Intervention Flashcards
1
Q
Goal of intervention
A
1) The ultimate goal of intervention is to make the child a better communicator
2) ASHA requires that SLPs must be able to show that the change a child makes is due to intervention
3) We must establish goals carefully to make certain we are targeting what requires intervention
2
Q
Purposes of Intervention
A
1) Change or eliminate the underlying problem
2) Change (modify) the disorder
3) Teach compensatory strategies
3
Q
Intervention: Changing Behavior
A
- Facilitation
- Maintenance
- Induction
4
Q
Evidence Based Practice
A
“the conscientious, explicit, and unbiased use of current best research results in making decisions about the care of individual clients”
5
Q
Internal Evidence
A
- The characteristics of the client and family
- Willingness to participate in a given approach
- Family preferences
- Our preferences
- Our professional competencies
- Family values
- Our values
- The values of the institution in which we work
6
Q
How to approach using EBP in intervention
A
- Formulate clinical questions
- Use internal evidence
- Find the external research evidence base (ASHA, Medline, Psychinfo, etc.)
- Grade studies
- Integrate internal and external evidence
- Evaluate the decision made by documenting outcomes
7
Q
Aspects of an intervention plan
A
- The objectives
- Processes used to achieve the objectives
- Environments in which the intervention takes place
8
Q
Levels of Intervention
A
- Basic
- Intermediate
- Specific
9
Q
Priorities for setting goals
A
- Highest Priority – forms and functions child uses 10-50% of required contexts
- High Priority – forms and functions used in 1-10% of required contexts, but understood in receptive task formats
- Lower Priority – a. forms and functions used in 50-90% of required contexts, b. forms the client does not use at all and does not demonstrate understanding of in receptive tasks
10
Q
Zone of Proximal Development
A
Distance between child’s current level of independent functioning and potential level of performance (what the child is ready to learn with assistance)
11
Q
Considerations for setting long and short term goals
A
- Communicative Effectiveness
- New forms express old functions / new functions are expressed by old forms
- Client phonological abilities
- Teachability
12
Q
Continuum of Naturalness
A
- Child-centered (Ex. Facilitated play, daily activities)
- Hybrid (Ex. Milieu Therapy, Focused stimulation, Script therapy)
- Clinician – directed (Ex. Drill, Drill play,
Modeling)
13
Q
Clinician-directed approach
A
- Drill
- Drill play
- Modeling
14
Q
Drill
A
- SLP instructs the child concerning the response he/she should give
- Provides a training stimulus (word or phrase to be repeated)
- Stimuli are planned and controlled by the SLP
- Often involves prompts which are faded
15
Q
Drill Play
A
- Differs from drill in that it attempts to provide some motivation into the drill structure
- The motivating event occurs during the original training stimulus vs. after
16
Q
Modeling
A
- Highly structured format
- Formal interactive context
- Child’s job is listen as SLP models
numerous examples of structure being taught - Through listening child is expected to “induce” and later produce the target
17
Q
Child-centered
A
- May be better for children who refuse clinician-directed treatment
- May be better for unassertive children who respond but rarely initiate communication
- SLP organizes activities to provide child with an opportunity to provide the target response with a natural play context
- No tangible reinforces are used
- No requirements exist and no prompts used
- Child directs the activity (though the SLP chooses therapy material initially)
- SLP makes a consistent and salient match between what child is doing and the language used to talk about it
18
Q
Child-centered Approach: The keys… (4)
A
- The SLP must learn to wait
- The SLP may have to interpret a child’s actions as if they are attempts at communication (and reinforce with child)
- The SLP then must respond to the child’s behavior in a way that models communicative language use
- The SLP is not attempting to elicit specific structures but is reacting to the child’s behavior and placing it in communicative context (giving it linguistic mapping)
19
Q
Child Centered Approaches
A
- Self-talk and parallel talk
- Imitations
- Expansions
- Extensions
- Build ups and breakdowns
- Recast sentences
20
Q
Self Talk
A
- SLP describes his/her own actions during parallel play
- Ex. If child is putting balls in a bucket, SLP mirrors the action
- While partipating the SLP says “I’m dropping balls. I’m dropping balls in my bucket. See the balls? See the bucket?, etc.
