Principles Of Intervention Flashcards
What is management?
Another word for intervention aka therapy
What is a plateau?
A period where there is a little or no improvement or change in the patient following a period where progress towards goals was evident
What is prognosis?
An estimate of how your patient’s skills will improve with therapy
EBP is the integration of three expertise. What are these? Define them.
Clinical expertise/expert opinion - the knowledge, judgment, and critical reasoning acquired through your training and professional experiences
Evidence (external and internal) - the best available information gathered from the scientific literature (external evidence) and from data and observations collected on your individual client (internal evidence)
Client/patient/caregiver perspectives - the unique set of personal and cultural circumstances, values, priorities, and expectations identified by your client and their caregiver
What is stimulability?
The degree to which a client can approximate the correct production of an error pattern on imitation
This involved the selection and sequencing of specific communicative behaviors
Programming
The rate of growth learning is accelerated, but the final outcome is not changed. Helps children to achieve language milestones sooner than they would have if left to their own devices, but it does not mean that they ultimately achieve higher levels of language function than they would have without intervention (e.g., child with phonological disorder), it could be that the child “grew out of it”. The client can get to the end point without intervention but with intervention, it will be faster.
Facilitation
What is maintenance?
Preserves the behavior that would otherwise decrease or disappear (e.g., toddler with cleft palate, delayed surgery)
What is induction?
Intervention completely determines whether some endpoint will be reached. So without intervention, the outcome is not achieved. (Example: hearing impaired 4 year old who uses very little spoken language, who comes from a hearing family, and who has no access to the deaf community)
So intervention follows a process, what are these?
New behaviors are introduce → activities progress through a hierarchy of difficulty and complexity, with decreasing support from the clinician → generalization → client’s habitual and spontaneous use of behavior in everyday speaking and listening situations
What are the five phases of intervention
- Formulation of behavioral objectives
- Selection of therapy targets
- Sequencing of therapy targets
- Generalization/carry over
- Termination of therapy
What is the developmental/normative approach?
We based our goals based on known normative sequences of communicative behaviors in typically achieving individuals Therapy targets are taught in the same general order as they emerge developmentally.
When two or more potential targets are identified from baseline procedures, the earliest emerging behaviors are selected as the first therapy objectives.
Tends to be most effective for articulation and language interventions with children
Developmental/normative approach should be implemented with careful consideration of at least two factors. Why?
Sample population from which the norms were derived may have been too small to permit valid generalization of the findings to other populations
The characteristics of the standardization sample (e.g., ethnicity, gender, socioeconomic status) may differ significantly from those of an individual client
Provide an example of a normative/developmental approach
A 5-year-old child with an articulation disorder produces the following speech sound errors on baseline procedure:
/p/ for /f/, /t/ for /ʃ/, /d/ for /b/.
The use of the developmental strategy guides the clinician to select /b/ as the initial therapy target because typically developing children demonstrate mastery of this sound earlier than the others. According to a developmental progression, /f/ is the next logical target, followed by /ʃ/
What is the client-specific approach?
Therapy targets are chosen based on an individual’s specific needs rather than according to developmental norms.
Relevant factors in the selection of treatment objectives: (1) the frequency with which a specific communicative behavior occurs in a client’s daily activities, (2) the relative importance of a specific communicative behavior to the client, regardless of how often it occurs (example: of writing is more important to the patient, we prioritize it), (3) the client’s potential for mastery of a given communication skill - stimulability nila
What is the bottom-up approach?
Is when you focus on the foundational level
The bottom-up approach in speech therapy focuses on developing specific, foundational speech and language skills first, before moving to higher-level communication. This method starts with the smaller components of speech, such as phonemes (individual sounds), articulation, or motor skills involved in speech production, and gradually works up to more complex language tasks, like sentence formation and conversation.
What is the top-down approach?
The top-down approach focuses on higher-level cognitive and linguistic skills before addressing more specific speech and language elements. Rather than starting with the smallest units of speech (like sounds or phonemes), this approach emphasizes broader, more functional communication skills such as understanding context, using language in conversation, and comprehending complex sentences.
What is a behavioral objective?
Also known as the goal
Statement that describes a specific target behavior in observable and measurable terms
Allows the client, as well as the clinician, to know exactly what the therapy target is, how it is to be accomplished, and what constitutes successful performance
What are the 3 main components of behavioral objectives?
