Module 1: Intervention Taxonomies, Assessment & VanRiper Traditional Approach

Introduction: Chapter 1: Objectives

The students will be able to:
- 1. Discuss the organization of the required textbook.
-2. Discuss the components of each chapter.

Introduction: Chapter 1: Purpose of The Textbook

1. Learn how to implement approaches with Fidelity.
2. Learn how to foster clinical reasoning and clinical decision making in selecting approaches.
3. Learn how to tailor interventions to achieve success
4. Learn how to identify similarities and differences of intervention elements that comprise each approach.

Introduction: Chapter 1: Headings in Our Textbook

1. Target Population: Who we are looking at, Who we are evaluating, Age, type of disability, severity level.
2. Assessment and Analysis: What are we gonna use
3. Theoretical Basis: Ev

Target Populations

1. Description of population(s) for which empirical and/or theoretical support of the intervention is available (e.g., in terms of age, major disability, prerequisite skills).
2. Who are we looking at?
3. Who are we evaluating?
4. Age, Type of Disability, and Severity Level.

Assessment & Analysis

1. Standardized and/or informal measures used and the type of analysis completed.
2. Assessment linked to ICF-CY model to address other aspects assessed beyond Body Structure and Body Function (e.g., Activities and Participation).
3. What are we going to use?

Theoretical Basis

1. The dominant rationale for the intervention.
2. Assumptions are made about the deficits, compensatory strategies, or strengths that are targeted.
3. Nature of outcomes targeted (e.g., positive effect on social roles, decreased functional limitation).
4. Area of functioning being targeted (e.g., intelligibility, movement for speech), including the nature of the outcomes targeted within the ICF-CY framework.
5. Evidence-Based Practice: Patient Preference, Expertise (SLPs) is Internal Evidence, Research (Articles) is Internal Evidence.

Empirical Basis

1. Summary and interpretation of studies.
2. Study descriptions that provide information about participants and the study design, including an evaluation of the quality of the experimental designs using PEDro (group designs) and RoBiNT scales (single-subject designs).
3. Level of Evidence table providing a quick reference to the strength of the designs included in this section, tabled according to whether or not the studies support the intervention.

Practical Requirements

1. Time demands
2. Personnel demands, including training, for both professionals and family members.
3. Type of sessions (e.g., group, individual).
4. Frequency and Duration (dosage).
5. Procedures

Key Components

1. Target selection approach, including impairment-based and social-based goals.
2. Types of goals targeted (e.g., production of a specific sound, improved phonological awareness).
3. Goal attack strategy for addressing multiple goals (sequential, cyclic, simultaneous).
4. Procedures (therapeutic actions of the primary clinician, who may be a professional or family member depending on the approach).
5. Activities in which procedures are embedded (e.g., storybook reading, play, conversation, structured repetition).
6. Materials used in the intervention.
7. List of general therapy steps, often including a flowchart to convey this information.
8. Roles of secondary personnel (e.g., teachers, family members, the clinician for family-based interventions).

Monitoring Progress and Generalization

1. Recommendations for data collection and for how decisions are made regarding the alteration of goals, methods, stimuli, termination of therapy, and so forth.
2. Include ICF or ICF-CY framework in measuring outcomes to include changes in participation.

Ex: Kid learning outside therapy. Allowing patient to practice in home, reeces, school, etc.

Considerations for Children from Culturally and Linguistically Diverse Backgrounds

1. Applicability of approach to children of different linguistic and cultural backgrounds.
2. Recommended ways in which the intervention can be adapted to better meet child and caregiver needs.

Case Study

1. Description of one or more children for whom the intervention was helpful (used to illustrate children's responses to the intervention and ongoing decision making).
2. Inclusion of first-hand accounts from parents/families/children regarding the impact of intervention.

Learning Activities

1. Two to three activities that help readers apply information about the intervention approach.

Future Directions

1. Recommendations for areas of further study regarding the intervention; these may include additional populations for which it may be useful.

