Principles of Intervention Flashcards

1
Q

Successful Intervention

A

Occurs when the child is able to use the forms and functions that have been targeted to effect REAL communication

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2
Q

What is Real Communication?

A

has intent, is persistent, is usually directed toward someone, not always verbal; child expressing wants and needs in whatever way possible

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3
Q

The ultimate goal of intervention

A

to make the child a better communicator

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4
Q

ASHA requires that SLPs must be able to show…

A

that the change a child makes is due to intervention

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5
Q

We must establish goals carefully to make certain…

A

we are targeting what requires intervention

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6
Q

3 Major Purposes of Intervention

A
  1. Change or eliminate the underlying problem (make perfectly typical)
  2. Change or modify the disorder (what we do the most of); improve certain aspects of language, but it doesn’t guarantee carryover to all aspects
  3. teach compensatory strategies
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7
Q

How do we decide the purpose of our intervention?

A

Intervention history of the child (what has and hasn’t worked before)
Nature of the disorder (does it progress, stay the same, etc)
The way the environment interacts w/ the child’s communication
Data collected from communication appraisal

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8
Q

3 Ways to Modify/Change Behavior: Intervention

A

Facilitation
Maintenance
Induction

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9
Q

Facilitation

A

outcome is the same, but we help make it come about faster

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10
Q

Maintenance

A

preservation of behavior that would otherwise disappear (with unrepaired cleft–maintenance of compensatory strategies)

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11
Q

Induction

A

intervention completely determines whether positive change will occur; progress won’t happen without intervention; hearing impaired child with hearing parents

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12
Q

What is evidence based practice?

A

the conscientious, explicit, and unbiased use of current best research results in making decisions bout the care of individual clients

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13
Q

2 types of EBP

A

internal evidence

external evidence

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14
Q

Internal Evidence

A
Characteristics of client & family
Willingness to participate in a given approach
Family preferences
Our preferences
Our professional competencies
Family values
Our values
Values of the institution in which we work
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15
Q

How to 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 used

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16
Q

Questions to ask in determining strength of study structure

A

Does report review a series of other studies?
If yes, does it review well-designed & randomized studies?
If no, does the study report results?

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17
Q

What to think about 1st when using EBP in intervention

A
  1. What’s the problem & what’s the patient?
  2. Would an alternative technique be better?
  3. Consider & compare the approaches
  4. What is the desired outcome?
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18
Q

How to approach using EBP in intervention

A

Formulate clinical ?s
Use internal evidence
Find external research evidence base (ASHA, Medline, etc)
Grade studies
Integrate internal & external evidence
Evaluate the decision made by documenting outcomes

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19
Q

Evaluation of decisions made by documenting outcomes

A

do the technique for 6 weeks while collecting data; if no positives are appearing, change course; if positives are appearing, keep going

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20
Q

Aspects of an intervention plan

A

The objectives
Processes used to achieve the objectives
Environments in which the intervention takes place (may be different plans for different environments)

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21
Q

Levels of intervention

A

Basic
Intermediate
Specific
*helps format thoughts; insurance usually uses intermediate goals, but others help us as a guide for therapy

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22
Q

Basic goals

A

big, broad, long-term goals

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23
Q

Intermediate goals

A

steps to basic goal (use pronouns 75% of the time)

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24
Q

Specific goals

A

session-level (use “me” and “I” x amount of times

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25
Q

Highest priority for setting goals

A

formas and functions a child uses 10-50% of required contexts

26
Q

High priority for setting goals

A

forms & functions used in 1-10% of required contexts, but understood in receptive tasks formats

27
Q

Lower priority for setting goals

A
  1. forms & functions used in 50-90% of required contexts (can be used as part of activities, but not written as goals)
  2. forms the client does not have at all & does not demonstrate understanding of in receptive tasks
28
Q

Zone of proximal development

A

what the child is ready to learn with assistance

Distance between child’s current level of independent functioning & potential level of performance

29
Q

Guidelines in goal writing

A

Usually need receptive awareness first
Choosing a goal that is very easy is a waste of time
If goals are beyond the zone, it is a waste of time
If child is 40% accurate in 1st session & after a few weeks is at 80%, you’ve chosen well

30
Q

Considerations for setting long & short term goals

A

Communication effectiveness
New forms express old functions/ new functions are expressed by old forms (don’t change more than 1 thing at a time)
Client phonological abilities (need these 1st before targeting words)
Teachability (want child to be teachable in concept)

31
Q

Continuum of Naturalness

A

Child-centered–Hybrid–Clinician-directed
Child-centered is most natural (very natural & all about child)
Clinician-directed is least natural; SLP is choosing everything; very structured

32
Q

Types of Clinician-Directed Techniques

A

Drill
Drill Play
Modeling

33
Q

Drill

A

SLP instructs child concerning response he/she could give
Provides a training stimulus (word or phrase to be repeated)
Stimuli are planned & controlled by SLP
Often involves prompts which are faded
Very rigid but can be useable; not very natural
Flashcards often

34
Q

Drill Play

A

Differs from drill in that it attempts to provide some motivation into the drill structure
Motivating event occurs DURING original training stimulus vs. AFTER
Animal names & sound, for example
Stickers: pulling off & sticking
Drill better for higher level

35
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” & later produce target
can incorporate into games, etc.

