approach to Aphasia
Contributing photographers: Brian Ballweg and Phil Marino
Stuart Rabinowitz, J.D. President Herman A. Berliner, Ph.D. Provost and Senior Vice President for Academic Affairs Sofia Kakoulidis, M.B.A. Associate Provost for Research and Sponsored Programs Alice Diaz-Bonhomme, B.A. Assistant Provost for Research and Sponsored Programs
Assistant Provost and Executive Director Joseph Scardapane, who is also the director of the Psychological Evaluation, Research and Counseling (PERC) Clinic leads off this issue by briefly describing each of the four clinics as well as the child care institute. His article on the PERC Clinic describes the innovative services of the PERC Clinic, which also provides clinical experience to students in Hofstra’s doctoral programs in school/community psychology and clinical psychology. In 2002 Dr. Andrea García, associate professor of literacy studies and director of the Reading/Writing Learning (RWL) Clinic, and Michèle Marx, administrative coordinator, began an exciting scholarship initiative. To date, this donor-funded program, titled Community Literacy Connection, has helped more than 200 third- and fourthgrade students from local school districts receive valuable literacy support services. This is but one of the exceptional educational programs offered through the RWL Clinic. Accredited by the National Association for the Education of Young Children, the Diane Lindner-Goldberg Child Care Institute (CCI) is headed by Director Donna Tudda. Accepting children since 1991, the CCI provides a kindergarten readiness program and works closely with the Saltzman Center clinics. The next article by Marriage and Family Therapy Clinic Director Madeline Seifer highlights the cutting-edge approaches and specialties of the five licensed marriage and family therapists on staff. Finally, Wendy Silverman, assistant professor of speech-languagehearing sciences, takes us through the needs, assessment methods and treatments of aphasia. As director of the Speech-LanguageHearing Clinic, Ms. Silverman utilizes a nontraditional approach focusing on social participation. More than presenting the work of these Hofstra faculty and administrators, this special issue symbolizes the fine work and extensive scholarly productivity of the staff and students at the Saltzman Center. Their expertise helps to ensure high-level services to the community and an outstanding educational experience for our students. Sincerely,
Herman A. Berliner, Ph.D. Provost and Senior Vice President for Academic Affairs
Introduction from the Assistant
Provost and Executive Director of the Joan and Arnold Saltzman Community Services Center Joseph R. Scardapane, Ph.D.
am pleased to have the opportunity to highlight the Joan and Arnold Saltzman Community Services Center in this issue of Hofstra Horizons. Located at the most western corner of the South Campus, the Saltzman Center is often referred to as the “best kept secret” at the University. Many of you may have heard of the outstanding Diane LindnerGoldberg Child Care Institute (CCI), which serves approximately 85 children aged 2 months to 5 years. With the able leadership of Donna Tudda, the CCI not only is licensed by New York state but also has received the prestigious accreditation from the National Association for the Education of Young Children (NAEYC). The staff at the CCI is one of the best trained and most highly educated of all child care facilities in the tri-state area.
also train clinical psychologists to work in a variety of settings such as hospitals, community mental health centers and universities. Students also receive training to become independent practitioners in each of these disciplines. The Joan and Arnold Saltzman Community Services Center opened its doors in 1991, and all the clinics and the CCI are housed in one building. This gives us the opportunity to educate students in each academic discipline and to engage in multidisciplinary work when needed. Our students benefit greatly by seeing firsthand the advantages of working with other professionals who enhance the services afforded to clients in our community, and they also enjoy a wealth of variety in research opportunities.
In addition to the CCI, we have four doctoral and master’s level training clinics. The goal of these clinics is to provide education for our students and services to the community; the clinics work with Hofstra’s academic areas to engage in cutting-edge research to add to the existing body of knowledge in each field. These four clinics – Marriage and Family Therapy Clinic; Psychological Evaluation, Research and Counseling Clinic; Reading/Writing Learning Clinic; and Speech-Language-Hearing Clinic – serve as training sites for students in each of their respective disciplines.
The Saltzman Center allows the University to give back to the community by reaching out to people who otherwise could not afford these professional services. Our fees are moderate to low, and none of the clinics turn anyone away because of the inability to pay. We engage in fund-raising programs and work closely with Hofstra’s Development Office to reach out to individuals and organizations that appreciate the value of our clinics. Donations are sometimes earmarked for specific areas such as autism, child care or reading; others are shared with all the clinics and the CCI. We are grateful to our generous donors, particularly in these difficult financial times.
Our clinics prepare Hofstra students for the varied professions they will enter upon graduation. We prepare students to work in schools as reading specialists, speech therapists, marriage and family therapy counselors, and school psychologists. We
I hope that you find the initiatives of the Joan and Arnold Saltzman Community Services Center both interesting and informative, and that you visit to see these clinics and the CCI in action.
Psychological Evaluation, Research and Counseling Clinic Photo courtesy of thinkstock.com.
Joseph R. Scardapane, Ph.D., Director
he Psychological Evaluation, Research and Counseling (PERC) Clinic was started in the mid1960s by Dr. Julia Vane. At a time when most of the psychology world was still using psychoanalytic techniques, Dr. Vane brought in behavioral techniques such as home token economies that relied on the work of B.F. Skinner. The concept of reinforcement was applied to psychotherapy in many ways, including verbal praise, stickers and tokens for children, and increased social interaction and pleasant events for adults. While this might seem logical today, it was revolutionary in the 1960s.
The focus of the therapy was still on the therapeutic relationship, but the context was very different. Since that time, the PERC Clinic has evolved into a clinic that serves two doctoral programs â&#x20AC;&#x201C; one in school psychology and the other in clinical psychology. The clinic provides direct clinical experience in a number of ways, the most important being the provision of cutting-edge services to the community, including psychodiagnostic assessment, psychotherapy and applied behavior analysis, where appropriate. We also have the technology to go along with these new techniques. The clinics and institutes
within the PERC Clinic are supervised by Hofstra faculty and administrators who specialize in each area. This joining of expertise and student enthusiasm makes the education and service components of the clinic a very rich experience for all. The PERC Clinic focuses on psychodiagnostic assessments for children, adolescents and adults. The assessment consists of a biographical data review. This occurs through the use of interviews and detailed background questionnaires. Patients are provided with a comprehensive assessment, which includes tests of intelligence, academic achievement, memory, visual
motor development, emotional and behavioral functioning, and personality traits. An interpretive conference is convened shortly after the assessment. The individual adult or parents/adult guardians attend these conferences to review findings and discuss recommendations. A full psychological report, including test results, diagnostic interpretations and recommendations, is mailed to the individual or parents/ adult guardians. When requested, and with written informed consent, a copy of the report is sent to agencies, schools or other professionals. If psychiatric or medical care, remedial reading or speech-language-hearing services are needed, a referral is made. An effort is made to work in conjunction with other professionals to facilitate rapid remediation of problems. The clinic engages in the collection and analysis of data with a view toward refining its own services and expanding knowledge in the field of psychology and mental health. Publications in journals and presentations at national and international conferences often result from this work. The PERC Clinic accepts referrals from physicians, educators, clergy, attorneys, psychologists and other professionals. The following paragraphs describe each of the specialty clinics that now make up the PERC Clinic.
With adjustment disorder, people become angry in reaction to a specific and limited set of circumstances, such as divorce or loss of a job. Although they may have been previously welladjusted, their anger may now appear in multiple situations and include general irritability, sarcasm, complaining and â&#x20AC;&#x153;being on edge.â&#x20AC;? With general anger disorder, people become angry in reaction to a wide variety of problems, including disappointments, frustrations, perceived insults or perceived social neglect. Their anger may be frequent and intense and may endure for long periods of time. The anger may be associated with aggressive behavior or may exist as an internal, personal experience that leads to yelling, arguing or sarcasm. With situational anger disorder, people become angry or aggressive in reaction to a limited set of circumstances. Their anger may show itself only while driving or only when interacting with a spouse or a child. In other situations, such as work, they remain relatively calm. It is common that people with this disorder deny that they have a real anger problem.
Director: Dr. Howard Kassinove
The evaluation consists of a structured clinical interview and psychological tests to assess the frequency, intensity and duration of specific anger episodes. The strength of an anger trait is also assessed.
The Institute for the Study and Treatment of Anger and Aggression involves the evaluation, management and investigation of anger disorders. Three types of anger in adults and adolescents have been identified:
In the management of anger, there are four steps. First, a collaborative plan is developed to gain agreement on the goals and methods to be used. Second, techniques are taught to help change response to anger-provoking situations.
Institute for the Study and Treatment of Anger and Aggression
adjustment disorder with anger, general anger disorder and situational anger disorder.
Third, a perspective that centers on reality and forgiveness is promoted. Relapse prevention skills are also developed. This program for the treatment of anger and aggression provides clients with the opportunity to drastically change their lives with regard to the negative consequences of these behaviors. The impact of this change can be both life enhancing and punishment diminishing. It is common for the probation department to refer clients for the treatment of anger disorders. This system of referrals from this department allows the clinic to work with individuals whose behavior has resulted in involvement with the legal system.
Institute for Family Forensic Psychology Director: Dr. Paul Meller Divorce, separation, or any other family transition can create a great deal of stress for a child. During this time, children are confronted with many changes at one time. These changes include understanding family roles, redefining relationships with parents, changes in schedules, and the possibility of changing schools and establishing new friendships. Conflict between parents is one of the most destabilizing factors in a family reorganization. The Institute for Family Forensic Psychology provides services to help parents responsively manage their conflict. Evaluations of the strengths and needs of the parents and children and therapeutic programs for children and families going through divorce or other family transitions are provided. The two major components of this institute are evaluations and family therapeutic services. Family therapeutic services include Peace4Kids and
Peace4Kids is one of the family therapeutic services offered through the institute. It is a psycho-educational program designed to help children from kindergarten through fourth grade. The goal is to help these children cope more effectively with divorce. Children meet in a group setting for six one-hour sessions. Through age-appropriate activities, children learn to effectively adjust to family changes. The topics of the sessions include defining a family, problem solving, understanding legal issues, responding to changes, and asking for help. The language used for these topics depends upon the developmental level of the children in each group. Therapeutic visitation is designed to help mend parent/child relationships
Photo courtesy of thinkstock.com.
therapeutic visitation. Evaluations include helping parents and the courts make appropriate decisions regarding time spent with each child and responsibility for financial and housing arrangements. When parents cannot agree on basic issues about the children, they often go to court. At this time, a judge may order a forensic evaluation, which is sometimes called a custody and visitation evaluation. The primary purpose of this evaluation is to assess the family unit and provide the court with objective information to help the family make decisions. All assessments follow the guidelines of the Association of Family and Conciliation Courts and the New York State Matrimonial Commission. Additionally, the guidelines of the American Psychological Association are followed closely so that doctoral students learn to write these assessments in an appropriate and useful manner. All assessments are supervised by an experienced forensic evaluator and licensed psychologist.
that may have been affected by parental conflict. The expertise of the supervisors and the education provided to doctoral students allow the services of the Institute for Family Forensic Psychology to be highly professional and meaningful. This institute is yet another example of the diverse training available to our doctoral candidates.
