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We are discussing the biggest challenges that are currently holding back the field of speech-language pathology. We present the issues with facts and invite you to be a part of joining our movement to make things better, one conversation at a time. Let's fix SLP!
Hosted by Jeanette Benigas, PhD, SLP
Jeanette Benigas 0:00
Hey fixers. I'm Dr. Jeanette Benigas, one of the cofounders of fix SLP. Our platform exists to discuss the biggest challenges that are currently holding back the field of speech language pathology. We present the issues with facts and invite you to be a part of joining this movement to make things better one conversation at a time. So let's fix SLP.
Hi, everybody, welcome back to the state by state series. Today we have Shelby Midbo, president of the Montana Speech Language and Hearing Association. Before we begin, I want to preface the conversation by letting everyone know that the views stated today are not reflective of Shelby's personal opinion, but instead representative of the executive board as a whole from the Montana Speech Language and Hearing Association. Thanks for joining us, Shelby. Here. Yeah, taking some time, we, you know, we had to put a pause on fix SLP. But we're back and you're helping us jump back in strong. So before we get into the all the questions, tell everyone a little bit about yourself.
Shelby Midboe 1:15
Before I start talking about me, I want to say thanks to fix LP for their efforts in highlighting state associations. There are a lot of people out there across the country doing the work that's necessary for our field and state associations. And I really appreciate and love that you guys are providing a platform for us. It's awesome. So it about me, I have a husband, I have two kids. And they're 25 and 21. As far as the state association goes, I've done a little bit of everything for the association. I've been involved for many, many years. And I think I was thinking back I think since 2016. I've been on the board. So last year was my second term as President, and there's no president or president elect right now. So I'm kind of still acting as the president and looking for someone to step up into that role. I am a speech therapist at a preschool through eighth grade school. And my I'm also active in my union in my district and my state. So as far as hobbies, go, Mom, my kids are both swimmers growing up and my daughter played volleyball. So I used to coach swimming that took up most of our time for many, many years. I used to play volleyball and League teams and now my knees just vote no to that. So now I just work out at the gym and spend as much possible time doing what my school site calls extra averting in all of its forms.
Jeanette Benigas 2:30
That your knees say No, I have one. I'm not looking forward to the other knee joining no president or you are the president. But there's no president elect.
Shelby Midboe 2:43
I'm actually the past president. There is no more president elect. So we have we're trying to run things right now. The president that we had two years ago, had in mind kind of a flat leadership model where we just everybody was assigned different roles in committees, but not necessarily like hierarchical ladder of leadership. And so we're we're putting that to the test right now. And we're pulling off a state conference.
Jeanette Benigas 3:09
Well, while ago we had Ashley from Iowa, who just kind of got thrown in. So if anybody out there in Montana wants to get thrown in like Ashley did from Iowa. Now is your moment. Shelby, how did you get involved with the state association? It sounds like it's been maybe eight years since you joined? And what do you love about it? Why do you stay involved?
Shelby Midboe 3:32
I got involved because a woman named Rachel Stansbury, pretty much said, you're going to be in the state of state association. These are the things that are available. So I initially joined as a member of our scholarship committee. So I started that way. And then I realized how much I loved the work that was happening and how much those of us who are just practicing in the field really have no idea all of the things that are going on behind the scenes at the state level. And I just decided I really wanted to be part of that. What do I love about our state association, I love being around other badass women who are super smart, and who are willing to spend some of their precious free time to help out other people, which is essentially what state associations do. And that is huge for me, I love that everybody on the board is interested in different aspects of our practice and in the different needs that we have as a state. So we've tried to really focus recently on getting people from all practice settings involved in our boards so that we have better representation in the things that we do, and the way that we set our agenda for what we want to accomplish. So when we all come together, it's just really powerful, I think and we do a lot of good things for clinicians and clients. And then with that, we've had a lot of medical and private practice participation. That's grown a lot. So now it seems like we're really doing a better job of serving the full spectrum of clinical and professional needs, and we're not just seen as something that the school based SLPs belong to. And then the last thing that I love about ourselves ch one is that we only have one CSD program in Montana shout out to you Mm. And so we work really closely with the Department. And we have a liaison from that department on our board. And then we also have a non voting member from the student organization that attends meetings. And so that allows us to collaborate and they come and help us out at convention, and then our hill, they are advocacy.