36
Q

Child-Centered Approach

A

Seems to be used the most
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 target response with a natural play context
No tangible reinforcers used; no requirements exist & no prompts used
Child directs activity (though SLP chooses therapy material initially)
SLP makes consistent & salient match between what child is doing & language used to talk about it

37
Q

The keys to a child-centered approach

A

SLP must learn to wait
SLP may have to interpret a child’s action as if they are attempts at communication (& reinforce w/ child)
SLP then must respond to child’s behavior in a way that models communicative language use
SLP is not attempting to elicit specific structures but is reacting to child’s behavior & placing it in communicative contexts (giving it linguistic mapping)

38
Q

Types of Child-centered approaches

A
Self-talk & parallel talk
Imitations
Expansions
Extensions
Buildups & breakdowns
Recast sentences
39
Q

Self-talk

A

SLP describes his/her own actions during parallel play; if child is pudding balls in a bucket, SLP mirrors action while participating SLP says “I’m dropping balls. I’m dropping balls in my bucket. See the balls? See the bucket?”
Provides a clear & simple match between actions & words
Modeling & talking about play

40
Q

Parallel talk

A

We provide self-talk for the child; give a running commentary
We mirror child’s actions & “speak” for them: “You’ are dropping balls. You are dropping balls in the bucket. You see the balls. You see the bucket.”

41
Q

Imitation

A

SLP imitates child; in typical development, adults often imitate children & then child imitates imitation
Research supports that anything that increases amount of child talk accelerates language development
The more the child says the more opportunity for practice of phonological, lexical, & syntactic forms
As child repeats our imitation, we have opportunity to use some of the other forms of contingent responses available in indirect language stimulation (allows to provide more focused & extensive feedback)
Can also use child’s imitation to initiate a back & forth exchange that encourages turn-taking

42
Q

Expansions

A

SLP “expands” on child’s utterance & adds grammatical markers & semantic details to make it more adult-like
Have been shown to increase probability that a child will spontaneously imitate at least part of the “expansion”
May also be called “recasts”

43
Q

Extensions

A

Comments that add some semantic info to a remark made by a child
Research indicates they are associated with significant increases in children’s sentence length
AKA expatiations
Focused mainly on semantics

44
Q

Build Ups and Breakdowns

A

Step 1: expand child’s utterance to a fully grammatical form (“yes baby is in bed”)
Step 2: Break the larger phrase down into several bite/phrase-sized pieces (sequential utterances that overlap content) (“the bed…the baby…the baby is in the bed”)

45
Q

Recast Sentences

A

We expand a child’s utterance into a grammatically correct version
Expand the child’s remark into a different type or more elaborated sentence (“is the dog in the house?”)

46
Q

Characteristics of Hybrid Approaches

A

Target 1 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 child but also to model & highlight forms being targeted
Gives SLP some control
Child is tempted but not required

47
Q

Focused Stimulation

A

Hybrid Approach
SLP arranges context of interaction so child is “tempted” to produce targets; SLP provides multiple models of 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 & then presents other models

48
Q

Vertical Structuring

A

Hybrid Model
Step 1: SLP responds to child’s incomplete utterance with a contingent ?
Step 2: If/when child response with another fragmented remark, SLP takes 2 pieces from child & expands into a more complete utterance; ask ? after eliciting response then combine w/ another utterance
Less natural

49
Q

Intervention Activities: Rate

A

Reducing our rate of speech may help child by reducing number of units he/she needs to process over time

50
Q

Intervention Activities: Repetition

A

Repeated exposure enhances opportunity for a child with language disorders to acquire language forms

51
Q

Intervention Activities to Increase Perceptual Saliency

A

Through prosody & through word order

52
Q

Intervention Activities: Complexity

A

Our sentences should be slightly longer than the child’s & refer to concepts that are semantically accessible to him/her

53
Q

Intervention Activities: obligating pragmatically appropriate responses

A

Generally be mindful to use linguistic stimuli that will yield entire response you are looking for (“Tell me about…”)

54
Q

Consultative Model

A

SLP determines targets, procedures, & contexts & trains parent/teacher/etc. to carryover (SLP is expert)

55
Q

Language-based classroom model

A

SLP is classroom teacher for a group of students with language disorders; SLP provides a continuous form of intervention embedded within the context of daily activities

56
Q

Collaborative Model

A

SLP works with 1 or more students with language disorders in the mainstream classroom in collaboration with teacher; may be a combination of pull out & sit in

57
Q

ASHA 2004 Termination Criteria

A

Communication is now WNL
All goals & objectives have been met
Client’s communication is comparable to others of the same age, sex, ethnic, & cultural backgrounds
Individual’s speech or language skills no longer adversely affect social, emotional, behavioral, or educational status
Individual uses an AAC system & has achieved optimal communication across partners & settings
Client has attained desired level of communication skills
Can be difficult to get parents to agree to discharge

58
Q

How to help parents with discharge

A

try sessions 1 time a month for 3 months

59
Q

General Criteria for discharge

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…)

60
Q

Primary Prevention Strategies identified by ASHA

A

Public education
Genetic counseling
Mass screenings & early identification
Proper health & medical care (including immunizations & prenatal care)

61
Q

SLPs and Prevention

A

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