“Do” action statement
Condition
Criterion
What is the “do” statement in the behavioral objectives
- Identifies the specific action the client is expected to perform
- Should contain verbs that denote observable activity. It should be measurable
What is the condition in the behavioral objectives?
Identifies the situation in which the target behavior is to be performed
Specifies one or more of the following:
(1) when the behavior will occur
(2) where it will be performed
(3) what materials and cues will be used to elicit the target
What is the criterion in the behavioral objectives?
Specifies how well the target behavior must be performed for the objective to be achieved. It can be expressed in: percentages, within a given time period, minimum number of correct responses, maximum number of error responses
Example: 90% accuracy, 8/10 trials
What is the “do” statement, condition, and criterion in this goal: The client will verbally segment 100 written multisyllabic words into their component syllables with no more than four errors
Do statement: Verbally segment
Condition: Given a written list of 100 written multisyllabic words
Criterion: with no more than four errors
What is the “do” statement, condition, and criterion in this goal: The client will use a slow rate of speech (four syllables) with 85% accuracy or higher while reading single sentences over to consecutive sessions
Do statement: The client will use slow rate of speech
Condition: while reading single sentences
Criterion: with 85% accuracy over to consecutive sessions
What is the “do” statement, condition, and criterion in this goal: Given the clinician’s model, the client will say /s/-initial single words with 90% accuracy while naming animal pictures.
Do statement: say s-initial single words
Condition: Given the clinician’s model while naming animal picture
Criterion: 90% accuracy
Define a SMART goal
S - specific
M - measurable
A - achievable (Is the goal obtainable? Think about the client’s performance)
R - relevant (is the goal relevant to the clients overall quality of life? This can also mean relevance to parents and teacher)
T - time limited
What are long term goals?
Months to years / over the course of the treatment program
Highest level of desired function (for a specific amount of time)
What are short term goals?
Session goals
What long-term goals are comprised of
There are 3 major factors that determine the progression of the therapy sequence. What are they?
Stimulus type
Task mode
Response level
Sequencing process starts with a decision regarding the _______________ to begin training on each target behavior
Sequencing process starts with a decision regarding the most appropriate level to begin training on each target behavior
What is the stimulus type?
Nature of input used to elicit target responses
Direct physical manipulation
Concrete symbols (a. Object, b. photographs/color pictures, c. black and white line drawings)
Abstract symbols (a. Oral language, b. Written language)
What is task mode?
Type of clinician support/scaffolding provided to obtain desired responses
Imitation
cue/prompt
Spontaneous
What is the response level?
Degree of difficulty of target responses
To increase the length and complexity of desired response (idolation, syllable, word, carrier phrase, phrase, sentence, text (conversation, narration)
Decrease latency (actual time) between stimulus presentation and client response level
What is branching?
Increasing or decreasing the difficulty level by one step according to the therapy sequence hierarchies listed previously
Pretreatment baseline data
Baseline score lower than 50% = training should begin just below the level of difficulty of the baseline stimulus items
Baseline score between 50% and 75% accuracy = training can begin at the same difficulty level as the baseline stimuli
Example: 5 year old client initial /s/ (1) word level = 65%, carrier phrase level = 40%, sentence level = 30%
What is the zone of proximal development?
The learner can do with guidance (zone of proximal development)
What is direct modeling?
Clinician demonstrates a specific behavior to provide an exemplar for the client to imitate.
Most frequently used in the early stages of therapy
Also employed whenever a target behavior is shifted to a higher level of response difficulty because this type of modeling provides the maximum amount of clinician support.
Minimizes the likelihood of client’s error response
Typically augmented with direct models with a variety of visual and verbal cues to establish correct responses at the level of imitation
Once a target behavior is established, continuous modeling should be eliminated because it does not facilitate strengthening or maintaining a target response
What is indirect modeling?
Clinician demonstrates a specific behavior frequently to expose a client to numerous well-formed examples of the target behavior.
What is shaping (by successive approximation)
A target behavior is broken down into small components and taught in an ascending sequence of difficulty
What are prompts?
The clinician provides additional verbal or nonverbal cues to facilitate a client’s production of a correct response
There are two types of prompts. What are they? Define both of them.
