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Teen girl in wheelchair with a communication system beside two adults
Bloom Blog

For Linda, communication starts with seeing through a child's eyes

Linda Buskin (photo above centre) has been a speech-language pathologist at Holland Bloorview for 37 years. Originally from South Africa, she trained in England and learned about Holland Bloorview when she was on a placement at Hamilton’s Chedoke Hospital. At that time, she attended a Blissymbolics workshop at what was then the Ontario Crippled Children’s Centre.

Most of her work here has been in the community. Pulling a cart on wheels with her technology, communication boards and other materials, she’s driven to homes, daycares and schools in the GTA and far beyond into cottage country, to work with children who use voice devices, communication or letter boards or other augmentative and alternative communication (AAC). Sometimes it even means going with a client to the local Tim Horton’s or Walmart to practise having a conversation.

BLOOM: How did you get into this field?

Linda Buskin: I did an undergraduate degree in psychology and was on a pathway to become a clinical psychologist in South Africa when I finished that degree and moved to England. Leaving South Africa was a decision many of my peers and I made, at that time, to make our lives in a country that was less filled with racism.

While in England I worked with a couple—he was a psychoanalyst and she was a speech-language pathologist—and was introduced to speech therapy, and made the decision to switch over. The common thread was communication. We were working with a range of children with autism and severe language disorders who had great difficulty communicating, and that embodied a lot of what I was interested in.

BLOOM: What do you love about your work here?

Linda Buskin: I have many great joys as I see families and clients I work with progress.

Recently we met with the parents of a client who in the past has been extremely reluctant to go to any community events, programs or camps, except for school. They are newcomers to Canada, and he will be graduating this year. His parents were struggling with what his future will look like. 

During our visit they had big smiles and told us he’d gone to sleep-away camp, with great apprehension, last summer. After the first day, he loved being there so much that he didn't want to come home at the end of the week.  He’s become so much more confident in interacting with others, and this year he’s going to camp for longer. He and his parents are feeling so much more optimistic about his future and we're hoping they will get support from Holland Bloorview's Transition program to explore his future options.

At the other end of the continuum I've been working with a young girl with autism in her first year at school. She started to use a [voice device] as her speech was very limited. At our last visit with the family and school team, I learned she's doing really well using the device to communicate, and her speech is also progressing. Her parents are delighted and her mom sent me a little video of her saying “Thank you Linda” with her voice.

We celebrate all of these accomplishments—whether it’s a child using their AAC system or socially progressing in some way.

BLOOM: What’s the greatest challenge?

Linda Buskin: Wait lists. I screen for new clients, and one of the biggest challenges is we have to turn away or redirect clients who don’t meet our referral criteria, when we know the resources are so limited in the community.

We may say to a family ‘You need to go get help from another professional or clinic because of your child's early level of using AAC, or their diagnosis, or where you live,' when we know that the wait for service can be months to years.

We’ve done a lot to build capacity with our community partners to help children at early stages of learning. But there are still huge limitations on community resources. 

We’ve also had such an influx of newcomers and refugees to the GTA whose children have AAC needs and resources are far too limited. My hope for the future is that we would have a more centralized way of managing these families, and linking them to services and resources without lengthy waits.

BLOOM: What qualities do you need to be good at your job?

Linda Buskin: You have to be humble. You do have expertise and clinical skills, but you’re not the sole expert. You may think you have the ideal solution for someone, but you have to listen and understand what’s important for that person, and their family. Listening is really, really important.

You have to have a lot of flexibility and creativity, because you need to take everyone’s perspectives and meld them, with your skills, into recommendations of what might be the best tools or ways to move a child’s communication forward.

You have to take on a child’s preferences and how they see the world. Historically, we set up vocabulary in a communication system in a grid. You put an image in a square, and the child points to it, or activates it.

In more recent research, these symbols and pictures were shown to children and they taught us that what's very clear to adults, may look very different to children. For example, the traditional symbol for 'want' is a picture of disembodied hands. The children were asked, ‘If you wanted to say “want,” what would that look like?’ These kids drew beautiful pictures of a child reaching up for mommy. 

We also learned that for some clients at an early level of learning to communicate, a photo that provides a familiar visual scene, instead of a grid of symbols, may be more meaningful and a better introduction. 

For one client who is learning to use his eye gaze to communicate, we took a photo of all of his familiar things the way he sees them in his living room. Instead of a grid, we put a 'hot spot' on each item. So if the child looks at the TV in the photo, it activates the message 'I want to watch TV' and brings up a screen of his favourite shows.

We need to inform families of options and possibilities. As clinicians, we can’t just stay in our comfort zone, using our favourite system or technology.

BLOOM: What emotions come with the job?

Linda Buskin: A lot. I think you feel the initial despair of families, in the loss of their dream for their child. You also feel their excitement, and their change in expectations. You may feel unsure, because there isn’t one right way, and you’re always trying to achieve the perfect situation. There can be times of self-questioning: ‘Have I gone the wrong route? Have I taken this family to the wrong place?’

BLOOM: What do you do then?

Linda Buskin: I have the privilege of working with the most amazing group of people. I always consult with my colleagues. You get different perspectives on the journeys others have travelled, and reassurance that this is part of the process, to feel this way. The other thing I’ve learned in this situation is that it’s okay to say to a family ‘I don’t really know, but this is what I think might be a good starting point.’

BLOOM: Because that feeds partnership.

Linda Buskin: Partnership is critical.

BLOOM: Do you do anything specific to manage stress?

Linda Buskin: I go to the gym a lot. I enjoy hiking, cycling, kayaking and spending time up north at our cottage. I love to cook and eat! I find it very calming and meditative and get much joy out of gathering my family and friends at my home for a big feast. 

BLOOM: If you could change one thing about rehab for children with AAC needs, what would it be?

Linda Buskin: Shorter wait times. The wait times are horrendous. There’s a huge emphasis on early intervention for young children, and that’s very hard for families of kids who are older, who haven’t gotten any services.

BLOOM: Because they feel they’ve missed out on their child’s only opportunity to make gains.

Linda Buskin: Yes. On a positive note, I’ve met clients in their teen years who make amazing progress and have incredible breakthroughs. 

Over the past couple of years I was introduced to an extraordinary young man in his final years of high school who had lost his vision. His speech was very difficult to understand and he had difficulties pointing to small targets. His school team had introduced a set of tactile symbols for him to touch, but of course, he could only have a small number at a time, which was so limiting.

We provided him with a communication system that he could control with two switches with his hands. Within a very short time, he learned to navigate through his vocabulary pages to put words together to express himself, often with great humour, as well as to spell and write. He 'blew my socks off.'

I just saw my last client. When I met her a few years ago, she couldn’t manage any consistent switch access. But following some interventions, she’s better able to control her body, and she now uses two switches with her head to control a high-tech system that presents her with vocabulary [that she hears] and then chooses.

She can also use her system to e-mail, and every now and then I get an email from her with a question like ‘What music do you like?’ or 'How was your weekend?' She's also learning to use a cell phone with her communication device to chat to her family and friends. 

What we want to do is help clients connect in with their worlds. Social media has great value for our kids. We also want our AAC technology to be more mainstream, and to look more like the tools the general public are using.

BLOOM: You’ve been here for so many years. Is anything dramatically different today from our approach earlier?

Linda Buskin: I do feel that today there is an absolutely genuine and sincere commitment to seek partnership and input from frontline staff and directly from clients and families to shape decision-making to improve quality of care.