CTC 3 Assessment and Intervention: Children w/ Medical & Working with kids, fams, and others

What are medically complex cases?

Children who are mentally complex may require intensive hospital, home, and or community based services, specialized technology, and or pharmacological interventions.

WHO: defined pre-term?

The World Health Organization has defined preterm as any infant born PRIOR to 37 WEEKS gestation.

• moderate to late pre-term: 32 to 37 weeks

• very pre-term: 28 to 32 weeks

• Extremely pre-term: less than 28 weeks

What are some examples of Medically Complex Cases?

• Neonatal abstinence syndrome (NAS): a group of withdrawal symptoms that a newborn baby experiences after being exposed to certain drugs, primarily opioids, in the womb

• Anoxia (lack of oxygen) resulting in neurological issues (e.g., CP)

• Genetic disorder present from birth (e.g, down syndrome, fragile X)

• Children with Cleft Palate

Where should medically complex cases be delivered?

The most natural setting:

• NICU (newborns)

• PICU (Peds)

• Medical home (any place in the community)

  • Approach /philosophy

  • Patient-Family centered primary care

  • Comprehensive, accessible, continuous

  • Coordinated, team based efforts

Medical team?

• surgeons

• orthodontist

• pediatricians

• audiologists

• speciality SLPs (e.g., cleft palate SLP)

Community team?

• school psych, SLP, OT, audiologist

• EI service coordinators + teams

• social worker

Nancy: 18 month toddler potential assessment plan for language, speech mech, resonance, and artic

Assessments: REEL-4, Sequenced Inventory of Communication Development, a language sample, and speech mechanism exam

• Language: REEL & Sequenced Inventory of Communication Development

• Speech Mech Exam

• Resonance: moderate hyper nasality, suspected nasal air emissions, nasal grimacing and snorting

• Articulation: speech sample during play and after single-word imitation

Nancy vs Mateo: how is an assessment for this medically complex case different from Mateo?

Mateo:

• was not born with medical complications like a cleft lip

• His assessment was mostly focused on EI and Language while Nancy was more interdisplinary

• He is bilingual

• PLS-5 and Leap Q

Nancy:

• medically complex case, NOT language

• Multiple professional collaboration

• Articulation

ECO for Nancy?

Outcome 2: Acquiring Language to Communicate

When does development happen?

Development is happening rapidly in the FIRST 5 YEARS and all at once: nothing is happening in isolation

Developmental peaks and plateaus?

• peaks: often higher

• Plateaus: longer

children are sponges and need time to fully absorb

How do SLPs design individualize programs?

SLPs create adaptations, accommodations, and modifications within the Childs ‘Zone of Proximal Development”.

Assessment, Evaluation & Programming: System for Infants and Children (3rd edition)

AEPS Assessment: uses same numbering system as AEPS curriculum for easy transfer of info and development of goals/objectives

• There are 8 developmental areas (e.g., social communication, cognitive, social emotional, literacy)

• It included 18 routines and activities (e.g, active/outdoor play, bath time, music/movements, nap/sleep, and meals/snacks)

HELP: assessment linked to Curricula

1000 activities for parents and caregivers to address specific skills and behaviors

TPBI-2: assessment linked to Curricula

• use in natural settings within daily routines

• Extensive communication section

What are the key takeaways for manualized curriculum?

• Annualized curriculum is a great way of getting everyone in the team on the same page

• provides consistent message across multiple contexts within school and at home.

Applied Behavior Analysis (ABA)

• Based on BF Skinner’s theory of operant conditioning (antecedent-behavior-consequence)

• Teaches individual skills one at a time via repetitive training trials & extrinsic reinforcement

• Through prompting, shaping, and fading eventually behaviors change

• ABA involves detailed data collection

ABA: DTT vs PRT vs VB

DTT: discrete trial training (training one program at a time)

VB: Verbal behavior (20% new & 80% mastered)

PRT: doing something fun w/ targeted object

What is Early Start Denver Model (ESDM)

• combines ABA with relationship-based approaches

• for 12-48 months old

• String parent involvement & interpersonal exchange developing communication skills through affect based relationships

What is the Hanen Program

• utilize group training sessions for parents, 3 visits with parents and child, and group recording of one visit to review, discuss, and strategize

• for birth-five year old population & their parents

What is the SCERTS Model?

Social Communication Emotional Regulation Transactional Support

• Its general philosophy: work with child in the moment.

  • Helps develop spontaneous, functional communications and emotional regulations

  • Echolalia may have positive connotations

What are the best practices?

• recognition of continually evolving etiology of conditions

• recognition of continually evolving research based interventions methods

• using ongoing assessment to drive individuals programming

• collaborating w/ other professionals to learn new approaches

• teaching professional colleagues the importance of careful observation

• validating with others about the ubiquitous nature of communication