Jeanette Benigas 5:21
This is sort of off topic, but it is so interesting to me that there's only one program where in Pennsylvania, where I have taught there, there are a ton, there's like 25, or 26, or there's something some super high number, which is one of the most in the country. Do you know how many students they take how many graduate students their cohort takes?
Shelby Midboe 5:43
When I was in school, and I'm a new SLP. So I just graduated with my master's in 2013. There were 26 in our cohort, I think, I think that they're trying to take more now. But of course, the limitation is finding all of the clinical practicum settings. Yep. Yep, people. And so they've also just started a SLPA associates at the Missoula College, which is affiliated And so hopefully, we'll have more people that we can put to work that way in Montana.
Jeanette Benigas 6:17
okay, well, yeah. All right. What is one area of advocacy that your state has undertaken in previous years that has made a difference for Montana clinicians?
Shelby Midboe 6:29
We're really active in the legislature and we run one or two bills a session. And then we also jump in on bills that we need to support or work on. So for example, we were active last year and tweaking language in a bill that we were not originally involved on last year, but we keep our eye on a lot of things, thanks to our fabulous lobbyists that we work with each session, and they say, Oh, this bill looks like you know, it has keywords that might interest you read it, do we need to come in for against anything needs to happen in the bill. And so we're, we're active in that way. Last year, we did the interstate compact. So that is a thing for Montana now. And then we amended our assistant bill. So that licensing is about to go live in Montana.
Jeanette Benigas 7:09
So that's exciting, right, which explains why the university wants to add the program. So that's great.
Shelby Midboe 7:15
Yeah, we actually had a series of back and forth with the legislature because we originally took the bill for assistance. And they said, it's not ready yet. You don't have any place for this training in Montana. So we had to work really closely with the University of Montana to get that ready, and then design the bill kind of together in that way. So it's nice that partners
Jeanette Benigas 7:35
so what is something that your state is working on right now? And how can clinicians in your state best support that effort?
Shelby Midboe 7:42
We are working on a lot of things right now. And I think that when I talk to people and say, this is happening right now, in Montana, we only have a legislature every other year, it's four months from January to April ish. And, but right now is March of 2024. And we're already writing language and getting grassroots movements ready for the 2025 session. And so I think that first thing that people can do to help is pay attention and get ready to help us for this legislative movement. policy wise, we're already hard at work with our state we actually belong to well, we have formed, I guess, I should say, kind of a connection with our OT and PT associations, because they're in the same boat with us. And so we are working to bring a bill to increase Medicaid reimbursement for all three fields. We meet monthly, and we're developing an action plan. So we have a big meeting in about two weeks with all three associations to discuss our game plan and map out advocacy efforts that all the clinicians can participate in now, well before the legislature convenes. So Medicaid is kind of a mess in Montana. I think that that's happening around the country. And it's a big impact. In Montana, there's a lot of people that aren't on Medicaid that used to be. So that's a problem, but also what's going on around the country, the rates that are being paid for Medicaid reimbursement, really make it difficult to keep enough therapists in the office and to run small businesses. And so our clients are impacted because we can't run small businesses and pay for therapists and one of the highest housing booms in the country. In larger cities, we've just had crazy increases in the amount that houses cost. And so we can't pay people to come here to help cover our shortage, especially with Medicaid rates. And so as a result, clinics are making long or very long wait lists for people to receive services who are on Medicaid, and that's just it's hurting our clinicians, and it's really, really impacting some of our most vulnerable clients. And so it's a big problem. And so that's, that's something that we're working on now.