Diagnostic and Research Institute for Autism Spectrum Disorders Director: Dr. Kimberly Gilbert Autism is a neuro-biological developmental disability that generally appears before the age of 3. Individuals with Autism Spectrum Disorders typically have difficulty with communication and social interaction, and display repetitive/stereotyped behaviors. Research clearly indicates the importance of early identification and implementation of behavior and language interventions. Knowing that early and accurate diagnosis provides the most efficacious treatment for this population, the institute employs the most current diagnostic measures and research-based practices. The institute offers a full range of services to address the needs of the
family as a system. Clinical services include comprehensive assessments and behavior/language interventions such as prelinguistic milieu intervention, social skills groups, and sibling and family support groups. Interventions and therapy for individuals with Autism Spectrum Disorders include functional behavioral assessments; behavior intervention plans; milieu communication therapy for young talkers; social skills groups for children, adolescents and adults; home curriculum development; and psychotherapy. Family therapy, parent support groups and sibling workshops are offered to support the entire family. Ongoing research is conducted at the institute in order to help develop and enhance treatment methods and contribute to the current body of scientific literature.
Acceptance and Commitment Therapy (ACT) Clinic Director: Dr. Joseph R. Scardapane The Acceptance and Commitment Therapy (ACT) Clinic serves individuals who are 18 years of age and older. Rather than focus on specific
disorders, the ACT Clinic focuses on behavior, emotions and thoughts that act as barriers to living meaningful lives. This therapy encourages people to accept what is out of their personal control while committing to do whatever is in their personal control, to improve the quality of their lives. ACT teaches psychological skills to deal effectively with painful thoughts and feelings. These psychological skills are taught in such a way that these painful thoughts and feelings have much less impact on the individual. ACT also helps people clarify what is truly important and meaningful to them. The therapist helps clients use that knowledge to guide, inspire and motivate them to change their lives for the better. The aim of ACT is to help people create rich, full and meaningful lives while effectively handling the pain and stress that life inevitably brings. The approaches used in ACT include mindfulness meditation, which helps increase awareness and decrease experiential avoidance. Developing willingness to experience all that life brings is associated with letting go of those things we cannot control. Cognitive diffusion is a technique that separates thoughts from the thinker, and helps the client experience thoughts as mere words and sounds. In addition, values as chosen life directions are explored and decided upon by the client. These values lead to committed action. Committed action is defined as behavior needed to act in line with the client’s values. It is common that these behaviors were associated with difficult emotions or thoughts in the past and are therefore avoided. ACT helps clients understand why they may be willing to suffer from feelings and thoughts they previously avoided. For example, if a client develops a value that family relationships are important
to the meaning of their lives, they are likely to engage in behavior that enhances that value. However, if a client is fearful of crossing bridges, and his/ her son lives in an area that involves crossing a bridge, the client is stuck in the dilemma involved in approaching or avoiding emotions. When faced with the choice of staying home or crossing the bridge to visit a son and his family, the anxiety associated with the latter behavior is put in the context of the values in his/her life. Willingness to suffer the anxiety is an important aspect of decreasing emotional avoidance and increasing behavior associated with living a rich life. These are the basic paradigms associated with ACT.
Phobia and Trauma Clinic Director: Dr. Mitchell Schare The Phobia and Trauma Clinic offers treatment for patients whose fears inhibit their quality of life as well as for clients with posttraumatic stress disorder, a condition caused by a devastating or tragic experience. These people tend to avoid certain life activities because of their fears and phobias. Although some people actually participate in these activities, they experience extreme dread. Others miss out on activities such as family celebrations, vacations and professional obligations. The clinic treats clients with a fear of traveling on airplanes and trains, public speaking, heights and animals, among other common phobias. The clinic uses a treatment called “exposure therapy.” This treatment involves therapy under safe, controlled clinic conditions. Patients are immersed in situations they have long avoided or asked to confront traumas they have experienced in their lives. On a case-bycase basis, therapists may simulate environments that trigger a phobic response so patients can learn to better manage their fears.
The therapeutic techniques used in this clinic include the following: • Imaginal exposure: Therapist-guided mental imagery associated with phobic responses in the patient. • Virtual reality exposure: Computergenerated environments that create sights, sounds and physical cues associated with the patient’s fear. • In-vivo exposure: Confronting fear cues in the real world (for example, a patient with public speaking anxiety giving a speech in front of five people).
These treatments for phobia and trauma combine well-researched approaches and cutting-edge technology to help these patients live lives that are less restricted by fear and anxiety.
Child and Parent Psychotherapy Services (CAPPS) Clinic Director: Dr. Phyllis Ohr The Child and Parent Psychotherapy Services Clinic serves all child/ adolescent and parent clients who apply for psychological services at the Saltzman Community Services Center. The clinic provides cognitive-behavior therapy, play therapy, behavioral parent consultation, and mindfulness-based programs to enhance awareness and values. The focus tends to be on the parent-child dyad or triad. Therefore, the child is never seen in isolation but rather as part of a larger context in the home and at school. One of the most important components of the CAPPS Clinic is Parent-Child Interaction Therapy, which is detailed below.
Parent-Child Interaction Therapy (PCIT) Parent-Child Interaction Therapy (PCIT) is a positive and intensive program for children aged 2 to 7 years and their parents, specially designed to enrich the quality of their relationship,
reduce parenting stress, and improve overall child behavior. Individual psychotherapy sessions and conjoint parent-child sessions offer behavior therapy, cognitive-behavior therapy and play therapy. The treatments are effective for individuals with aggressive behaviors, anger, defiance/oppositional behaviors, impulsivity, mood swings, obsessive/ compulsive behaviors, panic, phobia, general anxiety, sadness, school and test anxiety, separation difficulties, shyness and inhibitions, worries and fears, among other difficulties. PCIT is appropriate for families with child relationship problems, highly stressed parents, and children with adjustment problems, aggressive behaviors, attention difficulties, separation anxiety and social difficulties. Techniques used include
behavior therapy, behavioral parent consultation, cognitive-behavior therapy, mindfulness and acceptance commitment therapies, video-based parent training programs, and parent training programs for child management. The parent training programs for child management and video-based parent training involve the opportunity to use technology to accomplish therapeutic goals. At the beginning of treatment, therapists interact with the child in a manner that typically brings out a problematic behavior such as tantruming. At this point, therapists interact with the child to meet his or her current need without reinforcing the problematic behavior. This approach allows parents to view new behavior to improve the interaction between themselves and their child. They are able to view and hear this new type of
interaction through the use of a one-way mirror and blue-tooth technology. The second phase of this approach allows the parent to try out the new behaviors modeled by the therapist. Initially, a therapist is in the room helping to guide the parentâ&#x20AC;&#x2122;s behavior. Subsequently, the parent interacts with the child while being viewed by the therapist (who gives the parent verbal feedback via blue-tooth). The advantage of this approach is that the behavior recommended to the parent can actually be shaped, modeled and established. It is a much more powerful approach than traditional verbal therapy, which involves little emphasis on actual behavior. Our doctoral students learn an approach that is not only efficacious but cost-effective for parents and the institutions they may serve.
Joseph R. Scardapane, Ph.D., has been a teaching administrator, supervising psychologist and researcher at Hofstra University since 1991. Currently assistant provost and executive director of the Joan and Arnold Saltzman Community Services Center and director of the Psychological Evaluation, Research and Counseling (PERC) Clinic, Dr. Scardapane previously held positions as school psychologist for the Board of Cooperative Educational Services for Southern Westchester and chief clinical psychologist at the Southeast Nassau Guidance Center in Seaford, New York. He has presented both nationally and internationally on topics ranging from the intellectual assessment of bilingual children to the use of acceptance-based techniques in cognitive-behavioral therapy. As director of a psychology training clinic, he serves two doctoral programs by teaching and supervising students in psychological assessment and cognitive-behavioral therapy. With Dr. Scardapaneâ&#x20AC;&#x2122;s direction, the PERC Clinic continues to provide cutting-edge services to Joseph R. Scardapane the community while providing educational and research opportunities to Hofstra University doctoral students. He has helped establish specialty clinics to train students in a comprehensive manner, utilizing the expertise of the Department of Psychology faculty in areas such as the treatment of anger disorders, phobias, childhood behavioral disorders, and autism spectrum disorders. In addition, the Institute for Family Forensic Psychology provides evaluations, therapy and supervised or therapeutic visitation services for families referred from family court. Dr. Scardapane also directs the Acceptance and Commitment Therapy Clinic, which provides services to patients suffering with chronic physical or emotional pain that is interfering with their quality of life. Dr. Scardapane also serves as institutes chairperson for the Association for Behavioral and Cognitive Therapies (ABCT) and as treasurer for the Association of Directors of Psychology Training Clinics (ADPTC).
Reading/Writing Learning Clinic:
Building Literacy Connections One
Community at a Time
Small group instruction in Community Literacy Connection satellite program.
Andrea García, Clinic Director; Associate Professor of Literacy Studies Michèle A. Marx, Administrative Coordinator
n a small classroom in a local elementary school, third and fourth grade writers prepare to share their work with their peers and parents. It is the closing Literacy Celebration, where students participating in a literacy program have taken on the role of authors and will now read from their published work. Their summer literacy program is part of the Community Literacy Connection. The students have been working every day for two hours in one of two small groups. Each group of five students that has gathered together for
this literacy event has been taught by a certified literacy specialist and has had the benefit of an intern from Hofstra University’s Literacy Studies Department. Parents sit proudly in the room as they listen to their children read aloud from their work. Kayla (all names are pseudonyms) reads her poem: The Rainy Day Dew drops On the grass shining Water puddles Getting splashed
Water hitting my face Imagine Having to walk To school On a rainy day I was soaked The end The author is congratulated with thunderous applause; she proudly returns to her seat. At the conclusion of the celebration, the children and their families share in juice and cookies, and browse their published work.
During a different celebration for the same program, another proud author reads his writing. Henry has selected to read a poem where he found a place to express his cultural and linguistic experiences and explore his expanding understanding of culture, informed by his new experiences in the United States. Where I’m From I am from Martinique, From a hot island. I am from the heat of the sun (Hot, great, it felt so exciting). I’m from the school that had Halloween, In the morning. I’m from the carnival in the night and all the fun At the end of both celebrations, parents have a conference with the literacy specialist who has worked with their children. At that time, teachers share with parents highlights of the literacy development of their children during the program; they discuss other samples of students’ writing, as well as the reading and writing strategies their children use when composing or reading text. Parents can ask questions, and they also receive suggestions for how to continue to support literacy development at home. And just like that, another successful Community Literacy Connection program comes to an end.
Community Literacy Connection Kayla and Henry are two learners who have participated in the Community Literacy Connection (CLC), a donorfunded scholarship program that was developed in 2002 by the Reading/ Writing Learning (RWL) Clinic at the
Joan and Arnold Saltzman Community Services Center. The goal of the program is to make literacy support services available to third and fourth grade children who are struggling with reading and writing and whose families’ economic means might not enable them to take advantage of such opportunities outside of school. To date, the program has awarded more than 200 scholarships to students in local school districts. Funding has allowed us to bring the CLC program to the neighboring communities of Hofstra University, such as Hempstead, Uniondale, and Roosevelt. Students selected by their districts for a CLC scholarship receive a full academic year of literacy support services, as well as a comprehensive literacy evaluation that provides a detailed appraisal of the learner’s reading and writing strengths and needs.
