Chp. 7 comprehensive and evidence based treatment program Flashcards
Selecting potential target behaviors
a. Introduction
- target behavior
- we need to select short term objectives and long-term goals
- in the schools, we say “benchmarks”
General considerations
- 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
Remember…
- connect treatment to classroom curriculum
- always keep common core state standards in mind
- I always treat speech sound errors and lang together
Select more readily taught treatment targets
- 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
Select targets that affect intelligibility the most
- 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
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 this decsions include child’s
- motivation: intellectual level
- age
- lang and learning skills
- time frame (1yr? 2 mnths?)
Establishing baselines
a. into
- 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
Baselines in our own lives
- 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
3 purposes of baselines
- establish clinician accountability
- evaluate ch PROGRESS OVER TIME
- modify treatment procedures if ch. not improving as expected
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 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 sequence of training
- baselines help us create appropriate treatment objectives
- PBH: best to start treatment at WORD LEVEL -function words especially
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 clients intelligibility of speech
- improve the clients 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 part payers like insurance companies demand detailed documentation of improvement
to write a good objective
- 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)
Remember that data collection
- should be done THROUGHOUT THERAPY
- a good baseline will support this
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
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 begin training the sound at one of several levels
- isolation
- syllable
- word
- phrase
- sentence
If the child cannot create phrase or sentence with the target word
-we can use a carrier phrase such as
“i see ____”
“here is a ____”
structuring treatment sessions
- initial treatment sessions highly structured
- treatment sessions gradually loosen up to replicate natural “real world” more
- helps child generalize target sounds to spontaneous speech
increasing and strengthening established behaviors
A. selecting potential reinforces
-positive reinforcer – rewards and strengthens the behaviors
primary reinforcers
food
water
secondary reinforcers
social value: -verbal praise tokens (e.g., play money, marbles) -stickers -(treasure chest rocks)
generalization
- 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
implementing a maintenance program
a. general considerations
- maintenance= ultimate goal
- skills
- sustained OVER TIME
- select stimuli from clients NATRUAL ENVIRONMENT
- for ex: classroom lang arts book
we should vary the physical setting
-conduct therapy in DIFFERENT ENVIRONMENT
we need to teach multiple exemplars
- 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
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 other to reinforce ch for correct speech production in NATURAL ENVIRONMENT
- teach self-monitoring/self - correctinbg skills (I use the terms interchangeably)
involve family members and significant others
- 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
