Principles of Intervention Flashcards
Successful Intervention
Occurs when the child is able to use the forms and functions that have been targeted to effect REAL communication
What is Real Communication?
has intent, is persistent, is usually directed toward someone, not always verbal; child expressing wants and needs in whatever way possible
The ultimate goal of intervention
to make the child a better communicator
ASHA requires that SLPs 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 Major Purposes of Intervention
- Change or eliminate the underlying problem (make perfectly typical)
- 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
- teach compensatory strategies
How do we decide the purpose of our intervention?
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
3 Ways to Modify/Change Behavior: Intervention
Facilitation
Maintenance
Induction
Facilitation
outcome is the same, but we help make it come about faster
Maintenance
preservation of behavior that would otherwise disappear (with unrepaired cleft–maintenance of compensatory strategies)
Induction
intervention completely determines whether positive change will occur; progress won’t happen without intervention; hearing impaired child with hearing parents
What is evidence based practice?
the conscientious, explicit, and unbiased use of current best research results in making decisions bout the care of individual clients
2 types of EBP
internal evidence
external evidence
Internal Evidence
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
How to evaluate external evidence
View the opinions of experts with skepticism
Realize that some studies are structured better than others
Be critical of the quality of evidence used
Questions to ask in determining strength of study structure
Does report review a series of other studies?
If yes, does it review well-designed & randomized studies?
If no, does the study report results?
What to think about 1st when using EBP in intervention
- What’s the problem & what’s the patient?
- Would an alternative technique be better?
- Consider & compare the approaches
- What is the desired outcome?
How to approach using EBP in intervention
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
Evaluation of decisions made by documenting outcomes
do the technique for 6 weeks while collecting data; if no positives are appearing, change course; if positives are appearing, keep going
Aspects of an intervention plan
The objectives
Processes used to achieve the objectives
Environments in which the intervention takes place (may be different plans for different environments)
Levels of intervention
Basic
Intermediate
Specific
*helps format thoughts; insurance usually uses intermediate goals, but others help us as a guide for therapy
Basic goals
big, broad, long-term goals
Intermediate goals
steps to basic goal (use pronouns 75% of the time)
Specific goals
session-level (use “me” and “I” x amount of times
Highest priority for setting goals
formas and functions a child uses 10-50% of required contexts
High priority for setting goals
forms & functions used in 1-10% of required contexts, but understood in receptive tasks formats
Lower priority for setting goals
- forms & functions used in 50-90% of required contexts (can be used as part of activities, but not written as goals)
- forms the client does not have at all & does not demonstrate understanding of in receptive tasks
Zone of proximal development
what the child is ready to learn with assistance
Distance between child’s current level of independent functioning & potential level of performance
Guidelines in goal writing
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
Considerations for setting long & short term goals
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)
Continuum of Naturalness
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
Types of Clinician-Directed Techniques
Drill
Drill Play
Modeling
Drill
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
Drill Play
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
Modeling
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.
Child-Centered Approach
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
The keys to a child-centered approach
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)
Types of Child-centered approaches
Self-talk & parallel talk Imitations Expansions Extensions Buildups & breakdowns Recast sentences
Self-talk
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
Parallel talk
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.”
Imitation
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
Expansions
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”
Extensions
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
Build Ups and Breakdowns
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”)
Recast Sentences
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?”)
Characteristics of Hybrid Approaches
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
Focused Stimulation
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
Vertical Structuring
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
Intervention Activities: Rate
Reducing our rate of speech may help child by reducing number of units he/she needs to process over time
Intervention Activities: Repetition
Repeated exposure enhances opportunity for a child with language disorders to acquire language forms
Intervention Activities to Increase Perceptual Saliency
Through prosody & through word order
Intervention Activities: Complexity
Our sentences should be slightly longer than the child’s & refer to concepts that are semantically accessible to him/her
Intervention Activities: obligating pragmatically appropriate responses
Generally be mindful to use linguistic stimuli that will yield entire response you are looking for (“Tell me about…”)
Consultative Model
SLP determines targets, procedures, & contexts & trains parent/teacher/etc. to carryover (SLP is expert)
Language-based classroom model
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
Collaborative Model
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
ASHA 2004 Termination Criteria
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
How to help parents with discharge
try sessions 1 time a month for 3 months
General Criteria for discharge
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…)
Primary Prevention Strategies identified by ASHA
Public education
Genetic counseling
Mass screenings & early identification
Proper health & medical care (including immunizations & prenatal care)
SLPs 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
