Ch.7 A Comprehensive and Evidence Based Treatment Program Flashcards
I. SELECTING POTENTIAL TARGET BEHAVIORS**
- Target behavior
- We need to select ________ term objectives and _______-term goals
In the schools, we say “_____________”
B. General Considerations**
- Select Tx targets that are _____________ and ____________ appropriate for the client
- Select targets that will make an _____________ and ____________ significant difference in the client’s _______________ skills
Remember to connect Tx to classroom ____________
Always keep _________ in mind <_<
Dr. R always Tx speech sound errors and language together
I. SELECTING POTENTIAL TARGET BEHAVIORS**
- Target behavior
- We need to select short term objectives and long-term goals
In the schools, we say “benchmarks”
B. General Considerations**
- Select Tx targets that are linguistically and culturally appropriate for the client
- Select targets that will make an immediate and socially significant difference in the client’s communication skills
Remember to connect Tx to classroom curriculum
Always keep CCSS in mind <_<
Dr. R always Tx speech sound errors and language together
C. Select More Readily Taught Treatment Targets**
- _____________ sounds treated before non-____________ sounds
- Teach ____________ sounds before non-__________ sounds (e.g., /th/ before /r/ because easier to see)
- For a phonological process to be treated, should occur at least ___% of the time
D. Select Targets that Affect Intelligibility the Most**
- Select phonological processes that affect the most __________; processes that contribute the most to the child’s lack of _______________
- E.g., ____________ affects many sounds
C. Select More Readily Taught Treatment Targets**
- Stimulable sounds treated before non-stimulable sounds
- Teach visible sounds before non-visible sounds (e.g., /th/ before /r/ because easier to see)
- For a phonological process to be treated, should occur at least 40% of the time
D. Select Targets that Affect Intelligibility the Most**
- Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility
- E.g., stopping affects many sounds
II. DECIDING ON THE NUMBER OF SOUNDS OR PATTERNS TO TEACH**
- If the child only has __-__ errors, the decision is easy
- If the child has __________ errors, then we need to decide: do we train _________ sounds at once, or just a ______?
Variables impacting the decision of the number of sounds to teach includes the child’s ____________, ____________ level, age, language and ____________ skills as well as the ________ _________ you have to do therapy
II. DECIDING ON THE NUMBER OF SOUNDS OR PATTERNS TO TEACH**
- If the child only has 1-2 errors, the decision is easy
- If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?
Variables impacting the decision of the number of sounds to teach includes the child’s motivation, intellectual level, age, language and learning skills as well as the time frame you have to do therapy
III. ESTABLISHING BASELINES**
- When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not ____________ sampled
- For example, an artic test may sample /r/ one time in initial, medial, final position of words
Because of this very __________ sampling, ____________ can be made**
- For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off
- But later, lo and behold, the child makes the /f/ with 90% ____________ on repeated measures!
We ____________ this problem by establishing _____________ of potential treatment targets ___________ starting therapy
•baselines are measured rates of ____________ in the absence of _____________
III. ESTABLISHING BASELINES**
- When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled
- For example, an artic test may sample /r/ one time in initial, medial, final position of words
Because of this very limited sampling, mistakes can be made**
- For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off
- But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!
We counteract this problem by establishing baselines of potential treatment targets before starting therapy
•Baselines are measured rates of behaviors in the absence of treatment
3 purposes of baselines
- establish clinician ____________ (many 3rd parties want #’s or quantitative data to evaluate progress)
- evaluate ch’s ____________ over ________
- modify Tx _____________ if ch. is not improving as expected
3 purposes of baselines
- establish clinician accountability (many 3rd parties want #’s or quantitative data to evaluate progress)
- evaluate ch’s progress over time
- modify Tx procedures if ch. is not improving as expected
C. Baseline Procedures**
- Specify the treatment targets in ___________ terms
- For example:
–-produce /r/ in word-final position with 80% accuracy
–Reduce use of final consonant deletion from 70% to 20% in conversation
We need to be sure to specify response ______________**
- This refers to the ____________ level of ____________
- For example, do we want to begin with /r/ in isolation?
- Do we want to begin with /r/ in word-initial position in sentences?
Selecting the initial level and sequencing of training
____________ help us create appropriate tx _____________
PBH: best to start tx at the ________ level, _____________ words especially
C. Baseline Procedures**
- Specify the treatment targets in measurable terms
- For example:
–-produce /r/ in word-final position with 80% accuracy
–Reduce use of final consonant deletion from 70% to 20% in conversation
We need to be sure to specify response topography**
- This refers to the linguistic level of training
- For example, do we want to begin with /r/ in isolation?
- Do we want to begin with /r/ in word-initial position in sentences?
Selecting the initial level and sequencing of training
baselines help us create appropriate tx objectives
PBH: best to start tx at the word level, functional words especially
V. DEVELOPING MEASURABLE OBJECTIVES**
- Treatment or _______-term ____________ are the skills the clinician _________ to teach on the way toward achieving the selected treatment ___________ or _______-term goals
- Appropriate long-term goals might be:
–“Increase the client’s _____________ of speech”
–Improve the client’s ______________ skills”
However, measurable short-term objectives are needed**
- These objectives ___________ how a _________ will be achieved
- The objectives must be _____________ so that ___________ observers can verify the ___________ of the clinical services provided
- Many 3rd party payers like insurance companies ___________ detailed ______________ of ______________
V. DEVELOPING MEASURABLE OBJECTIVES**
- Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals
- Appropriate long-term goals might be:
–“Increase the client’s intelligibility of speech”
–Improve the client’s phonological skills”
However, measurable short-term objectives are needed**
- These objectives specify how a goal will be achieved
- The objectives must be measurable so that external observers can verify the results of the clinical services provided
- Many 3rd party payers like insurance companies demand detailed documentation of improvement
How to write a good objective!
