Chp. 7 comprehensive and evidence based treatment program

Question 1

Selecting potential target behaviors

a. Introduction

Answer 1

• target behavior
• we need to select short term objectives and long-term goals
• in the schools, we say “benchmarks”

Question 2

General considerations

Answer 2

• select treatment targets that are linguistically and culturally appropriate for the client
• select targets that will make an immediate and socially significant difference in the clients communication skills

Question 3

Remember…

Answer 3

• connect treatment to classroom curriculum
• always keep common core state standards in mind
• I always treat speech sound errors and lang together

Question 4

Select more readily taught treatment targets

Answer 4

• STIMULABLE SOUNDS treated before non-stimulable sounds
• teach VISIBLE sounds before non-visble sounds (e.g., /th/ before /r/)
• for a phonological process to be treated, should occur at least 40% of the time

Question 5

Select targets that affect intelligibility the most

Answer 5

• select phonological processes that affect the most sounds; processes that contribute the most to the childs lack of intelligibility
• e.g., STOPPING affects many sounds

Question 6

Deciding on the number of sounds or patterns to teach

Answer 6

• 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?

Question 7

Variables impacting this decsions include child’s

Answer 7

• motivation: intellectual level
• age
• lang and learning skills
• time frame (1yr? 2 mnths?)

Question 8

Establishing baselines

a. into

Answer 8

• 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

Question 9

because of this very limited sampling, mistakes can be made

Answer 9

• 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

Question 10

we counteract this problem

Answer 10

• by establishing baselines of potential treatment targets before starting therapy
• baselines are MEASURED RATES OF BEHAVIORS IN THE ABSENCE OF TREATMENT

Question 11

Baselines in our own lives

Answer 11

• how much you weigh before you start diet
• how many pounds you can bench press when you start a new workout program
• how fast you can swim a lap before you start that swim class

Question 12

3 purposes of baselines

Answer 12

1. establish clinician accountability
2. evaluate ch PROGRESS OVER TIME
3. modify treatment procedures if ch. not improving as expected

Question 13

Baseline procedures

Answer 13

• 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

Question 14

we need to be sure to specify response topography

Answer 14

• this refers to the linguistic level 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

Question 15

selecting the initial level and sequence of training

Answer 15

• baselines help us create appropriate treatment objectives

- PBH: best to start treatment at WORD LEVEL -function words especially

Question 16

developing measurable objectives

Answer 16

• 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 clients intelligibility of speech
• improve the clients phonological skills

Question 17

However measurable short-term objectives are needed

Answer 17

• 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 part payers like insurance companies demand detailed documentation of improvement

Question 18

to write a good objective

Answer 18

• use OBSERVABLE BEHAVIORS (e.g., point to, say, write, read aloud, sing, match)
• don’t use words with non-observable behaviors (e.g., know, understand, remember, learn perceive, memorize think about, consider)

Question 19

Remember that data collection

Answer 19

• should be done THROUGHOUT THERAPY

- a good baseline will support this

Question 20

planning and developing a treatment program or plan

Answer 20

-PHONETIC PLACEMENT techniques are DIRECT METHODS to teach clients how to position the articulators and produce the sound appropriately

Question 21

Successive approximation or shaping

Answer 21

• 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/

Question 22

we begin training the sound at one of several levels

Answer 22

1. isolation
2. syllable
3. word
4. phrase
5. sentence

Question 23

If the child cannot create phrase or sentence with the target word

Answer 23

-we can use a carrier phrase such as
“i see ____”
“here is a ____”

Question 24

structuring treatment sessions

Answer 24

• initial treatment sessions highly structured
• treatment sessions gradually loosen up to replicate natural “real world” more
• helps child generalize target sounds to spontaneous speech

Question 25

increasing and strengthening established behaviors

A. selecting potential reinforces

Answer 25

-positive reinforcer – rewards and strengthens the behaviors

Question 26

primary reinforcers

Answer 26

food

water

Question 27

secondary reinforcers

Answer 27

social value:
-verbal praise
tokens (e.g., play money, marbles)
-stickers
-(treasure chest rocks)

Question 28

generalization

Answer 28

• generalization usually refers to the childs producing learned responses in SETTING OUTSIDE the clinic
• generalize across situations
• ch uses sounds in OTHER LOCATIONS w. OTHER AUDIENCES

Question 29

implementing a maintenance program

a. general considerations

Answer 29

• maintenance= ultimate goal
• skills
• sustained OVER TIME
• select stimuli from clients NATRUAL ENVIRONMENT
• for ex: classroom lang arts book

Question 30

we should vary the physical setting

Answer 30

-conduct therapy in DIFFERENT ENVIRONMENT

Question 31

we need to teach multiple exemplars

Answer 31

• for ex: “quick” ch. working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures
• some ch may need 50 pictures 30 objects and 10 books with /r/ initial stimuli before they achieve 90% accuracy

Question 32

Manipulation of response contingencies

Answer 32

• most important aspect of maintenance
• move from continuous to INTERMITTENT REINFORCEMENT SCHEDULE
• fade primary reinforcers, rely more on natural reinforcers

Question 33

we can also

Answer 33

• train parents and other to reinforce ch for correct speech production in NATURAL ENVIRONMENT
• teach self-monitoring/self - correctinbg skills (I use the terms interchangeably)

Question 34

involve family members and significant others

Answer 34

• best maintenance -involvement of PEOPLES IN CHILDS 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 childs PROGRESS in therapy