Summary

1. Main takeaway points of the intervention approach.

Suggested Readings

1. Three to five readings providing additional information about the intervention's theoretical or empirical basis or its procedures

Structural Framework for Intervention

1. Intervention approaches are implemented within a framework that encompasses a number of components that comprise an intervention package, so to speak.
2. To better Understand the individual components of the package, it is helpful to separate the parts to determine how they fit within a structural framework of intervention.
3. There is no certain number for Mastery. (ASHA says 80%)

Structural Framework for Intervention: Basic Goals

1. Increase speech accuracy and speech intelligibility.
2. Determine what you are working on.

Structural Framework for Intervention: Intervention Context

1. Clinic
2. Home
3. Classroom
( A setting )

Structural Framework for Intervention: Intermediate Goals

1. Rule or error pattern targeted.

Structural Framework for Intervention: Intervention Agent

1. Clinician
2. Teacher
3. Parent
( A person )

Structural Framework for Intervention: Left side Dosage

1. Frequency: sessions/week
( left side )

Structural Framework for Intervention: Specific Goals

1. Specified sounds or structures.

Structural Framework for Intervention: Right side Dosage

1. Intensity: length of sessions)
( right side )

Structural Framework for Intervention: Subgoals

Linguistic Level:
- Isolation
- Syllable
- Word
- Phrase
- Sentence
- Conversation

Structural Framework for Intervention: Procedures

1. Intervention approach
2. Steps on how to implement specific tasks to meet goals.

Structural Framework for Intervention: Activities

1. Activities and materials incorporated in intervention approach.
2. Using different Stimuli materials to illicit a response.

Structural Framework for Intervention: Goal Attack Strategies

1. Horizontal: When you are treating multiple sounds at one time. (Simultaneously)
2. Vertical: When you are treating one sound at a time in Hierarchy order. (Sequential-- Van Dike)
3. Cyclical: Cycles Approach, when you cycle different sounds the student is working on before they have had mastery.

Structural Framework for Intervention: Evaluation

1. Assessment
2. Data Collection
3. Progress Monitoring

EX: Standard Scores, Raw Scores (have to be converted by using the manual), Standard Deviation. Use these to see if patient qualifies.

Prevalence of SSD In Children

1. Children, especially between the ages of 3 and 6 years, with SSD comprise a significant portion of the caseloads of SLPs.

Prevalence of SSD In Children: 2012 Survey From the National Center of Health Statistics

1. SSD Only:
--- 48% (3-10 years old). --- 24% (11-12 years old)

2. Persistent/Residual:
--- 4% of 8 year old children.
--- 1% - 2% of older children and adults.

3. Complexity SSD:
--- 11% - 40% co-occurring language impairment.

Implementing Interventions: Chapter 2: Objectives

The Student Will be able to:
1. Discuss the five domains of implementing intervention approaches.
2. Classify and Describe intervention taxonomies.
3. Identify the guidelines for learning how to implement intervention approaches.

Implementing Interventions: Elements

1. Fundamental Building Blocks that characterize individual intervention approaches.
2. Some are Common, Some are Unique
3. Some are Essential, Some are Flexible
4. Some are easy to learn, some require more training and rich understanding.
5. Need to be implemented with acceptable fidelity.
6. Fidelity: You implementing the exact thing from literature. 100% accuracy.
7. May be complex bc one thing that works for one client, might not work for another.

What is Fidelity?

1. Fidelity means using an intervention just as it was designed to be used. It's like following a recipe exactly as written to make sure the dish turns out right. This includes sticking to the steps, using the right amount of ingredients, and doing everything as planned.

What is a Taxonomy?

Taxonomies provide clinicians and researchers with a common language or way to talk about, compare, implement, and study intervention approaches.

Intervention Taxonomies

1. Rehabilitation Treatment Taxonomy (RTT)
2. Phonological Intervention Taxonomy (PIT)

Intervention Taxonomies: RTT

1. Classified
2. Describe
3. Compare
Interventions reported in the rehabilitation literature.

Intervention Taxonomies: PIT

PIT has 4 domains:
1. Goals
2. Teaching Moments
3. Context
4. Procedural Issues

Intervention Taxonomies: PIT: Goals

Questions to consider when learning a new intervention approach:
1. What type of SSD is suitable for the intervention approach?
2. What is the focus of the intervention?
3. What are the goal characteristics?
4. If more than one goal is targeted, what is the strategy for targeting the goal?

Intervention Taxonomies: PIT: Goals

Every intervention approach addresses one or more goals or areas of focus, such as speech sounds, pattern-based errors, speech perception, speech rate, and/or intelligibility.
1. Theoretical Basis
2. Assessment and Analysis Methods
3. Target Areas of Intervention
4. Key Components: Target Selection, Goals, Goal Attack Strategies.