Jeanette Benigas 9:43
I was at our state convention this past weekend and had lunch with someone in our state where Medicaid rates recently went up. But what she was then saying was these managed care providers aren't even paying out What the rate bumped up to because they have the ability, the legal ability, at least in my state to pay less than the fee schedule. And so it was this huge win to get Medicaid rates up. And they're still not making that and and in fact, one of the Medicaid providers just ignored that the rate had gone up and for 90 days or something like that has been out of compliance with paying any increase rate. So it's been insane to watch this happen. Is that Is that something you know, is that something that they can these managed care plans can do in Montana?
Shelby Midboe 10:36
As a school practitioner, I don't have my fingers in it as much as some of the other people that are on our Medicaid team. So I really rely on your knowledge. So I wouldn't be able to answer that question.
Jeanette Benigas 10:46
Well, keep that in mind. That's one of the things we want to do, right? We just did it in Ohio or not, we I wasn't a part of it. But it just happened in Ohio. And now they're seeing the result of that, which is great. But there's these like loopholes. So something to consider as you're working to make those changes, be asking those questions, because now the person who was responsible for helping to organize all of that, in Ohio is going to be going back to fight these managed care plans who aren't paying the fee schedule. So it will be another whole bunch of years to make that happen.
Now, you know, upfront.
Shelby Midboe 11:19
Frustrating. Yeah, that's a great cautionary tale. We will keep that in mind.
Jeanette Benigas 11:24
Is there anything else that your state's working on right now? Or in you kind of already said, so I'll tie in the next question. You said, you're working ahead because the legislator only meets every other year. So the next question is always what's on the agenda for the future? But it sounds like you're working for the future right. Now. Is there anything else that you want to point out or talk about?
Shelby Midboe 11:45
Sure, there's always more things to talk about one thing that Montana just did as we develop the position called setting specific reps, and so they're organizing a survey right now for Montana to help us better respond to the needs of every people who work in all the settings. And so one of the things that we know we need to work on is caseload reform for schools. And we want to do it correctly by getting information input from all stakeholders and make sure that we're working together. And I want to look more at how Oregon is doing that. They just passed this study bill in Oregon, and I talked to our lobbyist about doing a study bill. And she said that that would be good. But apparently, all of the study builds that pass go into one pool, and then they pick the ones that they're going to fund adequately. And she doesn't know that something like this would be funded adequately by the legislature. So I thought that was really interesting, also a little bit disheartening, because I would love to run a study bill and then have time to say, okay, all stakeholders how is this going to work best for us? How is this going to make work conditions that will not cause the fleeing from schools that we see happening right now and people moving to different settings. So it's important that we work together with everybody. But also, I'm not sure how to do that in the best and most expedient way because meeting every other year means if it doesn't work one year, then we have to do it again. And it's two years down the road. So it'd be great to come into it doing it correctly, which is that way, we always try and do it. But it's a big undertaking.
Jeanette Benigas 13:08
Yeah, I didn't even think about your caseload or workload caps. With you saying that, there's a housing boom, and there's long waitlist, I can't imagine what's going on in the schools with kiddos who need therapy and lack of therapists. And I'm sure schools are taking advantage of that with workload, it can't imagine,
Shelby Midboe 13:29
we have a lot of kids that are really high. And whatever happened during COVID, there's many studies about it. But there's a lot going on that has to be dealt with in the schools to help kids be better learners. And of course, speech therapists are an integral part of that. So we need to make sure that it's sustainable, and good working conditions. So something that really needs to happen sooner than later, probably in most states. Yeah. Wow.
Jeanette Benigas 13:53
All right. So as you're thinking about what bills you're going to hop in on and what you're going to do with the legislator, how does your association set the agenda from year to year? How do you decide what you're going to get involved in and what you want to achieve?
