When selecting potential target behaviors:
- Target behavior
- We need to select short term objectives and long-term goals
- In the schools, we say “benchmarks”
What are some general characteristics?
- Select treatment targets that are linguistically and culturally appropriate for the client
- Select targets that will make an immediate and socially significant difference in the client’s communication skills
Remember…
- Connect treatment to classroom curriculum
- Always keep common core state standards in mind
- I always treat speech sound errors and language together
Select More Readily Taught Treatment Targets
- Stimulable sounds treated before non-stimulable sounds
- Teach visible sounds before non-visible sounds (e.g., /th/ before /r/)
- For a phonological process to be treated, should occur at least 40% of the time
Select Targets that Affect Intelligibility the Most
- Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility
- E.g., stopping affects many sounds
Deciding on the number of sounds or patterns to teach
- If the child only has 1-2 errors, the decision is easy
- If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?
Variables impacting the decision on the number of patterns to teach include child’s:
- Motivation
- Intellectual level
- Age
- Language and learning skills
- Time frame (1 year? 2 months?)
Establishing Baselines
- When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled
- For example, an artic test may sample /r/ one time in initial, medial, final position of words
Because of this very limited sampling (baseline), mistakes can be made
- For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off
- But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!
We counteract this problem(baselines)…
By establishing baselines of potential treatment targets before starting therapy
What are baselines?
Baselines are measured rates of behaviors in the absence of treatment
3 purposes of baselines:
- Establish clinician accountability (many 3rd parties want numbers or quantitative data to evaluate progress)
- Evaluate child’s progress over time
- Modify treatment procedure if child’s not improving expected
What are baseline procedures?
- Specify the treatment targets in measurable terms
- For example:
- produce /r/ in word-final position with 80% accuracy
- Reduce use of final consonant deletion from 70% to 20% in conversation
We need to be sure to specify response topography:
- This refers to the linguistic level of training
- For example, do we want to begin with /r/ in isolation?
- Do we want to begin with /r/ in word-initial position in sentences?
Selecting the initial level and sequence of training
- Baselines help us create appropriate treatment objectives
- PBH: best to start treatment at word level- functional words especially (exam)
DEVELOPING MEASURABLE OBJECTIVES
-Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals
- Appropriate long-term goals might be:
- “Increase the client’s intelligibility of speech”
- “Improve the client’s phonological skills”
Measurable short-term objectives are needed
- These objectives specify how a goal will be achieved
- The objectives must be measurable so that external observers can verify the results of the clinical services provided
- Many 3rd party payers like insurance companies demand detailed documentation of improvement
To write a good objective:
- Use observable behaviors (ex: point to, say, write, read aloud, sing, match)
- Don’t use words with non-observable behaviors (ex: know, understand, remember, learn, perceive, memorize, think about, consider)
Remember that data collection:
- Should be done throughout treatment
- A good baseline will support this
What are Phonetic placement techniques?
Are direct methods to teach clients how to position the articulators and produce the sound appropriately
What is Successive Approximation or Shaping?
- We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/).
- We have them make the /g/, and gradually move toward /r/.
We can begin training the sound at one of several levels:
- isolation
- syllable
- word
- phrase
- sentence
If the child cannot create a phrase or sentence with the target word…
- We can use a carrier phrase such as:
- “I see______”
- “Here is a ____”
Structuring treatment sessions
- Initial treatment sessions highly structured
- Treatment sessions gradually loosen up to replicate natural “real world” more
- Helps child generalize target sounds to spontaneous speech
