Intervention

Question 1

Goal of intervention

Answer 1

1) The ultimate goal of intervention is to make the child a better communicator
2) ASHA requires that SLPs must be able to show that the change a child makes is due to intervention
3) We must establish goals carefully to make certain we are targeting what requires intervention

Question 2

Purposes of Intervention

Answer 2

1) Change or eliminate the underlying problem
2) Change (modify) the disorder
3) Teach compensatory strategies

Question 3

Intervention: Changing Behavior

Answer 3

• Facilitation
• Maintenance
• Induction

Question 4

Evidence Based Practice

Answer 4

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

Question 5

Internal Evidence

Answer 5

• 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

Question 6

How to approach using EBP in intervention

Answer 6

• Formulate clinical questions
• 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

Question 7

Aspects of an intervention plan

Answer 7

• The objectives
• Processes used to achieve the objectives
• Environments in which the intervention takes place

Question 8

Levels of Intervention

Answer 8

• Basic
• Intermediate
• Specific

Question 9

Priorities for setting goals

Answer 9

• 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

Question 10

Zone of Proximal Development

Answer 10

Distance between child’s current level of independent functioning and potential level of performance (what the child is ready to learn with assistance)

Question 11

Considerations for setting long and short term goals

Answer 11

• Communicative Effectiveness
• New forms express old functions / new functions are expressed by old forms
• Client phonological abilities
• Teachability

Question 12

Continuum of Naturalness

Answer 12

1. Child-centered (Ex. Facilitated play, daily activities)
2. Hybrid (Ex. Milieu Therapy, Focused stimulation, Script therapy)
3. Clinician – directed (Ex. Drill, Drill play,
   Modeling)

Question 13

Clinician-directed approach

Answer 13

• Drill
• Drill play
• Modeling

Question 14

Drill

Answer 14

• 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

Question 15

Drill Play

Answer 15

• 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

Question 16

Modeling

Answer 16

• 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

Question 17

Child-centered

Answer 17

• 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

Question 18

Child-centered Approach: The keys… (4)

Answer 18

• 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)

Question 19

Child Centered Approaches

Answer 19

• Self-talk and parallel talk
• Imitations
• Expansions
• Extensions
• Build ups and breakdowns
• Recast sentences

Question 20

Self Talk

Answer 20

• 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

Question 21

Imitation

Answer 21

SLP imitates the child and kids will typically begin to imitate the imitation

Question 22

Child centered- expansions

Answer 22

• 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”

Question 23

Extensions

Answer 23

• 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”

Question 24

Build ups and Breakdowns

Answer 24

• 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

Question 25

Recast sentences

Answer 25

- We expand a child’s utterance into a grammatically correct version - Expand the child’s remarks into a different type or more elaborated sentence

Question 26

Hybrid Approaches

Answer 26

- 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

Question 27

Focused Stimulation

Answer 27

- Hybrid approach - 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

Question 28

Vertical Structuring - hybrid approach

Answer 28

- Step 1 – SLP 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”

Question 29

General features of intervention activities

Answer 29

- 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

Question 30

Service delivery models

Answer 30

- 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

Question 31

Termination Criteria

Answer 31

ASHA 2004- - 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

Question 32

General Criteria

Answer 32

- (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…)

Question 33

)Primary Prevention (7)

Answer 33

- Public education - Genetic counseling - Mass screenings and early identification - Proper health and medical care (including immunizations and prenatal care) - Promote wellness in family-centered early intervention programs - Provide education to parents of preemies - Encouraging pregnant women to avoid drug and alcohol use during pregancy