Shelby Midboe 14:09
We do a thing that I think I don't know if it's unique to us. But it's really important to us, we live in a huge state. And so meeting face to face with people, and feeling that synergy is really important. So we actually have an annual summer retreat. And summer weekends in Montana are precious. And so given the fact that there are people who joined this board, knowing that one of those weekends is going to be eaten up by their state association really speaks to the people who joined the board. But we ran a VRBO. And we do lots of small group work on various things. It's where ideas and problem solving happen and then what comes out of that is a strategic plan. We do it every three years and make sure that our strategic plan is what we think that it needs to be we set goals within that but the work at that annual retreat is really us workshopping individual pieces of that strategic plan. And then making sure that we're on track. And then throughout the year, the draft agenda template that we use has the sections of that strategic plan. So every time we meet, which is about quarterly, we're kind of checking in on how we're doing on areas of that strategic plan. And if there's nothing to report for one part that makes us say, hey, maybe we need to think about doing something in that area pretty soon. Um,
Jeanette Benigas 15:24
there's something great, though about reading a VRBO. Even if it's to work during the day, I imagine, hopefully, you're, you're doing something fun in the evening. Hopefully you all get along. I mean, you're not going to call that out here on the podcast. And I assume it's mostly women. It's like a girls weekend where you tell your partner like, Hey, I have to go do this. Watch the kids.
Shelby Midboe 15:48
It's a girls weekend, and nobody gets mad at you for talking about speech therapy. Amazing. I would die for that
Jeanette Benigas 15:56
I need to be good, even if it's to work during the day, if I can do something, but at night I met without also I
Shelby Midboe 16:04
want to, I keep on talking about speech therapy. We have tried to get audiologists on our board. And we have not had any luck for that. So if anyone from Montana is listening, who's an audiologist and you want to be part of an amazing team and help things work for audiologist, please. Yeah, please come on. Join the board, just even a committee anything we president,
Jeanette Benigas 16:24
come on in blind.
Shelby Midboe 16:27
Make this podcast about audiology. Let's go. They can
Jeanette Benigas 16:31
come back on and talk. I'll have them back again. Alright, so you've mentioned a lobbyist a couple of times. So I know now that your state is paying for a lobbyist? Do you know how much that costs?
Shelby Midboe 16:41
I do. I'm also the public policy chair. And so I signed the contract. Yeah, we have our lobbyist. It's a really big and it's unnecessary expense. It's actually gone up every year. Our current contract is we negotiated for $1,500 a month when the legislature is not in session, and $2,000 a month when it is. And so like I said, that's a four month biennial expense at that $2,000 a month. So this is an off year right now. And I think I said it on the bumble app that many people are turned off from politics, it's so divisive right now. So I've actually just started saying attorney instead of lobbyist when I do any kind of social media or anything, because what what they do for us is invaluable. And I don't want people to get turned off by the fact that we have a lobbyists. So the fact that a lot of people don't understand is that we are full time plus, in most cases, workers and we are the subject matter experts, but we are not lawyers. And so we need people with this implicit knowledge of how to move bills in the legislature, and people to run things when we hear, you know, XYZ from the licensing board or from legislators, I don't have a legal background. I don't know what they're expecting, or why this won't fly or won't, why that won't fly. And so that's why those people are just, like I said, invaluable to sustain associations and a lot of associations that just really are trying to make their voices heard for their clients and other clinicians in the area. So we have to work together with a lobbyist. And we just as an association, that's the number one thing in our strategic plan is advocacy. It's our most important role. So it's an expense that we just have to pay.
Jeanette Benigas 18:18
Yeah, and I did some quick math, I'm not really a math girl. But it sounds like maybe you're spending anywhere between 18 and 24,000 a year depending on what's in session and what's not does that sound in the data?
