SLP 6012 Ch 3 Principles of Intervention

Drill

*classic discrete trial intervention (DTI) -prompt: child is told how to respond correctly -fades: gradually eliminating prompts on a sch determined by clinician -reinforcement: + or - for intended response -shaping of incorrect form or untended target ex: sticker is given after correct response to paste in sticker album

Ways in which intervention can change language behavior

- Facilitation - Maintenance - Induction

Focused stimulation

allowing child to interact, but clinician is still guiding & leading

Purpose of intervention also based on

-age -intervention history -nature of disorder -interaction of the enviro w/ the child's comm. function -data collected from assessment

Drill-play

- attempts to provide some motivation in drill structure . It does so by adding an antecedent event that occurs not only after the target response is reinforced but before is even elicited. - more flexible for the child ex: child picks out the sticker he would like to paste on sticker album before answering a question

What is the purpose of intervention?

- change or eliminate the underlying problem - modify the disorder - teach compensatory strategies - optimize environment

Induction

- intervention must occur for a goal to be achieved - determine whether some end point can be reached

Context of intervention: choosing nonlinguistic stimuli

--Types -pictures/photos, toys, real objects, computers -pictures are not best first choice for young pop., better for older clients -real photos - basis for labeling, describing, writing about event -computers - danger in lack of interpersonal comm., make sure & interact w/ child as he/she uses machine --Timing -timing of nonlinguistic stimuli corresponds appropriately w/ what is being said (paper airplane - past tense)

Dev intervention plans

--evaluating intervention outcomes --termination criteria -80-90% correct usage in structured therapy -50% correct usage in natural setting (*may reduce therapy before just discharging) --evaluating effectiveness -should be able to show that your therapy worked -multiple baseline designs =shows that behaviors we targeted improved more than behaviors not targeted =targeted goals - generalization goals - control goals =if use of target & generalization goals show a significant increase over baseline, whereas use of control goal remains unchanged, intervention worked

3 objectives/goals of intervention

-basic goals: long term objectives. should not be too vague - intermediate goals: greater specification within the basic goal - specific goals: short term objectives; very specific should lead to long term goals. Steps along the way

When examining external evidence....

-be skeptical of the opinions of "expert" authorities -all research is NOT created equal -must be critical about the QUALITY of evidence used to guide clinical decision-making

What are some things to consider when setting goals?

-choose goals that increase ability to communicate -utilize functions that are already present (do only one thing at a time) -consider phonological abilities -choose goals that are teachable

CD approach includes

-drill -drill-play -modeling

Forms of hybrid intervention

-focused stimulation -vertical structuring -milieu teaching: incidental teaching & mand model -script therapy

Milieu Training methods

-incidental teaching -mand-model

Target behaviors should be clearly defined with

-measurable terms (follow 5 verbal directions) -specified structural level (follow verbal one-step directions) -specified accuracy criterion (follow one-step directions w/ 90% accuracy) -specified treatment stimuli (follow one-step direction with 90% accuracy when given by the clinician) -specified setting (where: clinic room, classroom, etc.)

Essential ingredients for successful therapy or Intervention activities

-modifying linguistic input -determining the intervention modality -consequating client language -generalizing language gains

3 parts of intervention plan:

-objectives of intervention -processes to achieve objectives -contexts where intervention takes place

Facilitation

-rate of growth or learning is accelerated but final outcome is not changed -improvement in one skill area may influence development in another.

CC approach includes

-self-talk -parallel talk -imitation -expansion -extension -build-ups/break-downs

Zone of proximal development

-the distance between the child's current level of independent functioning & potential level of performance -what the child is ready to learn w/ some help from a competent adult

Intervention approaches (continuum of naturalness)

1. Clinician-directed (CD) 2. Child-centered (CC) 3. Hybrid

Service delivery models

1. consultant model 2. language-bred classroom model 3. collaborative model

3 characteristics of hybrid approach

1. target one or a small set of specific language goals 2. clinician maintains control in selecting activities and materials, but does so in way that consciously tempts the child to make spontaneous use of utterances of the types being targeted 3. clinician uses linguistic stimuli to not just respond to child's communication but to model and highlight the forms being targeted

Which is the least natural approach to intervention?

Clinician-directed approach

When developing intervention plans, the techniques being used should be supported by scientific research. this is referred to as

Evidenced-based practice (EBP)

Child centered approach is also known as

Indirect language stimulation, facilitative play, pragmatic approach

Clinical question incluces

P - patient/problem I - interventions being considered C - comparing treatments O - desired outcomes

Consultant model

SLP provides information and ways to conduct therapy to another agent for intervention such as parent or teacher

Mand model

The clinician does not need to wait for the child to initiate communication. goals for intervention as stated very generally so that they can target child's need.

Vertical structuring

a form of expansion used to highlight target structures. the clinician provides a non-linguistic stimulus and attempts to elicit a particular language behavior from the child. it takes the child spontaneous utterances as the basis for the clinician response, rather than requiring imitation. Ex. What do you see? Lion Yes, and what is the lion doing? Roar Yes, he's roaring. The lion is roaring.

Modeling

child listens to multiple models; then is asked to talk like the model (not repeat) Ex: the girl is eating, the boy is drinking, the dog is jumping. Now look at the cat, what is the cat doing? the cat is swimming.