Torras (2008), the diversity of the population on Long Island has increased in the past few decades. Torras states, “Hempstead, Freeport, and Elmont in Nassau County and Brentwood in Suffolk County are by far the four largest immigrant communities on Long Island, with over 13 percent of Long Island’s immigrants among them” (p. 5). Many of these diverse communities include migrant workers and families who have recently immigrated to the United States. In the past five years, a growing number of students selected for our CLC program are from linguistically diverse families who bring multiple languages to their encounters with literacy. The CLC program provides literacy support to students who are in the process of developing as readers and writers while also learning English as their second language.
Since 2005, the RWL Clinic has expanded this initiative to create the Community Literacy Connection satellite program, which makes literacy support services and other related literacy experiences, such as parent workshops, available on-site. CLC satellite programs have been offered in the Elmont, Uniondale, and Long Beach communities. Offering the programs on-site reduces or eliminates the transportation challenges faced by many families. In addition to responding to the needs of parents and their school district representatives, the satellite programs serve the RWL Clinic’s mission to establish outreach programs in our surrounding communities.
A Focus on Literacy Celebrations
The CLC program has allowed the RWL Clinic to offer literacy support services to communities with rapidly changing demographics. According to
The Literacy Celebration described at the opening of this article is an opportunity for young authors to publicly and formally share their work. It has been a struggle for these writers and readers to reach this literacy event. Like Kayla and Henry, these young authors have been identified by their school districts as struggling with reading and writing; many carry the extra burden as being identified as an “at risk” learner (McDermott, Goldman, & Varenne, 2006). Where struggling readers have historically received remedial education services focused on correcting their “deficiencies” and addressing their weaknesses, at the RWL Clinic we take a different approach. Yetta Goodman (1997) reminds us that “There is no single road to literacy” (p. 56). Recognizing that there are multiple
“The key to creating an environment conducive to optimal literacy learning is respect and the belief that every student can learn.’’
roads, we start from where the children are (González, Moll, & Amanti, 2005) and create an environment where optimal literacy learning can take place. The key to creating an environment conducive to optimal literacy learning is respect and the belief that every student can learn. We revalue the learner and the linguistic strengths that students bring to their literacy learning (Goodman, 1988) so that learners can build a belief in themselves. Struggling readers and writers are redefined as readers and writers who may struggle to make meaning in particular contexts and with particular forms of literacy (Rhodes & Dudley-Marling, 1996); and struggling is just part of the natural work of the reader and the writer (Goodman, 1997). To use Frank Smith’s (1998) metaphor, readers and writers who participate in
the CLC program have been invited to join the “literacy club.” This means that they become stakeholders in their literacy development and become active participants in defining their academic success. In the following section we introduce the theory that grounds our work and discuss how this particular program, as exemplified by the Literacy Celebration event, captures the principles that sustain and inform our practice.
Building a Community of Learners The literacy experiences we provide to learners like Henry and Kayla carefully consider the relationship between the organization of literacy learning contexts and students’ experiences with them. Building on the work of Cambourne (1988), we incorporate in our teaching a series of conditions for supporting written language learning. Cambourne believes that learning contexts should provide learners with the type of engagements necessary for them to become acquainted with the multiple forms of oral and written language available in our world. His “Conditions for Language Learning” include immersion, demonstration, expectation, responsibility, use, approximation, and response. demonstrated the powerful effect that implementing these conditions for learning has in the performance of students traditionally labeled as “at risk” (Ruiz, Vargas, & Beltrán, 2002). A student-centered learning environment, where everyone is expected to be engaged and invested in their literacy development, offers learners like Kayla and Henry a different context in which to demonstrate what they are capable of doing with literacy. Creating optimal
learning environments for literacy learning is a cornerstone of our work. In order to accomplish this, instruction is provided in a small group setting with no more than five students per group. Our definition of community extends to include parents as partners in the literacy education of their children. We want parents to have the opportunity to ask questions and gain access to information about literacy development, and strategies for supporting their children’s development as readers and writers at home. In addition, an important component of our work includes providing parent workshops that focus on topics of interest to them.
Revaluing Readers and Writers The idea of revaluing learners is one of the most powerful ways to advocate for a shift in the way we construct images of students who may be struggling with reading and writing in school. The underlying principle for revaluing, as described by Ken Goodman (1982), is based on the assumption that teachers should “understand the tremendous strength that all pupils bring to learning to read and write. That understanding can help teachers to revalue non-achieving pupils and to understand that their failure is educators’ failure to help them use the strengths they have” (p. 89). Goodman (1996) has characterized this process of revaluing readers as a “long, slow rebuilding of the sense of self and the sense of reading” (p. 17). Goodman (1982) identifies risk-taking, self-monitoring and self-confidence as key elements in order to create a revaluing program where learners come to demystify the reading and writing processes and build their self-esteem as
learners and language users. In our teaching, these components are closely related to developing a sense of agency on the part of the learner and advocacy on the part of the teacher. In this way, the learner has to actively engage in the process of revaluing by beginning to understand his/her own reading and writing processes. The teacher is responsible for providing an environment where the conditions for learning promote risk-taking and support the learner’s approximations. Revaluing, thus, implies a subtle orchestration of the social and personal forces that drive the learning process. As learners begin to free themselves from the burden of labels and the deficit metaphors they carry with them, a new sense of possibility emerges, and educators can begin to recognize the real learning potential of these struggling readers and writers (McDermott, Goldman, & Varenne, 2006). For Kayla, this realization meant taking the risk to read aloud her poetry in front of her teacher and other adults; for Henry, it meant finding a meaningful space to use writing for self-expression, embracing all aspects of his cultural and linguistic experiences.
Focusing on a Meaning-Centered Approach to Literacy Teaching The poems presented by Kayla and Henry represent more than the strengths of the students in published work; they represent both what was learned and the best in teaching practices. Following a workshop approach for reading and writing that is literature-based, through read alouds, shared and guided reading experiences, and space for uninterrupted independent reading, the students were immersed in high-quality authentic literature. In our CLC program,
engagements with texts are more than an opportunity for developing the reading strategies of proficient readers; they are an opportunity to experience rich language and new worlds; to explore new interests or genres; and to build background knowledge and make connections across disciplines (Atwell, 1998; Laminack & Wadsworth, 2006). Literature discussions, journal responses, and curricular engagements like graffiti boards and sketch to stretch (Short, Harste, & Burke, 1996) create social and reflective opportunities that allow learners to deepen their understandings of the texts. Through their transactions with the texts, Kayla, Henry and their peers found connections to their own life experiences and interests and, in the process, found texts that mattered to them. These learning invitations move the reading experience from learning to read to reading to learn, and they validate learners in the community when they discover that there is no one way to respond to a book. As they learned to read like writers (Ray, 1999; Smith, 1988), the texts and authors Kayla and Henry came to know became their writing mentors. Using mentor texts to study the author’s craft allowed them to borrow “wondrous words” and envision possibilities in their own writing to express their own stories. These experiences exemplify the philosophy of the writer’s workshop at the RWL Clinic. In Kayla’s poem, her voice is clearly heard as she explores a small moment and plays with imagery after a group read aloud. Kayla’s presentation of her work came after engagement in the writing process of brainstorming of ideas, drafting, revising, editing and publication; like her reading experiences, the final sharing of her work came after participation in the authoring cycle as
Student participating in Community Literacy Connection satellite program.
well, where she was invited to literacy engagements in a collaborative, reflective learning curriculum (Short, Harste, & Burke, 1996). In the authoring cycle, both reading and writing are meaningful and purposeful.
Using Language and Culture as a Resource for Learning Years of research into the social and cultural nature of literacy learning have revealed that learners “acquire the foundations of literacy within their native language and culture” (Pérez, 2004, p. 27). The literacy engagements we provide in our instruction ensure that we build on the wealth of language experiences that students have in their homes and communities. That is, we
make use of a “funds of knowledge” framework (González, Moll, & Amanti, 2005), where students are invited to use their heritage languages and cultural practices as resources for academic success. Given the richness of the cultural and linguistic landscapes that exist in all the communities where we provide a CLC program, our literacy specialists strive to create multilingual and multicultural environments for literacy learning. This means that our stance as educators is informed by an ideology that values linguistic diversity as a resource, not a problem that needs to be overcome (Ruiz, 1984). The resulting learning context can be described as culturally responsive (Gay, 2000), where learners can make use of their language and their culture as a resource for making meaning. For reading, this means that we strive to invite our learners to transact with culturally authentic texts (Fox & Short, 2003) in order for them to tap into their schema and experiences to make sense of texts. In terms of writing, a culturally responsive approach ensures that teachers value the students’ approximations toward control of conventional writing structures in English, while allowing students to incorporate knowledge of their heritage language as a scaffold for their writing. Within this culturally responsive learning context, writers like Henry can compose a poem like “Where I’m From,” which is a personal variation of the work by George Ella Lyon, Henry expertly provides the reader with a sense of place by juxtaposing his homeland experiences in Martinique with his Halloween experiences in the United States, thus creating a text uniquely personal and grounded in his cultural identity.
Enacting Our Mission Our description of the theoretical principles and practices that shape our work through the CLC program is but one example of the multiple ways in which the RWL Clinic serves the community with high-quality out-ofschool programs. These principles permeate all the initiatives established at the RWL Clinic. It has been well documented in the literature that outof-school programs have the potential to provide literacy learning experiences that are different from those found in school; they build on what’s happening in schools, and they extend access to different literacy practices responding to specific community needs (Hull & Schultz, 2001).
Looking Into the Future: Developing 21st-Century Literacies The RWL Clinic is committed to valuing students’ linguistic and cultural lives, and incorporating students’ experiences with literacy in new and innovative ways to help them develop their strengths and identities as readers and writers for the 21st century. Our work focuses on supporting learners to recognize that reading and writing are purposeful and meaningful in our lives. Acknowledging multilingual, multimodal literacies, our goal is to promote out-of school literacies that build upon what students already know and help them expand their literacy practices and repertoires. We live in a rapidly changing world. To keep pace with the changing demands of society, our definitions of reading and writing need to include all the ways in which we communicate, collaborate, and connect. As an out-ofschool program, the CLC is well suited
to foster new forms of literacy. We believe that “It is essential that literacy educators and others support equal access to information technologies for all students to ensure that each student has equal access to life’s opportunities” (IRA, 2009). To that end, our programs are changing to address and prepare our students and our children with the skills and strategies necessary for the digital age. Utilizing the power of technology to engage all learners in higher-level thinking experiences, our students have the opportunity to incorporate multimodal and multimedia technology to re-envision writing in digital times and to compose their stories as they author themselves into the world.
References Cambourne, B. (1988). The whole story: Natural learning and the acquisition of literacy in the classroom. Auckland, Australia: Ashton Scholastic. Fox, D. L., and Short, K. G. (Eds.). (2003). Stories matter: The complexity of cultural authenticity in children’s literature. Urbana, IL: National Council of Teachers of English. Gay, G. (2000). Culturally responsive teaching: Theory, practice, & research. New York: Teachers College Press. González, N., Moll, L. C., and Amanti, C. (2005). Funds of knowledge: Theorizing practices in households, communities and classrooms. Mahwah, NJ: Lawrence Erlbaum. Goodman, K. (1982). Revaluing readers and reading. Topics in learning and learning disabilities, 1(4), 87-93. Goodman, K. (1996). Principles of revaluing. In Y. Goodman and A. Marek (Eds.), Retrospective miscue analysis. New York: Richard C. Owen Publishers.