Shelby Midboe 18:32
Okay, and our membership is $85. And so, wow, that doesn't really, that that math doesn't math, especially considering that we're currently at the highest membership that we've been in a very long time at 160 People in Montana, so the math is definitely not math thing. So thank goodness, back when we used to have to have in person conventions and bring speakers in. And there wasn't all of this online availability. The people who ran our study association were great stewards of the money that they collected from those and so we have actually investment accounts from past years that we are using to help fund our association every year.
Jeanette Benigas 19:14
Right? If you want to get really crazy at 160 people, you could probably rent a couple VRBOs and have your convention that way the convention
Shelby Midboe 19:24
has paid for itself. So that's why we really think that Montana also values Yeah, together in person. We're such a big state. It's hard to get to see people in person and also becoming unfortunately a lost art seeing people in person. Luckily, the convention even with bringing in speakers has paid for itself the last couple years. We don't make money off of it, but thank goodness Montana's still on board with coming together in that way. The state convention
Jeanette Benigas 19:51
that I was at was much smaller in numbers than it was previously you know, many years ago, eight years ago i i spoke at that particular convention and there were 200 people in the room just listening to me and a bunch of other speakers going on at the same time. And it was much smaller and intimate this year. But it was really nice to get to see people and connect with them and meet new people and just talk talk to people in the state who are doing the same things that I'm doing and having the same kind of wins and same kind of struggles. And there is value there. And I I wish it was as big as it used to be, because then there's even more people to connect with, but there is still value. I would hope that people attend those things when they can, because sitting online by yourself in a room, there's it's hard to connect with people. And we're speech pathologist, part of what we do is connecting.
Shelby Midboe 20:46
So I think about I know, and I'm online, and I am multitasking like crazy. And so how much am I actually even taking in when you're in person, you've got a lot more pressure on you to be present. And I think that you learned better that way and just connecting with people around you like you said,
Jeanette Benigas 21:03
yeah, so you said membership is high right now. But hopefully, after that, what's that? High in quotes? Yes. Hi, in votes, Pro. But hopefully after this episode airs, you'll get some more inquiries. So if people want to join your state association, what can they expect from the Association as a member?
Shelby Midboe 21:24
I've already talked a lot about advocacy. That's the number one thing that we do. And I think really an understanding that we strive to hear from all voices in the state, including audiologists again, and we we want to help everybody. And that's the biggest part of what we're doing. We're still trying, like I said, to provide relevant CPUs at a place to gather annually to share that synergy of in person discussion and collaboration. People are really upset this year, you know, that they can't stream what we're doing live. And we're just like, No, we're just not we're we just as a board decided we are not going to do that. Another thing that we're doing is changing our convention from October when it has been typically to April, we just see a lot of people who are having to split their time off from work and finances between going to our convention and the ASHA convention. So we're hoping to move it to April to try and alleviate some of that stress for people. So that's I guess, we're just thinking of the bottom line for people there. And then we're working on developing a directory and I've heard other states on your podcast talk about the directory and how useful it has been, it's really needed in Montana, because as much as I would love to say that just because I wear the hat of President, I knew every clinician and every practice in Montana, and when people email and say, Who do you recommend in Butte, Montana, we say Butte America here, but then I'm like, Well, I don't know, I'm gonna have to reach out to a board member who lives in view, because I don't know who's there. And there was a state rep directory, I think about what a bonus that would be for clinicians to have that information. And then clients could benefit from that as well. So that's something that we're working on. And then the other thing that people can expect from us is just tireless behind the scenes work to help continue improving situations for our clients and clinicians.
Jeanette Benigas 23:08
So you said that some clinicians are upset about not streaming online. And I think one thing that clinicians don't understand that when it comes to CPUs, especially reporting, if you're reporting to Asha, it is a different cost, the mode of delivery matters for payment. So if you're doing an in person CPU, and you report that you then have to pay again, or there's an additional costs to offer it online, which then bumps up the cost for everybody. So that's, that's also a money decision, sometimes is your mode of delivery. And if you're reporting or not reporting, that that adds money. So having done that, and wanting myself to offer it, both ways are offered in person and then online, I was going to have to pay almost the entire thing again, to then offer online, right? People don't get those logistical behind the scenes things.