Intervention Taxonomies: PIT: Teaching Moment

Questions to consider when learning a new intervention approach:
1. What constitutes a teach moment?
2. What type of model or instructions are provided?
3. What modalities are used to provide models or instructions?
4. What type of responses are expected of children?
5. What type of feedback is provided to children?

Intervention Taxonomies: PIT: Teaching Moment

The teaching moment is the heart of the intervention interaction and incorporates multiple decision points, including teaching cues. The teaching moment usually includes an antecedent event (something the SLP or intervention agent says and/or does to elicit a response from a child), Performance: self-correcting/ self-monitoring, etc.
Key Components:
--- Procedures
--- General Therapy Steps
--- Activities

(look at ppt slide 12)

Intervention Taxonomies: PIT: Context

Questions to consider when learning a new intervention approach:
1. Who will be involved in implementing intervention?
2. Where will intervention occur?
3. What format (methods of delivery) will be used for intervention? EX: Group, Individual
4. What type of resources are needed? EX: Therapy Material
5. Will the activities in which teach moments occur be structured or natural contexts? EX: Structured: Speech room bc it is controlled, Natural: Home, playground, outside of speech room.
6. Who, What, When, Where, Why?
7. Which cues do you implement?
8. How much cues do you provide?
9. When do you use the Cues?
10. Remove

Intervention Taxonomies: PIT: Context

Some approaches require or recommend involving other intervention agents, such as a parent or teacher. When others are involved, the SLP needs to know how to implement the approach first before teaching others.
1. Practical Requirements: Nature of Sessions, Personnel
2. Key Components: Procedures, General therapy steps, Activities, Materials

Intervention Taxonomies: PIT: Procedural Issues

Questions to consider when learning a new intervention approach:
1. What is the intensity of the intervention? EX: Frequency & Duration
2. Is specific training required for implementation? Yes, have to have credentials.
3. Does the intervention approach have a prescribed sequence. Yes, Van Riper
4. How will intervention be evaluated? Procedural Checklists
5. What tools/apps will be used to measure the effect of intervention? EX: Single-word Probe, Conversational Speech Sample, Intelligibility rating, parent and/or teacher report.

Intervention Taxonomies: PIT: Procedural Issues

What is important to understand is that the measurement tool needs to be sensitive to the expected and desired change in response to the intervention.
1. Practical Requirements: Nature of Sessions
2. Key Components: General therapy steps
3. Monitoring Progress and Generalization

Guidelines For Learning How to Implement Intervention Approaches With Fidelity

1. Develop your motivation (intrinsic, find your own boost to be Competent) and mindset to learn.
2. Read the Evidence (articles)
3. Listen and Observe (Shadowing an SLP, Observation Hours, Attend Conferences)
4. Implement (Under supervision for feedback, clarity, checklist)
5. Review Practice-Based Evidence (With knowledge/practice you increase Competence and Skillset.

Types of Cues

1. Auditory: Sound
2. Visual: Visual for P (pop mouth)
3. Tactile: Manual manipulation for articulators (candy or tongue compressor)
4. Verbal: Metaphonological Cue and Metaphor.
--- Metaphonological Cue: giving instructions to get them to put sound in right place. ex: the child is saying ti for see, give him a big mouth and show where his tongue needs to be.
--- Metaphor: describes a sound. ex: What sounds does a snake make? Sssss.
*Visual, Verbal, and Tactile are most common!!!

Choosing the Best Interventions: Chapter 24: Objectives

The student will be able to:
1. Integrate interventions and client characteristics.
2. Identify characteristics to promote clinical reasoning.
3. Discuss actions involved in choosing appropriate interventions.

Choosing the Best Interventions: Chapter 24: Nexus Framework

1. Child Characteristics: phonological system, diagnosis, child and family characteristics.
2. Intervention Characteristics: intervention elements, including number, type, and flexibility for inclusion in implementation.
3. Clinician Characteristics: Knowledge of interventions and elements, level of competence, prior clinical experience).