Goodman, Y. (1997). Multiple roads to literacy. In D. Taylor (Ed.), Many families, many literacies: An international declaration of principles (pp. 56-62). Portsmouth, NH: Heinemann.
London, R., Pastor, M., and Rosner, R. (2008). When the divide isn’t just digital: How technology-enriched afterschool programs help immigrant youth find a voice, a place and a future. Afterschool Matters, 7, 1-11.
Hull G., and Schultz, K. (2001). Literacy and learning out of school: A review of theory and research. Review of Educational Research, 71, 575-611.
McDermott, R., Goldman, S., and Varenne, H. (2006). The cultural work of learning disabilities. Educational Researcher, 35(6), 12-17.
International Reading Association. (2009). New literacies and 21st century technologies: A position statement of the International Reading Association. Newark, DE: International Reading Association.
Pérez, B. (2004). (Ed.). Sociocultural contexts of language and literacy (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.
Lankshear, C., and Knobel, M. (2007). (Eds.). Sampling “the new” in new literacies. A new literacies sampler. New York: Peter Lang.
Ray, K.W. (1999). Wondrous words: Writers and writing in the elementary classroom. Urbana, IL: National Council of Teachers of English.
Ruiz, R. (1984). Orientations in language planning. NABE Journal, 8(2): 15-34. Ruiz, N. T., Vargas, E., and Beltrán, A. (2002). Becoming a reader and writer in a bilingual special education classroom. Language Arts, 79, 297-309. Short, K., Harste, J., & Burke, C. (1996) Creating classrooms for authors and inquirers (2nd ed.). Portsmouth, NH: Heinemann. Smith, F. (1998). Joining the literacy club: Further essays into education. Portsmouth, NH: Heinemann. Torras, M. (2008). Strengthening Long Island: The economic contributions of immigrants to Nassau and Suffolk Counties. New York: The Hagedorn Foundation.
Andrea García, Ph.D., is an associate professor in the Literacy Studies Department at Hofstra University. She also serves as director of Hofstra University’s Reading/Writing Learning Clinic, located at the Joan and Arnold Saltzman Community Services Center. Dr. García holds a Ph.D. in language, reading and culture from the University of Arizona. She is from Mexico City, where she worked as a special education teacher and a speechlanguage pathologist. Her scholarly work is dedicated to understanding and supporting language and literacy development of individuals who are living in multilingual and transnational communities. Dr. García’s research interests include sociocultural and psycholinguistic perspectives of literacy, literacy assessment and instruction, and early literacy and biliteracy development in multilingual communities. She is also interested in promoting dialogue with teachers about sociopolitical issues related to linguistic and cultural diversity in literacy learning in schools.
Michèle A. Marx, M.S.Ed., is administrative coordinator of Hofstra University’s Reading/ Writing Learning Clinic. Ms. Marx is also a student in the Ph.D. Program in the Department of Literacy Studies at Hofstra’s School of Education, Health and Human Services. She earned an M.S.Ed. in literacy studies from Hofstra University and has extensive professional experience in early childhood education. Ms. Marx’s scholarly interests include the interplay between critical literacies and identity development from a sociocultural perspective. She is also interested in exploring the use of multimodal and digital literacies in the 21st century.
Michèle A. Marx
CCI preschoolers tend to their vegetable garden.
Child Care Institute Photo credit: CCI staff.
Donna Tudda, Director
s the percent of women in the workforce continues to grow, the question parents find themselves asking is, “Who will care for my children?” According to data from the U.S. Department of Labor, the percentage of women in the labor force rose from 42 percent in 1970 to 60 percent in 2005. (1) In 2009 the National Association of Child Care Resource & Referral Agencies (NACCRRA) stated in its “Family Characteristics and Need for
Child Care” report that according to the U.S. Census Bureau statistics in 2007, the percentage of children under the age of 6 living with both parents was at 68 percent, with 55 percent of those children living in families where both parents work. The percentage of children under age 6 living with a single working parent was reported at 76 percent, with this census survey reporting another 5 percent increase of mothers in the workforce from 2005 to 2009 (from 60 to 65 percent). (2) The significant growth of two-parent and single-parent working families has
driven many families to seek child care in a variety of settings, including au pairs, family day care, group family day care, and center-based care. Working parents may also rely on other family members, neighbors or friends to care for their children. For some, this is the preferred scenario. For many parents, an increasing number report that their own parents need to continue to work and cannot help with child care arrangements. The same is true for neighbors and close friends. It seems that more and more families find themselves in this situation and have to look elsewhere for child care. The
child care decision is weighty and differs significantly for all families. The most significant factors for families deciding on the type of child care are location, cost and quality, with quality usually being the most important of the three. Parents often express that if they cannot be there for their children during the day, they want to be assured that they are leaving them in a safe environment, with someone who is going to meet their child’s needs, foster their development and independence, and support their social and emotional growth. Making this decision takes time and legwork. The more research a family does, the more informed decision they can make. Many rely on the experiences of friends, family and co-workers. Some take to the Internet, researching programs, curriculums and trends. All make a decision that is very personal to them. It is never easy. For families choosing child care centers, there are many questions that need to be asked. What are the qualifications of the staff? Is professional development ongoing? Is the center licensed and regulated? Is it accredited? What is the center’s educational philosophy? How are children supervised? What are the staff/child ratios? Is the environment safe and in good condition? Are there enough materials? If meals are provided, are they nutritionally sound? The list could go on and on. The NACCRRA, through the Child Care Aware Program (www.childcareaware. org) helps parents find licensed care, and because licensing and regulations vary widely, parents need more to go on. The guide Is This the Right Place for My Child? 38 Research-Based
Indicators of High-Quality Care helps parents understand how to better judge quality. The organization developed this guide to assist families in their search for child care programs. Unlike most guides for selecting child care, this booklet explains why each question is important and how it relates to the quality of care. All the questions are based on research about what is important to children’s health, safety and development. (3) The Diane Lindner-Goldberg Child Care Institure (CCI) at Hofstra University is a full-time child care center, operating year-round for children aged 8 weeks through 5 years. Licensed through the New York State Office of Children and Family Services (NYSOCFS), the CCI upholds a rigorous set of regulations, safety guidelines and standards. The CCI is also accredited by the National Association for the Education of Young
Children (NAEYC), the most highly regarded accrediting body in the early childhood education field. Since 1985, the NAEYC has offered a national, voluntary accreditation system to set professional standards for early childhood education programs, and to help families identify high-quality programs. Today, NAEYC accreditation represents the mark of quality in early childhood education. More than 7,000 child care programs, preschools, early learning centers, and other center or school-based early childhood education programs are currently NAEYC accredited. These programs provide high-quality care and education to nearly one million young children in the United States, its territories, and programs affiliated with the U.S. Department of Defense. Although this number is impressive, it represents only about 8 percent of early care and education programs in the United States. (4)
Open-ended, hands-on activities help children learn. Photo credit: Hofstra University Relations staff.
“In a positive, fun, play-filled environment like this, children flourish and continuously reach their highest potential.’’
variety of activities to improve the availability and quality of early childhood programs. A growing number of states have created or are in the process of creating quality rating and improvement systems (QRIS). A QRIS is a systemic approach to assess, improve, and communicate the level of quality in early and school-aged care programs. Similar to rating systems for restaurants and hotels, QRIS award quality ratings to early and school-aged care programs that meet a set of defined program standards. These systems, which may also be called quality rating systems (QRS), provide an opportunity for states to increase the quality of care for children, increase parents’ understanding and demand for higher quality care, and increase professional development of child care providers. QRIS can also be a strategy for aligning components of the early and school-aged care system for increased accountability in improving quality of care. (5)
NAEYC accreditation requires commitment from its programs to maintain a consistent level of professionalism regarding early childhood education, staff qualifications, physical environment, and positive relationships with the families of children served, thereby strengthening the connection between home and school. In May 2009 the CCI was reaccredited under NAEYC’s newly designed system, which was implemented in 2006.
Quality Stars NY is the New York state initiative that is in the process of creating field tests of its newly designed QRIS program. The CCI has applied to become part of this statewide initiative of 20 programs that will include child care centers, as well as family daycares and school-aged programs. The decisions regarding participants will be made in spring 2010. (6) Once finalized, Quality Stars NY will be another system in place to assist families in finding quality child care in our state and help answer parents’ questions before they make a decision.
According to the U.S. Department of Health and Human Services, Administration for Children and Families, many states are involved in a
The following are the most frequent questions asked by parents who are considering the CCI for their infant, toddler or preschooler:
How will my child be supervised? What are the qualifications of the staff? The safety of all children is of the utmost priority of the CCI. Full-time teachers, assistant teachers and teacher aides are employed as the primary caregivers for all children. Children are never left unsupervised. NAEYC accreditation standards for supervision of children are strict and specific, and the CCI upholds these criteria at all times. In addition to the full-time staff assigned to each classroom, the CCI employs a full-time float and a select group of Hofstra University students that are trained and supervised by classroom staff to augment our staff/ child ratios. In addition, all CCI fulltime teaching staff members are trained in CPR and first aid, and all hold certificates from the American Red Cross. The teaching staff holds varying academic degrees in early childhood education, with many having earned, or in the process of earning, a master’s degree. Some staff members have earned a CDA (Child Development Associate) credential, a nationally recognized credential for early childhood professionals. (7) The CCI supports ongoing professional development for all teaching staff and provides a variety of training opportunities each year, including attendance at local, state and national early childhood conferences. Since the CCI is a New York state-licensed center, each staff member must participate in ongoing professional development in areas such as principles of childhood development (including the appropriate supervision of children, nutrition and health needs of children),
curriculum and program development, safety and security procedures (including communication between parents and staff, child abuse and maltreatment identification, and Shaken Baby Syndrome and prevention), and statutes and regulations pertaining to child day care. (8) What is the educational philosophy of the CCI? Will my child be prepared for kindergarten? The Diane Lindner-Goldberg Child Care Institute is a comprehensive early childhood program. The CCI supports an educational philosophy that focuses on the whole child, fostering social, physical, intellectual, creative, and emotional growth and development. The program is built on the understanding that children learn best through play. Providing open-ended, hands-on activities allows children to continue to build on what they have learned, challenging them in a positive manner and assisting them in reaching the next plateau in their development. Each classroom is designed with clearly defined centers, such as blocks, dramatic play, table toys and puzzles, library and science areas. Teachers provide opportunities for a variety of experiences in which children participate at their own pace. In a positive, fun, play-filled environment like this, children flourish and continuously reach their highest potential. Allowing children to choose their own activities keeps them focused, engaged and open to new learning. The children at the CCI benefit from a warm, nurturing environment that identifies and meets each child’s individual needs while enhancing strengths and interests. The focus of
the program is on the process, rather than the finished product. This allows the children to play, explore and create. Providing opportunities for children’s success through developmentally appropriate activities fosters a continued lifetime of learning. The CCI’s early childhood education philosophy supports kindergarten readiness in many ways. Children are exposed to reading and writing through small and large group literacy activities, songs and fingerplays. Children are encouraged to tell stories, illustrate their ideas and share cooperatively with others. Playing with blocks teaches children the basics of math (i.e., two smaller blocks placed next to each other equals the length of one long block, and so on). Setting the table at mealtime teaches on-to-one correspondence, another basic math skill. Children are given many opportunities to be heard and listened to with
respect.In kindergarten, children need to be socially and emotionally ready to work cooperatively, by sharing and taking turns, as well as working independently to solve disputes. At the CCI, children participate in activities designed for this specific purpose. Children are encouraged to interact with their peers through play, on a regular basis, learning the importance of respect, tolerance and selfregulation. In kindergarten, children are expected to understand and work within classroom rules, displaying appropriate behaviors. The preschool children at the CCI gain experience in this area by working as a group to establish classroom “rules,” creating a sense of ownership. Setting clear and consistent limits allows children to understand what is expected of them, giving them the power to behave accordingly. Giving children the ability to make real choices, within limits, gives them the experience necessary to be successful in kindergarten.
