Principles of Intervention
Language Disorders Principles of Intervention
Section goals
- Understand the purposes of intervention
- Consider EBP
- What should we consider when identifying appropriate goals?
- Know what the Continuum of Naturalness is and how it relates to intervention
- Learn what you should consider as you are planning intervention
- Know how to evaluate progress
Purpose of intervention
- Change or eliminate underlying problem
- Change the disorder (or its course)
- Teach compensatory skills
- Change the environment
- Depends on many factors:
o Age, intervention history, disorder, environmental factors
+ look at case study on pg 64
Evidence-based practice (EBP)
- Evidence
o External
§ Published literature
o Internal
§ Data and observations collected on individual client
- Client perspective
- Clinical expertise/expert opinion
The Intervention Plan
- Product: goals, objectives
- Process: approaches and strategies used to achieve the objectives
- Contexts: environments in which intervention takes place
Setting goals – considerations
- ZPD
o What child can learn with some help
- Communicative effectiveness
o Be functional – targets that are needed in daily life
- Choosing evidence-based targets
o Normal sequence of language development
- Complexity
o Control complexity but do not minimize it
§ Syntax – elaborating phrases, embedding sentences
§ Semantics- tier 1,2,3 words
§ Pragmatics
Setting priorities in goals
- Highest priority
o Forms and functions used in 10% to 50% of the required contexts
- High priority
o Functions used in 1% to 10% of required contexts, but understood in receptive task formats
- Lower priority
o Used in 50-90% of contexts. Does not use or understand
Continuum of Naturalness
- Type of activity
- Setting
- Person providing intervention
Most natural: child centered ------Hybrid---------Least natural: clinician-direction
Choosing an approach considerations
- Evaluate EBP
- Meet individual client’s needs
- Clinician’s abilities
- Be flexible
Clinician-directed (CD) approach General Guidelines
- Clinician specifies materials, schedule of reinforcement, setting, and activities
- Protocol
o Instructions
o Stimulus
o Client responds
o Clinician provides feedback
- Advantages
o Maximize opportunity
o “Unnaturalness” – taking context away to learn
o Predictability
- Disadvantages
o Generalizability?
§ Can sometimes be difficult to switch contexts
o Client behavior
- Use in initial phrases of treatment
CD approach Specific Strategies
- Drill
o Reinforcement after the fact
- Drill play
o Motivating even prior to production
o Reinforcement after the fact
- Modeling
o Listen and fins a pattern
o “talk like” the model
A Prompt Hierarchy
- Maximal: clinician is teaching (cues given 80-100% of time)
- Moderate: client is practicing (25-75% of time)
- Minimal: client shows use of skill, may self-monitor; clinician is coaching
Child-centered (CC) approach (also referred to as indirect language stimulation)
- Clinician arranges an opportunity under natural conditions
- No tangible reinforcers
- No prompts or shaping of incorrect response
- Follow child’s lead, use wait time
- Wait and respond to child
- Provide communicative opportunities
CC approach disadvantages/advantages
- Advantages
o Reduces behavior problems
o Engaging
- Disadvantages
o Clinician comfort
· Use with children who have MLU < 3.0
o Gives them comfortability and language forms and how they are used
o Scaffold and support them as they are attempting new language forms
CC approach; Specific Strategies
- 
Self-talk and parallel talk
o Describe clinician actions and child actions
o Non-talking children
- Imitations
o Copy the child
- 
Expansions/Recasts
o Add to the utterance to make it adult form
o Maintain word order = expansion,
o change sentence type = recast
- Extensions
o Add semantic information to child’s utterance
- Buildups and breakdowns
o Smaller phrases put together
- Communication temptations
o Tempt child-initiated communication
- Encourage parents to use these techniques!!
Hybrid approach Main characteristics
- Target specific goals
- Clinician controlled with child temptations
- Model/highlight form
- Especially effective for vocabulary and phonological awareness skills
Specific strategies
- Focused stimulation
o Arranged context to tempt obligatory forms
o Clinician is modeling and client is hearing the target form many, many times
- Vertical structuring
o Client responds
o Clinician asks questions to gather more information
o Combines child’s utterances into one
- Milieu teaching
o Evidence based
o Individual or small groups
o 3 main characteristics
§ Environment arrangement controlled by clinician
§ Clinician elicits initiations and provides natural consequences
§ Focus on child’s interests and initiations
o 4 variations
§ Incidental teaching
§ Mand-model
§ Pre-linguistic milieu teaching (PMT)
§ Enhanced milieu teaching (EMT)