- Provides a clear and simple match between actions and words
21
Q
Imitation
A
SLP imitates the child and kids will typically begin to imitate the imitation
22
Q
Child centered- expansions
A
- The SLP “expands” on the child’s utterance and adds grammatical markers and semantic details to make it more adult like
- Expansions have been shown to increase the probability that a child will spontaneously imitate at least part of the “expansion”
- May also be called “recasts”
23
Q
Extensions
A
- Comments that add some semantic information to a remark made by a child
- Research indicates that extensions are associated with significant increases in children’s sentence length
- Also called “expatiations”
24
Q
Build ups and Breakdowns
A
- Step 1 – expand child’s utterance to a fully grammatical form
- Step 2 – Break the larger phrase down into several phrase-sized pieces (sequential utterances that overlap content
25
Q
Recast sentences
A
- We expand a child’s utterance into a grammatically correct version
- Expand the child’s remarks into a different type or more elaborated sentence
26
Q
Hybrid Approaches
A
- Target one or a small set of specific language goals
- SLP maintains control in selecting activities but does so in a way that tempts the child to make use of utterances in relation to a target
- SLP uses linguistic stimuli to respond to the child but also to model and highlight forms being targeted
27
Q
Focused Stimulation
A
- Hybrid approach
- SLP arranges the context of interaction so the child is “tempted” to produce targets
- SLP provides multiple models
of the target forms in a meaningful way (usually play) - Helpful for improving comprehension of a form as well as production
- If target isn’t produced, SLP responds contingently and then presents other models
28
Q
Vertical Structuring - hybrid approach
A
- Step 1 – SLP responds to child’s incomplete utterance with a contingent question
- Step 2 - If / when child responds with another fragmented remark, SLP takes 2 pieces from child and expands into a more complete utterance
- Less “natural”
29
Q
General features of intervention activities
A
- Rate – Reducing our rate of speech may help the child by reducing the number of units he/she needs to process over time
- Repetition – Repeated exposure enhances the opportunity for a child with language disorders to acquire language forms
- Increasing perceptual saliency through prosody
- Increasing perceptual saliency through word order
- Complexity – Our sentences should be slightly longer than the child’s and refer to concepts that are semantically accessible to him/her
- Obligating pragmatically appropriate responses
— Generally be mindful to use linguistic stimuli that will yield the entire response you are looking for
30
Q
Service delivery models
A
- Consultative model – SLP determines targets, procedures, and contexts and trains parent/teacher/etc. to carryover
- Language-based classroom model – SLP is the classroom teacher for a group of students with language disorders. SLP provides a continuous form of intervention embedded w/I context of daily activities
- Collaborative - SLP works with one or more students with language disorders in the mainstream classroom in collaboration with the teacher.
—- May be a combination of pull out and sit in
31
Q
Termination Criteria
A
ASHA 2004-
- Communication is now WNL
- All goals and objectives have been met
- Client’s communication is comparable to others of the same age, sex, ethnic, and cultural backgrounds
- The individual’s speech or language skills no longer adversely affect social, emotional, or educational status
- The individual uses an AAC system and has achieved optimal communication across partners and settings
- The client has attained the desired level of communication skills
32
Q
General Criteria
A
- (Behaviorist criterion is usually 80-90 % accuracy in a structured intervention context)
- Paul recommends 50% accuracy in a natural language sample
- When accuracy in a natural context exceeds 50% direct therapy may be discontinued (with a periodic check…)
33
Q
)Primary Prevention (7)
A
- Public education
- Genetic counseling
- Mass screenings and early identification
- Proper health and medical care (including immunizations and prenatal care)
- Promote wellness in family-centered early intervention programs
- Provide education to parents of preemies
- Encouraging pregnant women to avoid drug and alcohol use during pregancy