CCI staff member helps children learn through play. Photo credit: CCI staff.
differences in people are important aspects of the program. Cultural diversity is celebrated and is an important part of the educational programming of the CCI. Parents are asked to contribute to their child’s learning in every way they can. Parents or family members wishing CCI student worker fosters social/emotional to share information development. Photo credit: CCI staff. about their jobs or special talents (such as art, music, dance, and science) are welcome to visit with Treating children with respect, giving their child’s class, strengthening the them love and support, providing them bond between school and home. with a safe learning environment that Parental feedback regarding the challenges, not frustrates, and aiding in program’s policies and procedures are the development of a positive selfkey in having a successful working image are important goals of the relationship. Parents are always program. welcome at the center and are encouraged to drop by anytime or join What role do parents and families us for lunch. The CCI is their center, play? Are parents welcome to visit and parents are considered an integral during the day? part of our program. The Child Care Institute firmly Why choose the CCI? believes in parents as a child’s first teachers. Making a smooth transition to full-day child care requires open communication between parents and caregivers. These lines of communication must remain strong. Written daily sheets for infants and toddlers communicate what has transpired during the day. Weekly information sheets for preschoolers give parents insight as to what activities and events took place during the week, as well as future plans. Parental input is necessary for the program to flourish. Family situations, cultural awareness, and similarities and
The CCI has been in operation since January 1991, and it maintains an impeccable record with NYOCFS, its licensing agency. The CCI is part of the Joan and Arnold Community Services Center, which houses four community service clinics. The Speech-LanguageHearing Clinic offers support to our children and teachers by providing weekly language stimulation lessons within our classrooms. The SpeechLanguage-Hearing Clinic students and clinicians work with our preschool children on a weekly basis,
encouraging language development and socialization. Hearing screenings for the children are conducted each year through the Speech-Language-Hearing Clinic at no cost to our families. The Reading/Writing Learning Clinic provides many support sessions for our teachers in the area of early literacy. In addition, this clinic offers evening programs for our parents that promote literacy and the understanding of developmental milestones in this area. Both the Speech-Language-Hearing Clinic and Reading/Writing Learning Clinic have been instrumental in helping the CCI obtain funding for more than 12 years through a grant supporting early literacy. The Initial Teaching Alphabet (ITA) Foundation has supported an early literacy program for the CCI children and families, strengthening the connection between families and teachers while supporting educational goals. Like all families, CCI families sometimes find themselves embarking on uncharted territories such as a disability or illness, divorce, loss of a loved one or sudden unemployment. For them, finding expert support in these areas is just a few steps away. As part of the Saltzman Community Services Center, CCI families have turned to the Marriage and Family Therapy Clinic (MFT) or the Psychological Evaluation, Research and Counseling (PERC) Clinic, where professionals help guide them through these difficult times. Both clinics also support our families and staff with on-site training and workshops in the areas of parenting, discipline, and setting limits and goals for children. Because parents and families trust the CCI, it is easy to suggest the help of our “friends” next door.
The CCI is fortunate to be a part of Hofstra University. The CCI children have access to the entire campus and are invited to participate in many University-wide activities. The CCI children visit the Hofstra University Museum galleries, fishpond, bird sanctuary, library, playhouse, theaters and athletic fields. As a registered arboretum, the University provides the children with surroundings that are both beautiful and educational, exposing them to the beauty of nature, and the wonders of larger-than-life sculptures, as the children take leisurely walks through the campus. The Hofstra University Physical Plant Department has designed a garden area within our playground. In this area, the children tend to growing plants and harvest vegetables while learning important values about good nutrition and our environment. The children have assisted in planting tulip bulbs and even trees on our beautiful campus. Since first opening its doors in 1991, the CCI has held a contract with Nassau County’s Department of Social Services to serve income-eligible working families subsidized to receive
child care benefits. In addition, through the support of generous private donors and foundations, the CCI has been able to offer scholarship assistance for families whose economic status would preclude them from being able to afford these child care services. The Diane Lindner-Goldberg Child Care Institute, with the support of the entire Hofstra University community, continues to provide young children with a positive, play-filled, educational, supportive and nurturing environment in which our youngest members of society can reach their highest potential, making the CCI’s name synonymous with quality early childhood programming.
Sources: 1. Data from U.S. Department of Labor, 2005, Employment and Earnings, Washington, DC: U.S. Government Printing Office, p. 196. 2. Child Care in America: State Fact Sheets, April 2009, http://www. naccrra.org/randd/
3. Is This the Right Place for My Child? 38 Research-Based Indicators of High-Quality Child Care, http:// www.naccrra.org/publications/ naccrra-publications/is-this-theright-place-for-my-child 4. The National Association for the Education of Young Children, http://www.naeyc.org/academy/ 5. U.S. Department of Health and Human Services, Administration for Children and Families, National Child Care Information and Technical Assistance Center, http://nccic.acf.hhs.gov/pubs/qrsdefsystems.html 6. Quality Stars NY, http://nccic.acf. hhs.gov/pubs/qrs-defsystems.html 7. Council for Professional Recognition, http://www.cdacouncil. org/cdawhat.htm 8. NYS Office of Children and Family Services, Division of Child Care Services, Regulations for Operating a Child Care Center, http://www. ocfs.state.ny.us/main/childcare/ regs/418-1_CDCC_regs.asp#s14
Donna Tudda, M.S., has served as director of Hofstra’s Diane Lindner-Goldberg Child Care Institute (CCI), a National Association for the Education of Young Children (NAEYC)-accredited child care center, since 1995. Ms. Tudda led the program to its first NAEYC accreditation in 2000, and the center has been NAEYC-accredited since then. Ms. Tudda holds a bachelor’s degree in elementary education and a master’s degree in early childhood education from Long Island University, and has been a presenter at national and local conferences.
Professor Seifer in session.
Marriage and Family Therapy Clinic Madeline Seifer, Director History of the Profession
he field of marriage and family therapy is relatively new. Its roots can be traced back to the early 20th century, where it first appeared in the child guidance movement and was labeled marriage counseling (Sholevar, 2003). Not until 1942, with the formation of the American Association of Marriage Counselors, did the field gain national recognition. In the mid-1950s, anthropologist Gregory Bateson and several of his colleagues adapted ideas from cybernetics and general systems
theories and postulated that certain feedback loops and homeostatic mechanisms influenced here-and-now behaviors among people in relationships, and they devised the notion of circular causality. This fundamental concept, upon which family therapy is based, has the clinician focused upon the existing process that is thought to maintain or exacerbate problems between individuals. During the mid-1960s, several distinct models of family therapy began to emerge, based upon the works of some of the original â&#x20AC;&#x153;giantsâ&#x20AC;? in the field.
These founders include Milton Erickson, Salvador Minuchin, Jay Haley, Virginia Satir, Carl Whitaker, and Murray Bowen. The 1970s and 1980s saw an evolution of several of these seminal models, through revision and integration. By the early 1990s, a post-modernistic approach to thinking about relationships and change process had emerged. This era produced more noted theorists, including Lynn Hoffman, Bill Oâ&#x20AC;&#x2122;Hanlon, and Michael White. Toward the end of the 20th century and into the 21st, family therapy had grown into the second most utilized form of
psychotherapy after cognitive behavioral therapy (Psychotherapy Networker, 2007).
History at Hofstra University While all of these theories and models of treatment were evolving internationally, the Marriage and Family Therapy (MFT) Program was taking root at Hofstra University. Dr. Don David Lusterman founded the MFT Program and began training students here in 1982. One year later, the directorship of the program was passed on to Dr. Joan Atwood, who fine-tuned it and maintained the program at the cutting edge of the developing field for 23 years. Founded in 1991, the Joan and Arnold Saltzman Center was an ideal site for the Marriage and Family Therapy Program to begin its clinical work, which occurred in 1992, under the directorship of Dr. Atwood. Progress was slow for the next few years. Referrals were sparse, offering limited opportunities for clinical training. Then in 2006 New York state licensed the practice of marriage and family therapy, which contributed to an increase in referrals. In addition, Professor Madeline Seifer was appointed director of the Marriage and Family Therapy Clinic. With the advent of regulation and the input of new personnel, the Marriage and Family Therapy Clinic took its place as an integral part of the Saltzman Center.
George Simon, M.S., LMFT The veteran member of the team, Professor George Simon began supervising at the Saltzman Center in 1994. He is one of the world’s foremost authorities in the field of structural family therapy. George Simon is an adjunct assistant professor in and director of the Master’s Program in Marriage and Family Therapy at Hofstra University. He is also a member of the faculty of the Minuchin Center for the Family. He sees couples and families in his therapeutic practice in Deer Park, New York. Professor Simon has published numerous articles in scholarly journals and co-authored, along with Salvador Minuchin and Wai-Yung Lee, Mastering Family Therapy: Journeys of Growth and Transformation, published by John Wiley & Sons. His most recent book is titled Beyond Technique in Family Therapy: Finding Your Therapeutic Voice, published by Allyn & Bacon. Recent publications
“Toward the end of the 20th century and into the 21st, family therapy had grown into the second most utilized form of psychotherapy after cognitive behavioral therapy.’’
