WSU SLP 6460 week 11 school age language intervention and all age phonological intervention

service delivery options in the schools

pull out of class, push in/classroom-based intervention (co-learning with the child in their classroom), response to intervention is important to be aware of

MTSS (used to be RTI)

multi-tiered systems of support - broader school-based framework, a way to provide support to all students (could be speech services, behavior, literacy, etc)

response to intervention (RTI) (now MTSS)

a multi-tier approach to the early identification and support of students with learning and behavior needs; has 3 tiers of intervention

RTI/MTSS tier 1

high-quality classroom instruction, screening, and group intervention = all children in the classroom

RTI/MTSS tier 2

targeted interventions, typically small groups of students who haven’t made gains from tier 1 supports

RTI/MTSS tier 3

intensive interventions and comprehensive evaluation, children who still haven’t made gains from tiers 1 or 2, or slow gains, and at this point referral for SPED services is made

basic ideas for implementing language treatment for school age children

may take a more clinician directed or hybrid approach; materials are very important; scaffolding procedures are used, connection to the academic setting is important

treatment methods for school age language intervention

Story Champs (can be used w preschoolers also), Writing Lab approach, Social Stories

Story Champs (Spencer & Petersen)

created to remediate language deficits (FCU) through narratives; can be done in a classroom, small group, or individually (MTSS format), can be used for preschoolers - 3rd grade; clinician directed/very scripted

goals that can be addressed by Story Champs

improves narrative/expository skill, can target vocabulary, production of discourse level utterances via storytelling, narrative generation

materials for Story Champs

picture stimuli, script-master lesson plans, story icons, clinician needs to know the story gestures, optional story games

Social Stories (Carol Gray)

created for children with ASD to assist with social interaction (pragmatic skills); facilitates the child’s understanding of the hidden rules of social interaction with peers and in certain scenarios; could be beneficial for any students who have significant deficits with attaining ‘social competence’ (typically students w autism)

history of early used methods; clinician’s focused on

proper positioning, targeting only a few sounds in error at a time, emphasized good listening/auditory discrimination skills

traditional approach/stimulus method for phonological intervention

very old method that is effective; focuses on the remediation of individual phonemes in error; targets one phoneme at a time (at the most 2); vertically structured approach where a child has to reach a level of mastery in each phase before moving on to the next

factors to consider when selecting targets for remediation

chronological age vs developmental norms for sound acquisition; stimulability

5 phases of implementing the traditional/stimulus approach

1. sensory-perceptual training (ear training)

2. production training (sound establishment)

3. production training (sound stabilization)

4. transfer/carryover

5. maintenance

1. sensory-perceptual training (ear training) (traditional approach)

defines the standard for the target sound; client doesn’t produce the sound, but listens only to the sound being produced; develops an accurate auditory model

2. production training (sound establishment) (traditional approach)

goal is to elicit and have the client produce and establish the new sound that will replace the child’s error production; can be difficult as old habits die hard; may try auditory stimulation/imitation, phonetic placement, sound approximation

3. production training (sound stabilization) (traditional approach)

want the client to be able to produce the sound quickly and easily; practice progressing through the articulation hierarchy

articulation hierarchy

isolation

nonsense syllables

words

phrases

sentences

conversation

verbal explanation cue

“bite your lip and blow”

visual cue

use a mirror or watching clinician’s oral posture for accurate sound production

motor cue

producing a physical movement with each sound or syllable, like moving like a train for ch sound

concept cue

names for the articulators that remind the client where to put the articulators; “put the tail on the bunny” for final consonant deletion; the ‘lazy T’ for s sound

written cue

use of a written letter/grapheme to elicit sound production

tactile cue

touch the placement for correct articulation; touching just the back of the TMJ for velar production; physically pressing lips together for bilabials

sound sequencing and blending cue

breaking up a word into individual sounds or syllables and then blending back together; aka syllable sequencing or “Elkonin” procedure when applied to early reading skills

compensatory techniques for unintelligible children

accepting word approximations (wawa for water); reducing speaking rate, increasing vocal intensity (particularly good with dysarthria)

4. transfer/carryover (traditional approach)

the ability to use the new sound in conversational speech; may provide structured tasks in which the child can use spontaneous speech (yet inclusive of the speech sounds as the stimuli); homework and negative practice

negative practice

the child can practice saying a word incorrectly and then correctly; child can catch the clinician making a speech error

5. maintenance (traditional approach)

refers to the retention of the newly acquired skills after the treatment protocol is completed; often neglected but very important (many clinicians dismiss their client before this period is completed); could have the client check in 1x/month for a few months, then gradually decrease to every 3 months, then 6 months, serves as wellness visits; could remind them of strategies and make sure the child hasn’t regressed