Choosing the Best Interventions: Chapter 24: Nexus Framework: Intervention Characteristics

1. Developmental Level (an approach may be sufficiently broad to address more than one developmental level)
2. Targeted Stage of Production (an approach can address one or more stages)
3. Targeted Outcomes (an approach can address one or more outcomes)

Intervention Characteristics: Developmental Level

1. Emerging: 1 year to 1 year and 6 months. It corresponds to first words period of phonological development.
2. Developing: 1 year/ 1 1/2 years to 4. It corresponds to phonemic period.
3. Elaborating: 4 to 8 years. It corresponds to stabilization period.

Intervention Characteristics: Targeted Stage of Production

1. Planning: moving articulators to make sound.
2. Programming: muscles you use
3. Execution: actually producing the sounds.

Intervention Characteristics: Targeted Outcomes

1. Speech Production: actually voicing of what is being produced.
2. Speech Perception: Hear it correctly
3. Phonological Awareness: 5 Components
4. Oral Language Skills: Form, Content, Use and Components
5. Literacy: Reading skills

Nexus Framework: Child Characteristics

This is the least researched.
1. Phonological System
2. Diagnosis
3. Child & Family Preferences
4. Unique

Nexus Framework: Clinician Characteristics

1. Novice (Pre-Professionals) Clinicians can benefit from an experienced clinician.
2. Cannot assume a clinician can achieve levels of fidelity.
Three Step Process:
--- 1. Find one well-developed intervention approach that has been devised for the clients you serve and their needs.
--- 2. Learn to use that approach masterfully.
--- 3. Repeat steps 1 and 2.

Article: Reasons For Clarity

1. First, clarity promotes replicability, a bedrock concept of modern scientific methods (Replication).
2. A second reason that clarity or transparency in intervention descriptions is a prime importance is its role in establishing intervention integrity (aka Fidelity).
3. Third, clear description of interventions allows researchers to study the effect of particular elements, with multiple benefits (Clarity helps with Understanding of Elements).
4. Finally, clear and detailed descriptions are central to SLP training and ongoing continuing education (Clarity helps with Continuing Education aka CEU's).

Article: A Priori Knowledge (Top-Down)

1. Guidelines/Checklists
2. Clarity
3. Theory
4. Thoughts/Ideas

Article: A Priori Knowledge (Top-Down): Two Guidelines

1. Consolidated Standards of Reporting Trials (CONSORT) statement was prepared to offer guidelines for the reporting of RANDOMIZED controlled trials.
2. Transparent Reporting of Evaluations of NON-RANDOMIZED Designs (TREND).

What does Randomized mean in Research?

Randomized= Unbiased, for ex: if person closes their eyes and selects people and puts them into different groups. They have no knowledge of who they picked and what group they put them in.

What does Non-Randomized mean in Research?

Non-Randomized= Biased, for ex: if person selects people and puts them into different groups with their eyes open. They have the knowledge of who they were picking and what group they placed them in.

What is the Journal Article Reporting Standards (JARS)

JARS stipulate eight relevant topics related to intervention description:
1. Intervention Content
2. Method of Intervention Delivery
3. Deliverer
4. Setting
5. Exposure Quantity and Duration
6. Time Span
7. Activities to Increase Compliance or Adherence (e.g., Incentives)

Manualization

1. Manualization requires explication of elements comprising a specific intervention approach, such as the goals (i.e., what is targeted), procedures (i.e., how goals are addressed), expected responses from children (i.e., children listen to and/or produce speech), and intervention intensity (i.e., session dose, frequency, duration, and total intervention duration).
2. Manualization also permits the systematic documentation or recording of how well a clinician implements an intervention.

Article: A Posteriori Knowledge (Bottom-Up)

1. Empirical Evidence
2. RTT, PIT
3. Knowledge of Outside Information
4. Observation
5. Experiment
6. Sensory Research

Article: PIT: Goal

Area of Focus:
1. Sound Segment Production
2. Phonological processes, rules, patterns, features, classes
3. Phonotactics (e.g., stress, word shapes)
4. Intelligibility / Communicative Effectiveness
5. Input processing / Speech Perception
6. Phonological Awareness / Literacy
7. Other linguistic abilities (e.g., morphosyntax)

Article: PIT: Goal

Characteristics of Target / Goal:
1. Stimulable sounds
2. Non-stimulable sounds
3. Early developing sounds
4. Later developing sounds
5. Sounds always incorrect
6. Sounds sometimes correct
7. Lexical inconsistency
8. Broader Factors