Current Supervisors The Marriage and Family Therapy Clinic utilizes the professional services of five supervisors, all of whom are licensed by the state of New York. They reflect various backgrounds and teach various models of family therapy. Photo courtesy of thinkstock.com.
include a chapter on structural therapy with couples in the fourth edition of the Clinical Handbook of Couple Therapy, and a co-authored chapter on family assessment in the third edition of the Handbook of Multicultural Assessment: Clinical, Psychological, and Educational Applications. Professor Simon holds a bachelor’s degree in meteorology from New York University, a master’s degree in philosophy from Fordham University, and a master’s degree in counseling, also from Fordham University. He was trained in structural family therapy by Salvador Minuchin, the chief architect of this therapeutic approach. Madeline Seifer, M.A., LMFT In addition to her duties as director of the Marriage and Family Therapy Clinic, Professor Madeline Seifer enjoys her role as a clinical supervisor. She is a New York state-licensed marriage and family therapist, as well as an approved supervisor for the American Association for Marriage and Family Therapy. She is an adjunct instructor in Hofstra University’s Marriage and Family Therapy Program, having graduated from the program in 1993. Prior to her graduate work at Hofstra University, Professor Seifer earned a bachelor’s degree in social psychology from CUNY’s Queens College. Professor Seifer brings a post-modern perspective to her model of supervision and offers students an opportunity to incorporate some solution-focused techniques into their clinical work. In her private practice in Jericho, New York, Professor Seifer specializes in relationship issues of all types, particularly those that involve chronic
illness, parenting and extramarital affairs. In her leisure time, Professor Seifer enjoys travel and musical theater, and is an avid tennis fan. Julie Askew, Ph.D., LMFT Dr. Julie Askew is an assistant professor in the Department of Health Professions and Family Studies. She earned a doctorate in child and family development with a marriage and family therapy specialization from the University of Georgia, and she holds a master’s degree in psychotherapy and psychosexual therapy from South Bank University in London, England. Dr. Askew has been working as a therapist since 1991 in a variety of settings, including private practice, mental health clinics and hospitals. She also completed two years of specialist training in couple relationships and sex therapy at the Maudsley Hospital and Institute of Psychiatry in London. Dr. Askew teaches courses in the areas of marriage and family therapy, and sexual health. Her current research is focused on women’s sexuality after hysterectomy, and she will soon begin a new study exploring minority youth sexual behaviors in the Hempstead, New York, area. Dr. Askew has published journal articles on topics such as couples and Viagra, gynecological surgery, sex education, mothers with breast cancer, and parenting. Nancy Cohan, M.A., LMFT Professor Nancy Cohan recently joined the supervisory staff at the Saltzman Center, having spent the past 10 years as the director/supervisor of Family and Children’s Association of Nassau County. Professor Cohan is a graduate of Hofstra University’s Marriage and
Family Therapy Program and is currently an adjunct professor in the same program. She is widely versed on several models of family therapy, but favors a solution-focused approach to her clients and to supervision. Rhiannon C. Beauregard, M.A., LMFT Rhiannon Beauregard is the assistant director of the Marriage and Family Therapy Clinic. She is a licensed marriage and family therapist and a clinical member of the AAMFT. She holds a B.S. in special education from Boston University and an M.A. in marriage and family therapy from Hofstra University. Ms. Beauregard is in private practice in Huntington, New York, and works with couples, families, and individuals, utilizing a client-centered, post-modern approach. She specializes in high-risk youth, families with children with disabilities, couples with sexual issues, LGBTQ couples and families, and children who are victims of sexual abuse. Ms. Beauregard is a certified equine assisted psychotherapist and specializes in using horses as a tool of emotional growth and learning. She is also certified in crisis prevention and intervention.
Different Approaches and Models of Family Therapy Family Therapy, a different point of view. When a child displays some acting out behavior, the explanation may be that he/she is “looking for attention,” has some learning disorder, is being mistreated, etc. These are all linear explanations. The family therapist tends to contextualize the behavior, looking for circular causality. The explanation tends to be more in context
with the child’s family or larger school systems. Let’s look at how a structural family therapist might conceptualize this behavior. A structural model of family therapy was first developed by Salvador Minuchin in the early 1970s. Professor George Simon has been teaching this model at the Saltzman Center since 1993. This model offers a blueprint for examining the process of family interactions. The structure of a family is conceptualized as the organized pattern in which family members interact. The clinician is directed to look for patterns as well as alliances and coalitions between family members. This is accomplished through a process known as enactments, during the family therapy sessions. When a misalignment of the subsystems prevents flexible functioning of the family, the clinician works to rearrange patterns of interaction by offering a wider range of behaviors to individual family members, with the hope of helping them change some of the rigid rules maintaining the problem.
Figure 1. Scapegoating as a Means of Detouring Conflict
In our example of the acting out youngster, the structural family therapist notices “scapegoating” of the child. See Figure 1 (reprinted from Nichols, 2006). Figure 1 represents a couple having difficulty resolving their own conflicts by diverting the focus of their concerns onto one of their children. This scapegoated child assumes the role of the reducer of conflict between his/her parents, resulting in the acting out behavior. Therapy would not merely suggest a behavior modification chart for the child, but would include a focus on the couple’s marital and parenting issues. A post-modern assessment of the presenting problem: Given a similar presenting problem, other supervisors at the Marriage and Family Clinic might approach the assessment and intervention differently. Both Professors Seifer and Cohan, who ascribe to a solution-focused model of family therapy, would perhaps direct their students to have family members detail times when the problem was not happening or was happening to a lesser extent. They would have the parents cite examples of times when the child was behaving better and notice what was different about those times. (Was the couple less conflicted? Were other siblings present? Did a certain activity precede the improved behavior?) The family would then be encouraged to amplify or exaggerate the times when the problem was NOT occurring. Another post-modern approach, often utilized by Dr. Askew with her students, is a narrative model. With this model, the family, with the help of the therapist, would be assisted in co-creating a slightly different story about the child’s behavior. The therapist
would externalize the problem for the family members so they could unify their forces against it.
Current Activities: Groups: In addition to the counseling services provided to family members, the Marriage and Family Therapy Clinic also facilitates psychoeducational and support groups for community members. These varied groups cover many diverse topics, and they have evolved out of particular student interests as well as community needs. As an example, one of the clinic’s most popular groups was the midlife group, begun by a “more mature” student who was interested in the topic. The group ran for a number of years, and its members maintained continuing relationships beyond their experiences at the Saltzman Center. Similarly, the women’s empowerment group began with two dedicated female interns, and continues today long after these students graduated. Currently, a student involved in his own family’s successful business is formulating a support group for community members involved in their own family businesses. In response to the Nassau County Court System, and general community demand, the Marriage and Family Therapy Clinic has, at various times, provided the following services: parenting groups, parenting through divorce group, divorce support group, and supervised visitations. As a multidisciplinary facility, the Saltzman Center clinics often work collaboratively to enhance each entity’s services. Several outgrowths of these sorts of collaborations have utilized the services of the Marriage and Family Therapy Clinic and have resulted in the
following groups, which run when there is a demand: autism support group (for families with a child on the Autism spectrum), caring for caregivers group (for spouses of aphasia patients being seen in the Speech/Language/Hearing Clinic), families with children with disabilities group (taking referrals from within and outside of the center), and the mother/ daughter group (an extension of a program developed by the Reading/ Writing Learning Clinic). Other areas of interest that have resulted in groups and workshops include: ៉ ៉ ៉ ៉ ៉ ៉ ៉ ៉
Bereavement Couples/intimacy group Domestic abuse Premarital group Self-esteem group Stress management and the family LGBTQ family support Teen talk group
Case Study: Marriage and family therapists provide treatment for a host of relationship issues. Typical cases treated at the Marriage and Family Therapy Clinic involve couple difficulties, parenting, and the strife associated with the divorce process. The following case involved divorce, co-parenting, extramarital affairs, self-destructive behaviors, and, finally, a readjustment to life after divorce. When Robert and Barbara (pseudonyms) were married 15 years ago, their future looked bright. He was an aspiring professional, and she was gainfully employed. A few years later, after he had opened his private practice, Barbara became pregnant with their first child. Another child
came along a few years later. Barbara enjoyed her new role as a full-time, stay-at-home mom, while Robert maintained the somewhat traditional role as the family breadwinner. As Robert’s practice became less lucrative, he became more withdrawn. Both partners, rather than supporting one another, succumbed to the stress and turned away from each other. They retreated into Internet affairs and impulse shopping. The stress in their lives mounted, as did their debt. They eventually filed for divorce and were referred to the Marriage and Family Therapy Clinic at the Saltzman Community Services Center for help with co-parenting their children through a highly contentious situation. The years of stress and mutual degradation had eroded their sense of themselves as a couple and as individuals. Their couple sessions devolved into shouting matches and name-calling. They were not willing, at this point in their lives, to put their issues on hold, not even for the sake of their children. Robert decided to discontinue therapy. As Barbara continued to come in for sessions with her therapist, she used the time to vent and complain about her situation and portrayed herself as a victim. She reported that she felt better after her sessions with the therapist. However, the clinician saw the need to move her along and help her restore a sense of competency and self-worth. Solution-focused therapy was utilized. Solution-focused therapy was developed by family therapists Steve deShazer, Bill O’Hanlon, Insoo Berg and Michelle Weiner-Davis. The model of therapy uses a competency-based approach rather than a deficit-based one. It looks for times when the
problem is not present (exceptions), amplifies those times, and presents a glass half-full, rather than half-empty, assessment to the client. This reminds clients that the solutions are within themselves, since there had been times when they were already applying their own solutions but are now mired in their problem-saturated stories. In the above-cited case, Barbara was asked about times when she felt better about her relationship and about herself. She noted that she hadn’t felt competent since she stopped working. She also noticed that her self-worth was primarily based upon other peoples’ assessment of her achievements rather than upon her own. The therapist focused the discussions onto times when the problems were not happening (exceptions). For example, it was noted that Barbara had actually been paid recently for participating in various surveys and clinical trials. She managed to save the money, and her sense of accomplishment for having done so was recognized, highlighted and amplified by the therapist. During this time, the problem (being a victim) was not happening, or was happening to a lesser extent. Noticing this, Barbara discovered the possibility for change. Almost immediately after this session, Barbara determined that she needed to find a job so that she could support herself and not remain dependent upon her ex-husband. Asked how she would do this, Barbara came up with a plan for securing a job and did so within one month. At present, she is employed, working off her debt, and feeling more competent and more confident. The issues with the children have improved, largely due to the fact that Barbara’s dependency on her husband has eased off. She is better able to handle the bickering at home and is moving forward with her life.
Future of the Field and the Clinic The field of marriage and family therapy is currently directed toward prediction and prevention of traumatic life experiences. Much like earthquakes and other natural disasters, devastation may be preventable if we have an awareness that some event is likely to occur. John Gottman (1994) has done the most extensive research in the areas of marital satisfaction and domestic violence. Others such as Carter and McGoldrick (2004) and Stith and colleaques (2003) have contributed to these areas of study as well, providing insight into predictable cycles of relational behavior. The Marriage and Family Therapy Clinic is interested in pursuing research initiatives, particularly in the areas of pre-marital counseling and the prevention of domestic violence.
External funding opportunities are continually being sought to facilitate these projects, an example of which is the Safe Homes Project, recently acknowledged by a gift to the Marriage and Family Therapy Clinic from the Target Corporation. As our burgeoning field continues to grow and develop, the Marriage and Family Therapy Clinic looks forward to an exciting future as an integral part of the Saltzman Center. Our students are eager to learn about and practice within the profession, and the clinic continues to expand its services to the community.
References Carter, B., & McGoldrick, M. (2004). The Expanded Family Life Cycle. Boston, MA: Allyn & Bacon.