DO use ____________ ____________ (e.g., point to, say, write, read aloud, sing, match)
DON’T use words with non-_____________ _____________ (e.g., avoid words like: know, understand, remember, learn, perceive, memorize, think about, consider)
Remember that ________ collection should be done _______________ Tx. A good ____________ will support this.
How to write a good objective!
DO use observable behaviors (e.g., point to, say, write, read aloud, sing, match)
DON’T use words with non-obsevable behaviors (e.g., avoid words like: know, understand, remember, learn, perceive, memorize, think about, consider)
Remember that data collection should be done throughout Tx. A good baseline will support this.
VI. PLANNING AND DEVELOPING A TREATMENT PROGRAM OR PLAN
_____________ ____________ techniques are direct methods to teach clients how to position the articulators and produce the sound appropriately
B. Successive Approximation or Shaping**
- We take advantage of a _________ the client _____ already make (e.g., /g/ if they cannot produce /r/).
- We have them make the /g/, and gradually move toward /r/.
We can begin training sounds at one of several levels
•___________, ___________, ________, ___________, ___________
If the child cannot create a phrase or sentence with the target word…**
- We can use a ___________ phrase such as:
- “I see______”
- “Here is a ____”
VI. PLANNING AND DEVELOPING A TREATMENT PROGRAM OR PLAN
Phonetic placement techniques are direct methods to teach clients how to position the articulators and produce the sound appropriately
B. Successive Approximation or Shaping**
- We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/).
- We have them make the /g/, and gradually move toward /r/.
We can begin training sounds at one of several levels
•isolation, syllable, word, phrase, sentence
If the child cannot create a phrase or sentence with the target word…**
- We can use a carrier phrase such as:
- “I see______”
- “Here is a ____”
VII. STRUCTURING TREATMENT SESSIONS**
- Initial tx sessions should be ___________ structured
- Tx sessions gradually loosen up to replicate the ________ _________
- Helps child ____________ target sounds to ____________ speech
VII. STRUCTURING TREATMENT SESSIONS**
- Initial tx sessions should be highly structured
- Tx sessions gradually loosen up to replicate the real world
- Helps child generalize target sounds to spontaneous speech
VIII. INCREASING AND STRENGTHENING ESTABLISHED BEHAVIORS**
•A. Selecting Potential Reinforcers
Positive reinforcer—rewards and strengthens the ___________
- Primary reinforcers—________ and water
- Secondary reinforcers - __________ value such as:
_________ praise
tokens
stickers
VIII. INCREASING AND STRENGTHENING ESTABLISHED BEHAVIORS**
•A. Selecting Potential Reinforcers
Positive reinforcer—rewards and strengthens the behavior
- Primary reinforcers—food and water
- Secondary reinforcers - social value such as:
verbal praise
tokens
stickers
IX. GENERALIZATION**
•Generalization usually refers to the child’s producing learned ____________ in settings __________ of the ___________
Generalize across situations
ex: ch. uses sound in other ____________ with other ____________
X. IMPLEMENTING A MAINTENANCE PROGRAM**
- A. General Considerations
- ______________ = ultimate goal
- Skills sustained over _________
- Select stimuli from client’s ___________ _____________
- For example, classroom language arts book
- Vary the ____________ setting
We Need to Teach Multiple Exemplars**
- For example, “________” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures
- Some children may need 50 pictures, 30 objects, and 10 books with /r/- initial stimuli ___________ they achieve 90% accuracy
B. Manipulation of Response Contingencies**
- Most _____________ aspect of maintenance
- Move from continuous to ______________ reinforcement schedule
- Fade ____________ reinforcers, rely more on ____________ reinforcers
We can also train parents and others to reinforce ch. for correct speech productions in ____________ environments
Teach self-____________/self-_____________ skills (I use the terms interchangeably)
C. Involve Family Members and Significant Others
Best maintenance - involvement of ___________ in child’s life
__________ can help each other, especially if they are in the same therapy group
They love being the “___________”
Classroom teachers can also help, especially with ___________ signals
Solicit the help of ___________; if they refuse, discuss how this will ____________ impact the child’s _____________ in therapy
IX. GENERALIZATION**
•Generalization usually refers to the child’s producing learned responses in settings outside of the clinic
Generalize across situations
ex: ch. uses sound in other locations with other audiences
X. IMPLEMENTING A MAINTENANCE PROGRAM**
- A. General Considerations
- Maintenance = ultimate goal
- Skills sustained over time
- Select stimuli from client’s natural environment
- For example, classroom language arts book
- Vary the physical setting
We Need to Teach Multiple Exemplars**
- For example, “quick” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures
- Some children may need 50 pictures, 30 objects, and 10 books with /r/- initial stimuli before they achieve 90% accuracy
B. Manipulation of Response Contingencies**
- Most important aspect of maintenance
- Move from continuous to intermittent reinforcement schedule
- Fade primary reinforcers, rely more on natural reinforcers
We can also train parents and others to reinforce ch. for correct speech productions in natural environments
Teach self-monitoring/self-correcting skills (I use the terms interchangeably)
C. Involve Family Members and Significant Others
Best maintenance - involvement of people in child’s life
Peers can help each other, especially if they are in the same therapy group
They love being the “teacher”
Classroom teachers can also help, especially with nonverbal signals
Solicit the help of parents; if they refuse, discuss how this will negatively impact the child’s progress in therapy