Attentional prompts - improve performance by focusing a client’s concentration on the task at hand. Example: “Look at me” or “Watch my mouth”, “Remember to pay attention”. So this is modeling the behavior with exaggerated loudness and duration.
Instructional cues: provide information that is directly related to the specific target behavior. (Examples: (1) Verbal prompts - “remember to elevate your tongue tip at the beginning of each word,” or “don’t forget to segment your words into syllables if you get stuck,” or “be sure that your answer has at least three words in it.” (2) Nonverbal - Index card with the name of the targeted fluency technique written on it. Gesture to indicate that voice loudness should be increased. Drawings that represent the grammatical categories of subject, verb, and object.
What is fading?
Stimulus or consequence manipulations (e.g., modeling, prompting, reinforcement) are reduced in gradual steps while maintaining the target response.
Gradual fading can be accomplished in at least two ways. How?
Client produces multiple imitations for each model demonstrated by the clinician (e.g., three imitative responses are required after each direct model.)
Progressive reduction of the length of the behavior modeled by the clinician. (direct model of “the boy is running” → “the boy is …,” → “the boy…,”
In general, fading procedures can be initiated once a client is able to produce at least _____________
Five consecutive correct imitative responses
What is expansion?
This is an example of language stimulation techniques
Clinician reformulates a client’s utterance into a more mature or complete version
Example: The kid says, “doggy eat”, the clinician will say, “dog is eating.”
What is negative practice?
The client is required to intentionally produce a target behavior using a habitual error pattern.
Facilitates learning by highlighting the contrast between the error pattern and the desired response
Generally is implemented only after a client demonstrates the ability to produce a given target consistently at the level of imitation
Best used on a short-term basis
What is target-specific feedback?
Clinician provides information regarding the accuracy or inaccuracy of a client’s response relative to the specific target behavior.
This technique serves three main functions: (a) feedback that consists of more than simple accuracy judgements regarding their responses; provides precise information about why responses are correct or incorrect (e.g., Good, I didn’t see your tongue peeking out when you said soup vs Good job!) (b) Maintains a client’s awareness of the exact response being targeted without the need for continuous reinstruction during a therapy activity. (c ) Assists clinicians in maintaining client focus on the communication behavior being targeted by a given therapy activity
Target-specific feedback
What is the prompting hierarchy?
Pause → indirect nonverbal prompt → indirect verbal prompt → request a response → gestural cue → partial verbal prompt → Model → direct model → physical assistance
Difference between cue and prompts
Cue gives clues
Prompts gives are more direct in giving the correct answer
What is generalization/carry over?
Transfer newly mastered communicative behaviors from clinical setting → everyday environment
Enhanced when intervention is provided in the most authentic, realistic, contexts possible.
Should not be viewed as distinct event that occurs only in the final phase of the therapy process
There are three main factors to successful generalization. What are these?
A variety of stimuli (objects, pictures, questions) should be used
Clinician should vary the physical environment (location in room, location in building, real world locations) in which therapy occurs
Vary the audience (familiar adult, sibling, unfamiliar adult) with whom therapy targets are practice, to maximize the likelihood of successful generalization
When do we terminate therapy?
At the current time, there is no valid empirical data that can be used to determine appropriate dismissal criteria for any particular communicative disorder
General discharge guidelines used by many clinicians include: (1) Attainment of communication skills are commensurate with a client’s chronological/developmental age or premorbid status (2) Attainment of functional communication skills that permit a client to operate in the daily environment without significant handicap (3) lack of discernible progress persisting beyond a predetermined time period
True or False. Under each long-term goal, specify relevant test results/baseline data that have been collected and used as the basis for development of the short-term objectives. Baseline data are generally obtained over the initial therapy sessions. Make note of any unusual or clinically significant behavior patterns.
t
What is reinforcement?
Type and schedule of reinforcers to be used for shaping target productions and attending behaviors.
Example: A continuous schedule of verbal reinforcement, coupled with token reinforcers, will be used to shape target behaviors.
What is a generalization plan?
In paragraph form, specify strategies for transfer of target objectives to home, school, or work setting
True or False. The first decision to be made is whether treatment will be delivered in an individual or group setting?
t
Basic training protocol
(1) Clinician presents the stimulus
(2) Clinician waits for the client to respond
(3) Clinician presents appropriate consequent event
(4) Clinician record response
(5) Clinician removes stimuli (as appropriate)
What is the task order?