Gottman, J.M. (1994). Why Marriages Succeed or Fail: And How You Can Make Yours Last. New York: Simon & Schuster. Nichols, M.P. (2006). Family Therapy Concepts and Methods. Boston, MA: Allyn & Bacon. Sholevar, G.P. (2003). Family theory and therapy. In Sholevar, G.P., & Schwoeri, L.D. Textbook of Family and Couples Therapy: Clinical Applications. Washington, DC: American Psychiatric Publishing Inc. Stith, S.M., Rosen, K.H., & McCollum, E.E. (2003). Effectiveness of couples treatment for spouse abuse. Journal of Marital & Family Therapy 29 (3). Psychotherapy Networker. (2007, March/April). The top 10: The most influential therapists of the past quarter-century.
Madeline Seifer, M.A., LMFT, is an adjunct professor in the Department of Marriage and Family Therapy at Hofstra University. She also serves as director of the Marriage and Family Therapy Clinic at the Joan and Arnold Saltzman Community Services Center. Professor Seifer holds degrees in social psychology and marriage and family therapy. Her scholarly work centers around research in the area of extramarital affairs and chronic illness. She has given numerous presentations at hospital facilities, to families and caretakers of chronically ill people. In addition to her work in the classroom, Professor Seifer holds the designation of approved supervisor for the American Association for Marriage and Family Therapy. This designation qualifies her to supervise graduate and postgraduate students in the field of marriage and family therapy. Madeline Seifer
Social Participation Approach to Aphasia Wendy C. Silverman, M.S., CCC-SLP, Director
magine that you are in a foreign country with a language not native to your own. You are not easily able to communicate with other people or understand what they are saying to you. Reading traffic signs and menus is difficult. Communicating your thoughts by writing is nearly impossible. You feel frustrated, helpless, angry or depressed and try to book the next plane out of town. What if you could never leave, and the constraints on your communication were permanent? The National Aphasia Association (NAA) states that the use of speech to
communicate is unique to humans. When speech is impaired or absent, the psychosocial impact on the person and his family is both profound and permanent. One of the most isolating and devastating communication disabilities is aphasia. According to the NAA Web site, aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to the brain â&#x20AC;&#x201C; most commonly from a stroke, particularly in older individuals. Brain injuries resulting in aphasia may also arise
from head trauma, brain tumors, or infection and inflammation. The NAA further explains that aphasia can range in severity. It can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired such that some channels remain accessible for a limited exchange of information. It is the job of the professional to
determine the amount of function available in listening, speaking, reading and writing in order to assess the possibility that treatment might enhance the use of the channels that are spared. Aphasia is a language-processing disorder that impairs a person’s ability to speak or understand speech. It manifests itself differently in different people, but generally the individual’s intelligence is intact. Nevertheless, a person with aphasia may not be able to read a utility shut-off notice, ask a waiter for a cup of coffee, or follow a news story on TV. More than one million Americans have acquired aphasia – a greater number of people than have cerebral palsy, multiple sclerosis, Parkinson’s disease, or muscular dystrophy. Approximately 20 percent of the 600,000 Americans who suffer a stroke each year will acquire aphasia. The onset of aphasia is sudden – in an instant, one’s life is irrevocably altered. The effects are generally long-term. “One does not recover from aphasia, one recovers with aphasia,” noted National Aphasia Association (NAA) President Dr. Martha Taylor Sarno. Because of the disconnect between their ability to think and their inability to communicate, people with aphasia often become extremely frustrated, depressed, and isolated. Everyone in the person’s life is affected by the disability, and caregivers require support to adjust to the challenges of living with aphasia. In a study published in the July 2001 issue of Stroke: Journal of the American Heart Association, researchers examined the short-term psychological effects of stroke on a group of patients’ spouses. Researchers found that spouses
experience a sharp decline in their sense of well-being and a sharp rise in psychological stress within days of their mate’s stroke. Previous studies have traced the psychological impact of stroke on families over time and found that 20 to 50 percent of caregivers experience emotional disturbances, especially depression. Other studies comment that the emotional and practical support of the caregiver is known to affect the functional and psychological outcome of the stroke patient. Spouses demonstrated lower psychological well-being compared with a normal population, and the extent of disability of the stroke patient was correlated with the spouse’s outlook on the future. Chapey (2001) and her colleagues describe many different approaches to the treatment of communication disorders associated with aphasia. Recently, treatment of aphasia has utilized a social participation model. This approach evolved for a variety of reasons. Medical insurance has reduced
“The onset of aphasia is sudden – in an instant, one’s life is irrevocably altered. The effects are generally long-term.’’
Professor Silverman in group session with graduate students and clients. Photo credit: Hofstra University Relations staff.
funding for speech-language therapy services, causing a significant reduction in services available to people with aphasia. Frattali (1996) describes that restructuring in health care has forced clinical service providers to balance quality outcome with cost of care. Pressure from consumers, desire to improve outcomes and changes in the health care industry suggest an urgent need for creative approaches that increase the quality of communicative life for those affected by aphasia. Chapey (2001) states that treatment that produces meaningful real-life outcomes, with the potential that these changes can enhance an individual’s quality of life, is essential. Social models provide a philosophical framework for developing interventions that fulfill this requirement. Psychosocial/functional approaches to clinical intervention have been discussed in the clinical literature. The focus of these approaches is on improving the person’s ability to participate in communication in daily living activities. The Life Participation Approach to Aphasia (LPAA) is a consumer-driven service delivery approach that supports individuals with aphasia and others affected by it in achieving their immediate and longerterm life goals (Chapey, 2001). LPAA places the life concerns of those affected by aphasia at the center of all decision making. It empowers the consumer to select and participate in the recovery process and to collaborate on the design of interventions that aim for a more rapid return to active life. Simmons-Mackie (2000) discusses how individuals with aphasia report social isolation, loneliness, loss of autonomy, restricted activities, role changes, and stigmatization. The social approach
acknowledges that aphasia is a chronic disorder with long-term consequences beyond the acute disruption of communication. The goal of a social approach is to promote membership in a communicating society and participation in personally relevant activities for those affected by aphasia. In spite of linguistic gains, many people with aphasia experience residual communication problems that significantly impact their daily lives and remain as barriers to full participation in social settings. Untreated or unrecognized psychological and social problems can increase disability, diminish community reintegration, and reduce response to rehabilitation.
an increasingly significant role in clinical management. Presently there is increased emphasis on treating individuals at the level of handicap or well-being, rather than treating their impairments per se. Multipurpose groups that attempt to address the needs of the “whole” patient are rapidly becoming the norm rather than the exception. Clinical researchers have recently developed novel group treatment methods. Treatment efficacy is being put to scientific tests, and data by researchers is accumulating to support the use of group therapy for aphasia (Elman, 1999). Group therapy is considered an essential component, rather than a supplement, to a treatment protocol.
Elman (1999) talks about how managed care and the decrease of funding for services for persons with aphasia have increased the need for group therapy for persons with aphasia. With less time and resources to treat patients, group therapy approaches are playing
Assessment Assessment tools within a social communication model go beyond traditional linguistic models to include measures of outcome that are functional. These tools may include
Graduate students facilitate social communication. Photo credit: Hofstra University Relations staff.
perspectives of those affected by aphasia, professional judgments of communication and participation, or actual life accomplishments. These accomplishments may include sharing a joke, returning to work, sharing a meal with friends or reading a story to a grandchild. Perspectives of those affected by aphasia can be measured in a number of ways. Ethnographic interviews have been recommended to determine the personal viewpoints of those affected by aphasia (Simmons-Mackie and Damico, 1996a, 1999a). Interviews analyzed before, during, and after intervention and general themes are analyzed for treatment goals. Communication profiling systems use interviews, personal journals and observation to identify communication behaviors of the clients and significant communication partners. Quality-oflife tools assess life satisfaction from the perspective of the person with aphasia at different times across the treatment program. Consumer satisfaction assessment measures rate clients’ and family members’ perceived satisfaction with communicative comfort, confidence, connectedness and pleasure. Professional judgments by speechlanguage pathologists are another way to measure outcomes. Functional assessment measures rate performance across a variety of tasks that are typical of the daily activities of the client. Activities can include talking on the phone or reading the newspaper. Communicative effectiveness ratings analyze communication interactions and may include success of the transmission of the message, communication efficiency, naturalness or pragmatic appropriateness.
Observational assessment collected by clinicians in natural communication settings is another useful method for analyzing the communication needs of a client and planning for treatment. Accomplishment measures may include participation measures that assess the number of social contacts per week or the variety of activities. Goal attainment scales measure improvement over time for a particular defined life participation goal, such as participating in a successful grocery store purchase. Typically at the beginning of a treatment period, a functional assessment is administered, such as the Quality of Communication Life Scale (ASHA, 2004). This scale is used to determine the impact of a communication disorder on an adult’s relationships and interactions with communication partners and on participation in daily life activities. Upon analysis of the scale, communication strengths and weaknesses can be identified and treatment goals established related to improving the quality of communication life. Specifically, a group member may withdraw from answering the telephone at home. A phone call received three times a week from a friendly and supportive group member may be introduced as an initial communication goal. Strategies are developed for communication success, and progress is discussed within the group.
Treatment The social participation approach to aphasia therapy includes goals of improving overall quality of communication and participation in life activities of choice (Simmons-Mackie,
2000). The treatment is client centered and includes a social network of caregivers as well. Treatment goals often include expanding particular social interaction skills and facilitating confidence in conversation. Conversational therapy is planned and designed to improve participants’ skills to exchange information and fulfill social needs. Skills such as debating, joke telling, and storytelling may be addressed, as well as improving linguistic form and content within a functional context. Enhanced compensatory strategy training is important for improving the naturalness of communication interactions. Strategies such as gestures, writing, drawing, asking for repeats and using augmentative aids are common. Conversational coaching provides practice of communication scripts to be developed jointly by the clinician and clients. In this method, the clinician serves as a coach in an equalized role with the client. The client makes active decisions regarding types of scripts that can be practiced and used in socially relevant situations. Group therapy provides a natural context for improving communication by facilitating participation and improving confidence and psychosocial well-being. Group therapy may also provide an opportunity for an individual with aphasia to practice a strategy, script or technique they learned in individual treatment. Partner training is another method of enhancing communication. By training communication partners in cueing and listening strategies, they become knowledgeable communication partners. Training speaking partners – family members, colleagues at work, friends and the community at large – improves the communication of the
“Using a social participation approach to treat communication disorders associated with aphasia requires a shift from traditional approaches.’’