Article: PIT: Goal

Linguistic Context of Stimulus:
1. Isolated speech sounds / articulatory movements
2. Nonwords
3. Real words
4. Sentences
5. Conversation
6. Contrastive words
7. Written letters, words, or sentences

Article: PIT: Goal

Goal Progression Strategy:
1. Vertical
2. Horizontal
3. Cyclical

Article: PIT: Teaching Moment

Antecedent Event:
--- Content of Model or Instruction:
1. Articulatory-phonetic
2. Phonological
3. Metaphor
4. Phonological Awareness / Literacy
5. Semantic / Morphologic / Syntactic

Article: PIT: Teaching Moment

Modality of Model of Instruction:
1. Spoken
2. Visual
3. Tactile / Kinesthetic
4. Gestural

Article: PIT: Teaching Moment

Response:
--- Level:
1. Imitation
2. Spontaneous

--- Requirement:
1. Phonetic production
2. Phonological awareness / Literacy related
3. Non-speech
4. Auditory / Listening
5. Gestural

Article: PIT: Teaching Moment

Consequent Event:
--- Evaluative Feedback:
1. Knowledge of Results
2. Knowledge of Performance
--- Reflective Feedback:
1. Self-Monitoring
--- Responsive Feedback:
1. Recast/Expansion

Article: PIT: Context

Agent:
1. Speech-Language Pathologist
2. Parent
3. Teacher
4. Other Children
5. Other Agents

Article: PIT: Context

Venue:
1. Clinic
2. Home
3. School

Article: PIT: Context

Session Format:
1. Individual
2. Group

Article: PIT: Context

Resources:
1. Paper-Based
2. Objects
3. Scripts
4. Computer / Technology

Article: PIT: Context

Activities/Resources:
--- Type:
1. Naturalistic: Anything outside of clinic, ex: playground
2. Structured: In the clinic
--- Social / Emotional Valence:
1. Challenging
2. Fun

Article: PIT: Procedural Issues

Intensity:
1. Session Frequency
2. Session Duration
3. Dose per Session
4. Total Intervention Duration

Article: PIT: Procedural Issues

Training:
1. Speech-Language Pathologist (SLP) training
2. Non-SLP Training

Article: PIT: Procedural Issues

Evaluation:
1. Criterion-Based Progression
2. Prescribed Data Collection

According to the goal attack strategy vertical is treating more than one sound.

False

According to the Framework of Intervention, provide an example of an Intervention Agent.

Clinician, Parent, or Teacher

What is the age range of children that make up the greatest portion of an SLPs caseload?

The age range of children that make up the greatest portion of an SLPs caseload is 3-6 year olds.

What is "fidelity?"

Means making sure that a program or intervention is done exactly as planned. When it's done right, just like the design or protocol said, it's called "high fidelity." This is important because it helps make sure that the research results are accurate and trustworthy.

What is a child's expected outcome with an intervention implemented with fidelity?

When an intervention is done exactly as planned, it helps the child get the full benefits and makes sure the results are real and trustworthy. A child's expected outcome is that they will receive the full benefits of the program or treatment as intended.

From the Phonological Intervention Taxonomy article, explain two types of knowledge.

1. A Priori Knowledge (Top-Down):
---> 1. Guidelines/Checklists
---> 2. Clarity
---> 3. Theory
---> 4. Thoughts/Ideas

2. A Posteriori Knowledge (Bottom-Up):
---> 1. Empirical Evidence
---> 2. RTT, PIT
---> 3. Knowledge of Outside Information
---> 4. Observation
---> 5. Experiment
---> 6. Sensory Research

According to the Phonological Intervention Taxonomy article, Consolidated Standards of Reporting Trials are guidelines for randomized controlled trials (RCT).

True

GFTA includes 3 levels

False

CAAP looks at 3 levels

True

What are the 3 levels involved in CAAP?

1. Singles
2. Clusters
3. Multisyllabic Sounds/Words

GFTA does/allows to measure words/sentences

True

CAAP starts at age 5 for sentence level

True

What ages does the CAAP start at and end?

2 years 6 months to 11 years 11 months

What ages does the GFTA start at and end?

2 years to 21 years and 11 months, but can start testing sentence level at age 6.