An ideal follows an “easy-hard-easy” pattern: success-oriented session design → high client motivation
Easy 1: Review of completed homework assignments or nearly mastered targets from a previous session.
Hard: Behavioral objectives that are most challenging to the client
Easy 2: Tasks that elicit fairly accurate performance with minimal effort
True or False. State instructions in the declarative form. Directions that are presented indirectly in the form of requests (e.g., can you say ____”) are pragmatically confusing and understandably may elicit negative replies (e.g., “no” or “i don’t want to)
True
True or False. If it becomes necessary to re-administer instructions, try to avoid significant reformulation of the original working. This is particularly important with client who have language disorders, because rewording tends to become a source of confusion rather than clarification
True
Group therapy has a variety of purposes. What are they?
Teach new communication skills at introductory levels
Provide clients with practice on skills previously established in individual sessions
Socialization
Self-help
Counseling
The group size varies depending on
Purpose
Setting
Client age
Availability of clients
Primary client characteristics to be considered:
Age
Gender
Disorder type
Disorder severity
Intelligence *
Socioeconomic status *
Education level *
Personality types
Rule of thumb for pediatric groups: age or developmental level of the members should be __________________.
within two or three years from one another.
Why is collaboration important?
Collaboration is critical to promoting communication among different professionals, all of whom possess specialized knowledge and skills.
Collaboration often does not occur because it requires a substantial degree of coordination and planning (Beck & Dennis, 1997)
Strategically select a client(s) for whom the potential benefits of co-treatment are most evident.
Eight guiding principles for effective collaborations (Paul, Blosser, & Jakubowitz, 2006):
(1) Engage in mutual problem solving and share responsibility for positive client outcomes
(2) Establish communication goals and priorities for clients on the basis of their strengths and needs.
(3) Form partnerships that are nonhierarchical and based on co-equal participation
(4) Recognize that collaboration is a dynamic process: the size, composition, goals, and function of teams change as client needs change
(5) Respect different professional perspectives
(6) Make partnerships a priority
(7) Establish realistic expectations for the partnership
(8) Celebrate success
What is the consultative model?
The clinician acts as a resource for professionals who work directly with a child and parents to help solve problems related to the child’s communicative deficit
What is the team teaching model?
The clinician and the teacher share the responsibility for classroom instruction
- a comprehensive program with strong language and academic components can be provided within the context of the classroom
What model is this: The clinician alone serves as the classroom teacher and is responsible for developing and implementing all aspects of the curriculum. Classroom activities are specifically designed to promote the development of language skills
Self-contained
What is interprofessional practice?
An increasingly well-regarded collaborative model where different health and social care professional regularly work together
Current healthcare and education reforms are prompting some rethinking about the academic and clinical preparation of future professionals in health-related professions (including speech-language pathology and audiology).
What is telepractice?
Delivery of services using telecommunication and internet technology to remotely connect clinicians to clients, other health care providers, and/or educational professional for screening, assessment, intervention, consultation, and/or education
May be the primary mode of service delivery or may supplement in-person services (known as hybrid service delivery)
Allows for one-on-one interaction in an environment where the patient is most comfortable. Therapy activities can be tailored to address “real life” functional needs and provide opportunities to individualize each patient’s care plan to their specific environmental and social needs. Affords added flexibility and autonomy, interaction with patients and families on a personal level, and opportunities for true interdisciplinary service delivery.
Home health
What is behavior modification?
Based on the theory of operant conditioning
Involves the relationship among a stimulus, a response, and a consequent event
AKA antecedent event. Event that precedes and elicits a response
Stimulus (it can be a picture or a question)
This is the behavior exhibited by an individual on presentation of the stimulus
Response
What is the consequence?
Event that is contingent on and immediately follows the response
It has different types: reinforcement - consequences that increase the probability that a particular behavior will recur and punishment - consequences designed to decrease the frequency of a behavior
What is primary positive reinforcement?
Client reacts favorably due to the biological makeup or physiologic predisposition of the individual
Most common example: food.
Very powerful and is used most effectively to establish new communicative behaviors
“Low-functioning” clients often respond well
Disadvantages of primary positive reinforcement
Difficult to present the reinforcement immediately after every occurrence of the target behavior
Susceptible to satiation
Often difficult to generalize outside of therapy setting
What is secondary positive reinforcement?