person with aphasia. Communication increases when partners are knowledgeable about the nature of aphasia and skilled in providing inclusive opportunities for sharing communication with the individual with aphasia. Saltzman Center Speech-LanguageHearing Clinic Social Model The Speech-Language-Hearing Clinic in the Joan and Arnold Saltzman Community Services Center at Hofstra University has utilized a social participation approach in group therapy for people with aphasia for a number of years. Group therapy services are designed to facilitate clients’ compensatory language strategies
during social conversation. It also serves to improve natural communication and psychosocial functioning. The sessions encourage social interaction and peer-modeling among the members of the group, which improves overall pragmatic language skills (Elman & BernsteinEllis, 1999). On a psychosocial level, group therapy serves as a support group environment for these individuals with aphasia, where successful adjustment to living with aphasia is encouraged and modeled by the clinicians and other group members with aphasia (Elman & Bernstein-Ellis, 1999). One group included nine men with aphasia. Each participant had sustained stroke or neurological injury. Length of onset of disability ranged from one year to 10 years or more. One clinical supervisor and two graduate students facilitated the group for a period of 15 weeks. All the goals, established together with the clients and group facilitators, were mutually agreed upon. Initial goals for the group included discussion of psychosocial issues related to living with aphasia, distribution and discussion of educational materials related to aphasia, and, lastly, development of strategies to reduce maladaptive coping styles. Guest lecturers were invited by clients and students. Special topics were presented by eldercare lawyers, psychologists, personal trainers and professors. Outings to campus eateries also provided a natural setting for the development of conversation. A number of functional communication outcomes naturally occurred as a result of the group participation. Over a 15-week period, the group worked together diligently to write an online
article for the National Aphasia Association’s Group of the Month. The process began with the group deciding on the attributes of a successful aphasia group. The clients explained the philosophy for the group as a psychosocial, client-driven model. Next, clients wrote their biographies with assistance from student clinicians. The activities created communication opportunities that challenged the members’ listening, speaking, reading and writing abilities. The group process instilled interpersonal confidence in the members, as they were required to make contributions that were commensurate with their communication abilities. Photos were taken, and drafts of the article were reviewed and edited for submission. The article appeared online in fall 2009, and the clients felt a sense of pride and accomplishment. The University itself provided many opportunities for the group’s communication and psychoeducational needs. Faculty from Hofstra University School of Law, and the Departments of Psychology, Speech-Language-Hearing Sciences, and School of Education, Health and Human Services volunteered time and expertise to provide in-services about pertinent topics that stimulated questions and conversation among the group members. Topics included current Medicare laws, seasonal affective disorder and depression, neurology of the brain, importance of exercise/ nutrition for recovery, and methods of advocating for the rights for individuals with disabilities. Trips to campus eateries provided locations where clients could use their communication skills functionally. A trip to the Hofstra University Museum was inspiring and promoted discussions regarding art
history, artistic style and personal art preferences. A few of the group members discussed meeting for a museum trip in New York City. Group members commented that satisfaction from attending the group was strong because of the fellowship and support achieved among members both during and outside of group sessions. Members shared that they could relate to each others’ unique difficulties and could offer honest advice born out of personal experience. All members were equally eager to learn from each other. Members shared requirements for an ideal group: be small enough in membership to facilitate conversation, be flexible in terms of goals, include discussions about both past and current life events, be clinician structured enough so that the conversation flows productively and natural communication rules are practiced and learned. Conclusion Using a social participation approach to treat communication disorders associated with aphasia requires a shift from traditional approaches. Approaches based on the medical model serve patients in the acute stages of recovery. However, this stage of recovery is limited in time and does not adequately address the needs of the individual who will be living with a chronic disorder of communication. It has become evident that there is a need to view the treatment of aphasia as a continuum of services adapted to meet the needs of persons with aphasia across the life span (Elman, 1998). In a social approach, the long-term personal consequences of aphasia are the focus of intervention (Chapey, 2001).
aphasia. In Worrall, L., & C. Frattali (eds.), Neurogenic communication disorders: A functional approach (pp. 162-187). New York: Thieme.
Speech-language pathologists play a critical role in teaching strategies and providing social opportunities for people with aphasia that are finely tuned to develop competence in communication and enhance the quality of life across the lifespan.
Simmons-Mackie, N., Damico, J., & Damico, H. (1999). A qualitative study of feedback in aphasia therapy. American Journal of SpeechLanguage Pathology, 8, 218-230.
References Chapey, R. (2001). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. Baltimore: Lippincott Williams & Wilkins Elman, R. (1998). Memories of the ”plateau”: Health-care changes provide an opportunity to redefine aphasia treatment and discharge. Aphasiology, 12, 227-231. Elman, R., & Bernstein-Ellis, E. (1999a). The efficacy of group communication treatment in adults with chronic aphasia. Journal of Speech, Language, and Hearing Research, 42, 411-419. Elman, R. & Bernstein-Ellis, E. (1999b). Psychosocial aspects of group communication treatment: Preliminary findings. Seminars in Speech & Language, 20(1), 65-72. Frattali, C. (1996) Measuring disability. ASHA Special Interest Division 2 Newsletter-Neurophysiology and Neurogenic Speech and Language Disorders, 6, 6-10. The National Aphasia Association. http://www.aphasia.org/ Simmons-Mackie, N. (2000). Social approaches to the management of
Simmons-Mackie, N., & Damico, J. (1996a). Accounting for handicaps in aphasia: Communicative assessment from an authentic social perspective. Disability and Rehabilitation, 18, 540-549.
The Speech-Language-Hearing Clinic offers diagnostic and treatment services to children and adults for a variety of communication disorders. All clinical services are supervised by professional speech-language pathologists and audiologists who hold certification by the American Speech-Language-Hearing Association. Speech-language pathology services include: ៉ Comprehensive evaluations of communication, including speech, language and literacy ៉ Language therapy ៉ Articulation therapy ៉ Voice therapy ៉ Treatment of stuttering ៉ Treatment of myofunctional disorders, swallowing and related functions ៉ Treatment of cognitivecommunication disorders ៉ Consultation regarding augmentative/ alternate communication
In addition, communication enhancement services are offered to: ៉ Improve English-language proficiency ៉ Modify accent Audiology services include: ៉ Audiological evaluations and screenings ៉ Hearing aid evaluations, including fitting and dispensing ៉ Central auditory processing evaluations ៉ Aural rehabilitation services Specialty programs within the Speech-Language-Hearing Clinic include:
៉ Aphasia Program – designed to assist in the recovery of speech, language, reading, writing and functional communication. Group therapy supports individual treatment, and provides opportunities for social participation. The program also includes a group for caregivers of people with aphasia. Community-based projects include:
៉ “Speaking of Toddlers”– a language stimulation group for preschoolers. Through developmentally appropriate play, sensory-based activities, and snack/craft/story time,
Wendy C. Silverman
children develop vocabulary and social communication skills. Language facilitation strategies, peer-to-peer interactions in small group settings, and parent training are used to achieve each child’s individual language/ communication goals.
៉ Language stimulation groups at the Saltzman Community Services Center’s Diane Lindner-Goldberg Child Care Institute (CCI). Through this program, infants,
toddlers and preschoolers enrolled at CCI participate in communication and literacy enrichment activities that include story telling, music, crafts and creative play. The goals of the program are to increase social communication skills, promote academic readiness and reduce risks for language-learning difficulties. ៉ Language-literacy support program at a local elementary school. This project provides language-literacy support for kindergarteners at high risk for developing language-literacy disorders. The instructional method uses an explicit, sequential approach to promote letter identification and phonological awareness. A responseto-intervention (RTI) approach is utilized to identify those individuals who may require further evaluation of language-literacy abilities.
Wendy C. Silverman, M.S., CCC-SLP, joined the staff of the Saltzman Center as director of the Speech-Language-Hearing Clinic in January 2002. She is also an assistant professor in the Department of Speech-Language-Hearing Sciences. She holds a Bachelor of Arts from SUNY Buffalo and a Master of Science from the University of Michigan. She was a staff speech-language pathologist at United Cerebral Palsy of Nassau County and the International Center for the Disabled (ICD), where she cultivated a special interest in neuro-rehabilitation. For more than a decade, Professor Silverman was employed at Transitions of Long Island, a multidisciplinary neuro-rehabilitation center within the North Shore-LIJ Health System, as coordinator of speech-language therapy services and case manager. While at Transitions, she diagnosed and treated individuals with acquired neurologic injuries, including traumatic brain injury, stroke, brain tumor, anoxia, encephalitis, mild head injury and other brain diseases. She has performed numerous administrative tasks designed to improve the quality of care for individuals with neurological disabilities. She has been a frequent guest lecturer at area universities and a presenter at state and national conferences.
Hofstra at a Glance
Trustees of Hofstra University As of May 2010
LOCATION: Hempstead, Long Island, 25 miles east of New York City. Telephone: (516) 463-6600 FOUNDING DATE: 1935
OFFICERS Marilyn B. Monter,* Chair Alan J. Bernon,* Vice Chair David S. Mack,* Vice Chair Joseph M. Gregory,* Secretary Stuart Rabinowitz, President
PRESIDENT: Stuart Rabinowitz, J.D. CHARACTER: A private, nonsectarian, coeducational university ACCESSIBILITY: Hofstra is 100 percent program accessible to persons with disabilities. COLLEGES AND SCHOOLS: Hofstra College of Liberal Arts and Sciences; Frank G. Zarb School of Business; School of Communication; School of Education, Health and Human Services; School of Law; School for University Studies; Hofstra University Honors College; Hofstra University Continuing Education; and Hofstra University School of Medicine in partnership with North Shore-LIJ Health System. FACULTY There are 1,180 faculty members, of whom 554 are full-time. Ninety-one percent of full-time faculty hold the highest degree in their fields. STUDENT BODY: Full-time undergraduate enrollment of 7,327. Total University enrollment, including part-time undergraduate, graduate and School of Law, is about 12,100. Male-female ratio is 45-to-55. DEGREES: Bachelorâ&#x20AC;&#x2122;s degrees are offered in about 140 undergraduate program options. Graduate degrees, including Ph.D., Ed.D., Psy.D., Au.D. and J.D., advanced certificates and professional diplomas, are offered in about 150 graduate program options. LIBRARIES: The Hofstra libraries contain 1.2 million print volumes and provide 24/7 online access to more than 49,000 full-text journals and 42,400 electronic books. JANUARY AND SUMMER SESSIONS: Hofstra offers a January session and three summer sessions between May and August.
MEMBERS George W. Bilicic, Jr. Tejinder Bindra Robert F. Dall* Helene Fortunoff Martin B. Greenberg* Leo A. Guthart Peter S. Kalikow* Abby Kenigsberg Arthur J. Kremer Karen L. Lutz Donna M. Mendes* Janis M. Meyer* John D. Miller* Martha S. Pope James E. Quinn* Lewis S. Ranieri Edwin C. Reed Robert D. Rosenthal* Debra A. Sandler* Thomas J. Sanzone* Joseph Sparacio* Frank G. Zarb*
DELEGATES Gregory Maney, Speaker of the Faculty William F. Nirode, Chair, University Senate Executive Committee Georgina D. Martorella, Chair, University Senate Planning and Budget Committee James Wells, President, Student Government Association Lucas Miedreich, Vice President, Student Government Association Laurie Bloom,* President, Alumni Organization James M. Shuart,* President Emeritus Wilbur Breslin, Trustee Emeritus Emil V. Cianciulli,* Chair Emeritus John J. Conefry, Jr., Chair Emeritus Maurice A. Deane,* Chair Emeritus George G. Dempster,* Chair Emeritus Joseph L. Dionne,* Trustee Emeritus Bernard Fixler,* Trustee Emeritus Florence Kaufman, Trustee Emerita Walter B. Kissinger, Trustee Emeritus Ann M. Mallouk,* Chair Emerita Thomas H. Oâ&#x20AC;&#x2122;Brien, Trustee Emeritus Donald A. Petrie,* Trustee Emeritus Arnold A. Saltzman, Trustee Emeritus Norman R. Tengstrom,* Trustee Emeritus *Hofstra alumni
Reading/Writing Learning Clinic: Building Literacy Connections One Community at a Time