Shelby Midboe 24:06
There are a lot of things like that we did it. One year, the year after COVID, the first inperson conference that we had after COVID, we did offer streaming, but just because we knew that there are so many people who had health conditions, or maybe fears of being in a big crowd like that, and we wanted to be really respectful of that. But just the way that things have changed. Now we just want to be back together. Yeah, the cost and being together. So thank you for adding that in because it's really true.
Jeanette Benigas 24:34
So once people become members, how can clinicians best communicate their ideas and concerns to the association? And then how do you all handle those ideas once they're received?
Shelby Midboe 24:46
Like I mentioned before, we have those specific setting representatives, they have been working to come up with a survey that will help us open the door to what issues people need to talk about right now. So the first thing is read respond to that survey. And we'll have it available online, not just in our membership portal through the email. And so some people who aren't members yet who still follow us, hopefully, they will understand what we're trying to accomplish and become members. But also fill out the survey so that we know what they need. Even if they don't want to become a member, we still are here to help them the other thing too, email Master president.com. And then we'll get it sent out to the right person, we follow up as quickly as we can, the best that we can. We're all volunteers with big jobs, like I said, so we all have families, we do the best we can. responses might not be immediate, but we do want to hear from people. So hopefully people will respond to the survey or go through the website, there's a Contact button.
Jeanette Benigas 25:43
Also, if people want to join, or just become an instant president, where can they apply to join the association?
Shelby Midboe 25:51
Well, first of all, they'd have to join the board and change the bylaws that say you have to be on the board for at least one year. It used to be two and we just have to take that very limiting if you want if you if you want to step away from this role.
Jeanette Benigas 26:04
Yeah, bylaws.
Shelby Midboe 26:07
I know there's just so much historical knowledge that comes with it. So you don't just work for one year, you would at least know where the resources are. To get them. I think stepping into the presidency would be a big job, but there's enough support, you could do it. That being said, you can go to Mattia online.org So MSHA online.org. And we have membership buttons there that you can push. Last year, we actually launched a group membership at a discount, you get 10%, if you join with a group of four or more people, and that helped, I think drive up our membership a little bit, that was a well received incentive. So hopefully more people will take advantage of that we made sure and left it live. It's not exclusive to private practices or hospitals and people who work in schools can all join together at the group rate also. So hopefully more people will take advantage of that.
Jeanette Benigas 26:56
That's a great idea. No other state has said they're doing that yet.
Shelby Midboe 26:59
We're fancy here. We're trying to we're trying to do anything we can to increase our membership. And
Jeanette Benigas 27:06
so you said already that membership is $85. Are there any other rates? Or is the rate $85? For everyone?
Shelby Midboe 27:13
If you are a first year graduate, and you are in your CF, it's only 25? We give you the student rate? Everybody else is just a flat 85 unless they're a lifetime member, retired and I can't remember how much that is right off the bat. I hope to know someday.
Jeanette Benigas 27:30
And are you guys on socials? Like your handles?
Shelby Midboe 27:33
We are on Facebook and Instagram. And I know for Instagram, it's the Montana Speech Language Hearing Association. I think that's how you can find us on both of those.
Jeanette Benigas 27:42
Okay. All right. Is there anything else that you want to cover Shelby? Or did we hit it all?
Shelby Midboe 27:47
I think that that's all that my brain can handle right now. There's a lot going on all the time. Yeah. Thanks so much for having me.
Jeanette Benigas 27:56
Sure. Thanks for being here. All right, everybody. If you love what we're doing, click the subscribe button. So the new episode is always in your queue. As soon as we drop it, give us a five star rating and review and we don't have a Patreon but we would love for you to become a sustaining partner at $5 a month. You can find all of the information on that at the fix slp.com And we'll see you next time. Thanks for fixing it. Bye everybody.