These are contingent events that a client must be taught to perceive as rewarding
Social positive reinforcement
Events such as smiling, eye contact, and verbal praise
Most commonly used type of reinforcement in speech-language remediation programs
Extremely easy to administer after each target response
Not very susceptible to satiation (although it is not totally immune)
Does occur in a client’s natural daily environment
Token economy
Consists of symbols or objects that are not perceived as valuable in and of themselves
Accrual of a specified number of these tokens → obtain a previously agreed-on reward
Examples: stickers, checkmarks, chips, point score
This is easy to administer contingent on each occurrence of a target behavior
Relatively resistant to satiation
Example: I am working for…
Performance feedback
Involves information that is given to a client regarding therapy performance and progress
Not intended to function as praise and need not be presented verbally
Decreases a client’s reliance on external sources of reinforcement by encouraging the development of intrinsic rewards (i.e., internal satisfaction and motivation) for mastering and maintaining a target behavior
What is negative reinforcement?
An unpleasant event/condition is removed contingent on the performance of a desired behavior
There are two types of negative reinforcement. What are they?
Escape
Avoidance
This requires the presence of a condition that the client perceives as aversive. Performance of the target behavior → termination of aversive condition → increased probability that the specified behavior will recur.
Escape
Give an example of escape
A clinician might place her hands firmly over a child’s hands and remove them only when the child exhibits the target behavior of imitatively producing /s/
In highschool, everyone is standing up and can only sit down when they are able to recite
What is avoidance?
Each performance of a target behavior prevents the occurrence of an anticipated aversive condition
For example, a clinician might inform a child that each imitative production of the target /s/ will prevent the imposition of hand restraint
Relatively uncommon in the treatment of communication disorders because it repeatedly exposes clients to unpleasant or aversive situations
You wanna avoid the consequence by doing the action
An event is presented contingent on the performance of an undesired behavior, to decrease the likelihood that the behavior will recur. It has two types. What is this
Punishment
What are the two types of punishment?
Type I: Prompt presentation of an aversive consequence after each demonstration of an unwanted behavior. Example: verbal utterances such as “no!”, frowning, or the presentation of bursts of white noise
Type II: Requires withdrawal of a pleasant condition contingent on the demonstration of an unwanted behavior. Most common forms: Time-out and response cost
What is timeout?
Temporary isolation or removal of a client to an environment with limited or no opportunity to receive positive reinforcement. Example: Turning the client’s chair toward a blank wall in the therapy room, withholding direct eye contact from the client for a short period of time.
What is the response-cost?
Previously earned positive reinforcers are deducted or taken back each time the undesirable behavior is demonstrated. Examples: removal of sticker, partial subtraction of point, unearned tokens at beginning of session
Punishment should be delivered after every instance of unwanted behavior. True or False.
True
True or False Punishment should be presented after a long time after the undesirable behavior
False. Punishment should be presented immediately following undesirable behavior.
True or False. Punishment should occur at the earliest signs of the unwanted behavior rather than waiting until the behaviors is full-blown
True
What is extinction?
If no contingent consequences occur following a targeted behavior, the frequency of that behavior will gradually decrease and ultimately disappear from a client’s repertoire
It does not occur immediately. Temporary increase in emission rate may be observed when the behavior is initially ignored
Behaviors that receive reinforcement on a continuous basis are most vulnerable to extinction, whereas those that are only periodically reinforced over a long period of time are least susceptible to this procedure.
Recommendation: extinction + positive reinforcement for the converse behavior
There is a schedule of reinforcements. What are the two main schedules?
Continuous
Intermittent
What is continuous reinforcement?
Reinforcer is presented after every correct performance of a target behavior
Most commonly use to shape and establish new communication behaviors
Can also be used when transitioning an already established skill from one level of difficulty to the nest (e.g., from word to sentence level)
Reduces the risk that a client’s production of a target behavior will “drift” from the intended response
Primary disadvantage: behaviors reinforced at such high density level are very susceptible to extinction and may interfere with a client’s production of a steady flow of responses
What is intermittent reinforcement?
Only some occurrences of a correct response are followed by a reinforcer
Most effective in strengthening responses that have been previously established
Reduces the probability of satiation during treatment and results in behaviors that are extremely resistant to extinction
