Preschool Intervention Flashcards
1
Q
Success defined…
A
Successful intervention occurs when the child is able to use the forms and functions that have been targeted to effect REAL communication
Real communication is being able t express wants and needs and is intentional
2
Q
General considerations about goals
A
- the ultimate goal of interventionn is to make the child a better communicator
- ASHA requires that SLP’s must be able to show that the change a child makes is due to intervention
- we must establish goals carefully to make certain we are targeting what requires intervention
3
Q
3 Major Purposes of intervention
A
- Change or eliminate the underlying problem
- Change (modify) the disorder (most common)
- Teach compensatory strategies
4
Q
How do we decide the purpose of our intervention?
A
- Intervention history of the child
- Nature of the disorder (how is it progressing)
- The way the environment interacts with the child’s communication
- Data collected from the communication appraisal
5
Q
Intervention: Changing Behavior
A
-Facilitation: where the child would catchup anyway; it would have happened anyway you just made it faster
- Maintenance: of a behavior that might otherwise disappear of lose where they are going
- Induction: invention completely determines whether positive change will occur
6
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”
- legitimizes what we are doing
- gives parents a knowledge that we are doing things that have evidence behind what we are doing
7
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
8
Q
How do we evaluate external evidence?
A
- View the opinions of experts with skepticism
- Realize that some studies are structured better than others
- Be critical of the quality of evidence we use
9
Q
How to approach using EBP in intervention
A
- Formulate clinical question
- 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
10
Q
Formulating Clinical Questions
A
- does it fit the problem and does it fit the patient
- would an alternative technique be better
- then compare them
- what is the desired out come that you are really doing for and that will help pick therapy
11
Q
Aspects of an Intervention Plan
A
- The objectives
- Processes used to achieve the objectives
- Environment in which the intervention takes place
12
Q
Levels of Intervention Goals
A
- Basic: big long term goal; broad
- Intermediate: steps to basic goal
- Specific
13
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
14
Q
Zone of Proximal Development
A
Distance between childs current level of independent functioning and potential level of performance (what the child is ready to learn with assistance)
15
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
16
Q
Continuum of Naturalness
A
- Child-centered (Ex. Facilitated play, daily activities) (most natural)
- Hybrid (Ex. Milieu Therapy, Focused stimulation, Script therapy) (will add structure to child centered)
Clinician – directed (Ex. Drill, Drill play, Modeling) (lest natural; more about structure)
17
Q
Clinician-directed Approach
A
- Drill
- Dill play
- Modeling
18
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
19
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
20
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
21
Q
Child-centered Approach
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
22
Q
Child-centered Approach: The Keys
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)
23
Q
Child Centered: Approaches
A
- Self-talk and parallel talk
- Imitations
- Expansions
- Extensions
- Build ups and breakdowns
- Recast sentences
24
Q
Child Centered: 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
25
Child Centered: Parallel Talk
- We provide “self-talk” for the child
- We give a running commentary
- We mirror the child’s actions and “speak” for them
- Ex. “You are dropping balls. You are dropping balls in the bucket. You see the balls. You seen the bucket
26
Child Centered: Imitation
- The SLP imitates the child
- In typical development adults often imitate children and the child then imitates the imitation
- Research supports that anything that increases the amount of child talk accelerates language development
- The more the child says the more opportunity for practice of phonological, lexical, and syntactic forms
- As the child repeats our imitation we have an opportunity to use some of the other forms of contingent responses available in indirect language stimulation (allows us to provide more focused and extensive feedback)
- We can also use the child’s imitation to initiate a back and forth exchange that encourages turn taking
27
Child Centered: Expansion
- 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”
28
Child Centered: Extensions
- 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”
29
Child Centered: Build Ups and Breakdowns
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)
30
Child Centered: Recast Sentences
- We expand a child’s utterance into a grammatically correct version
- Expand the child’s remarks into a different type or more elaborated sentence
31
Hybrid Approaches: Characteristics
- 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
32
Hybrid: Focused Stimulation
- 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
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Hybrid: Vertical Structural
Step 1 – Child 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”
34
Intervention Activities: General Features
- 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…
35
Service Delivery Models
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
36
Termination Criteria
ASHA 2004 e
-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
37
General Criteria
- (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…)
38
Primary Prevention
ASHA identifies several primary prevention strategies…
- Public education
- Genetic counseling
- Mass screenings and early identification
- Proper health and medical care (including immunizations and prenatal care)
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SLP's and Prevention
- Promote wellness in family-centered early intervention programs
- Provide education to parents of preemies
- Encouraging pregnant women to avoid drug and alcohol use during pregnancy