What is an important first step in the intervention plan

choosing which options is the best for the purpose of intervention (basic purpose)

Incidental teaching

clinician arranges the environment so that the things the child wants or needs are visible but out of reach. The child selects the topic of conversation by making some kind of request such as, gesturing or looking toward the desired item. Clinician waits for child to initiate a more elaborate request of not then child is prompted. Ex: which one do you want?

Imitation

clinician imitates what the child says, in turn the child should repeat what the clinician says

Pragmatically appropriateness

clinician should elicit lang that's semantically and pragmatically appropriate

Clinician-directed approach

clinician specifies all aspects of intervention *Advantages: max opportunity to product a form (repetition), produces a higher # of target responses, can have parent/teacher practice w/ child *Disadvantages: boring, unnatural, client has more difficulty generalizing, not motivating for child (especially young)

Extension

comments that are semantic information to a remark made by the child Ex: "doggie house" extension "He went inside" or "Yes, he got cold" *semantic

Determining intervention modality

how we want the child to respond 1. comprehension vs. production -for forms the child understands, production is high priority. -for forms not yet understood production should be priority 2. augmentatives and alternative modalities -for child who speech is not an option because language barriers alternative communication devices should be considered these include: -use of symbols: bliss symbols or PECS -use of interface (how to use aid): using the aid by pointing, writing or eye gaze

Most common intervention SLP's use to change language behavior?

induction

Vertical structuring

listen to child's response, clinician respond to child's incomplete utterance w/ complete utterance

Hybrid approach

modification of CD and CC approaches

Which purpose of intervention is most commonly used by the SLP?

modifying/ changing the disorder

Maintenance

preservation of a behavior that would disappear without intervention (i.e a child with a cleft palate to continue babbling)

Consequating client language

provide the client with a consequence for their production: 1. reinforcement- increases the frequency of the behavior (extrinsic / intrinsic) -E: tangible (sticker, toy, food) -I: verbal praise, high-5, clapping 2. feedback - gives client information about accuracy of communication, provides scaffold for more acceptable production -be careful about feedback that focuses on & repeats child's error, rather than providing appropriate alternative (very ineffective) -instead ignore or provide model of scaffolding form to help child correct error

Child-centered approach

puts child in driver's seat; attempts to map associations between child's action and words used to describe it -no reinforcers -no requirements for child to provide responses -no prompts or shaping of incorrect responses -requires clinician to wait & respond to clients comm. attempts *Advantages: better for "hard to treat" child, unassertive child, more natural/better generalization, safe enviro for child to try productions *Disadvantages: open ended, must provide high levels of intensity of input (provide one consequating remark/min to make method work)

Expansion

retake what the child says and add grammatical markers that would make it an acceptable adult utterance Ex: "doggy house" expanded "The dog is in the house" *grammatic

Parallel talk

self talk is provided for the child, but instead of commenting on our own actions we talk about the client's. For example, "You are building. You put on a block"

Lang-based classroom model

the SLP becomes the language teacher for a group of students with language disorders

Collaborative model

the SLP works with students who have been identified as having a language disorder but does so in the mainstream classroom in collaboration with the regular teacher. Intervention is delivered in the context of the regular classroom

Which intervention approach is best?

the best intervention is what is which ever is best for the child (sometimes it's trial & error to find the best fit)

Focused stimulation

the clinician TEMPTS the child to produce utterances with obligatory contexts for the forms being targeted. The clinician helps the child succeed by providing a very high density of models. Ex: the cat is in the truck. The dog is in the truck. The chicken is in the truck. what about the pig?

Script therapy

the clinician develops scripts or routines with the child in the intervention context. when script is disrupted, it challenges he child to communicate to repair the disruption. Ex: wearing name tag on your head instead of shirt.

Milieu Training

three major components: 1. environmental arrangement 2. responsive interaction 3. conversation based context that use the child's interest and initiation as opportunities for modeling and promoting communication in everyday setting

Generalizing language gains

using new taught forms in real conversation. is the child able to generalize what is being learned in therapy and carry it over in his/her everyday environment. -use many exemplars of target forms & functions -treatment material similar to those found in natural enviro -intermittent or delayed reinforcement -introduce distracter items into intervention stimuli (use stimuli semantically relevant but not direct target of intervention-resembles what happens in natural convos) -self-monitoring (encourage child to become internal teacher) -use peer models (practice in natural enviros)

Self-talk

we describe our own actions as we engage in parallel play with the child. Ex: child build tower with blocks, we build the same tower and comment "I'm building. I'm building with blocks"

Recast sentences

we expand the child's remark into a different type or more elaborated sentence. ex: questions, negative sentences, negative questions "doggy house" recast "is the doggy in the house." "The doggy is not in the house" or "isn't the doggy in the house?"

Build-ups / Break-downs

we start by expanding the child's utterance to a full grammatical form, then we brake it down in a into several phrased sized pieces in a series of sequential utterances that overlap in content. Ex: " Yes, the dog is in the house" The house. He's in the house. In the house. The dog. The dog is in the house."

Modifying linguistic input

what we can do to manipulate our linguistic signal to the client: -reduce rate of speech -increase repetition (for stimuli & direction) -increase perceptual saliency -complexity -obligating pragmatically appropriate responses

Perceptual saliency

word order & emphasis on morphemes, phonemes, utterances, etc.

Goals should target skills in the _________

zone of proximal development *do not choose goals w/in child's current knowledge base or beyond current level