Enhancing the Delivery of Quality Speech & Language Services and Children’s Progress in Therapy
Lately I’ve been thinking about ways that speech-language pathologists can continue to grow professionally. In our field it is critical to stay current with best practices in assessment and therapy services. It’s important that we know how best to remediate articulation, phonology, motor speech, feeding, speech fluency and language disorders. We need to be able to use therapeutic strategies and approaches to remediate these communication and feeding/swallowing disorders. We need to know about available speech-language interventions/curriculum programs and certifications that can help improve the quality of our service delivery. We also need to be aware of allied health therapy programs that may enhance the success of our clients as well. Some of these programs and interventions are supported by evidence-based research while others do not currently have evidence to support the validity of a proposed therapeutic approach to improve the communication, language, and literacy skills of children and adolescents. Therefore, it is important that speech-language pathologists are aware of the pros and cons of the available therapeutic programs and certifications.
Additionally, the methods of service delivery may change based on the job setting of a pediatric speech-language pathologist and if the SLP is providing individual vs. group therapy. Is it possible to enhance the delivery of quality speech & language services in both individual and group speech language therapy sessions? Can children and adolescents make progress on their speech/language skills in both types of therapeutic sessions? Over the years, I’ve worked in settings where I’ve had time to focus more on individualizing therapy sessions versus group pediatric therapy sessions. In some instances, I have been able to provide education and coaching for parents and teachers about ways to promote speech/language development for their children and students. This collaboration between speech-language pathologist and parents/teachers lead to increased gains and generalization of communication skills. Success in clinical practice is part of the triad necessary for evidence-based practice. The three components are clinical expertise, current external research evidence, and client/patient preferences. So yes it is possible to implement quality speech & language services during individual and group speech language sessions that will contribute to students’ progress and mastery of learning objectives.
Nevertheless, I have found that I have more time to reflect about the success or struggles of each child and how to tweak future sessions to foster growth of communication skills, when I have the luxury of working 1-on-1 with a child. This does not mean that SLPs do not reflect on the quality of their group sessions and make changes as needed. However, I have found that SLPs are able to reflect more frequently on the delivery of their therapy and students’ progress with less kids served each day and week. In these scenarios, access to an evidence-based intervention program may very well enhance the lessons taught during group therapy sessions and contribute to overall students’ gains of communication goals.
During individual sessions, SLPs naturally use research based strategies or approaches such as visual supports, verbal prompts, verbal cues, cycles approach, and language expansions or recasting to elicit children’s speech articulation/phonology targets or specific language skills during therapy. It is possible to implement some strategies and approaches when you provide group therapy sessions such as using literature/evidenced based lessons. I have found that there is greater success when you focus on 1-2 things to teach the entire group in therapy. For example, during a read aloud of a fiction story, an SLP may emphasize the characters, character traits, and overall plot development. In other sessions, the SLP may emphasize key words with student’s articulation targets from the book or tier 2 challenging vocabulary. During these mixed groups, each child typically has different skills to practice. The use of strategies are an integral part of effective speech-language therapy. But, what about intervention programs that have been proven to be successful for certain communication, language, and literacy disorders?
It is imperative that SLPs have good therapeutic systems available to facilitate more effective individual and group sessions. These systems or intervention/curriculum programs provide SLPs with the framework they need to teach speech/language skills and guide accompanying intervention activities that will target a variety of students’ speech/language objectives during each session. This is one of the reasons that I started thinking about speech/language intervention programs that may be effective for all students with communication disorders including those at risk for reading and writing disorders (SLD). Here’s a list of programs and intervention approaches categorized by communication disorders and learning needs:
DISCLAIMER: BSL Speech & Language Services does not endorse all intervention and curriculum programs listed below. However, I have found some research evidence to show children making gains as a result of these intervention programs. These are indicated below with an *EB and the others with NOT EB. I have included my complete reference list at the end of this blog article. Children and adolescents may make progress in speech language therapy without these programs, but they do so under the clinical expertise of a state licensed and/or ASHA certified SLP. Similarly, the specialized certification programs are designed to improve the quality of the delivery of speech-language therapy. However, this does not mean that you must be certified in one of these programs to provide quality therapy. Children can make progress in speech-language therapy without working with an SLP with these certifications. However, these certifications often enhance the SLPs professional skills, delivery of evidence based practice, and therefore further promote remediating communication and literacy disorders. Conversely not all available certification programs are considered evidence based according to current best practices. Note: Literacy programs listed below are often implemented by regular education teachers, special education teachers, and literacy specialists. According to ASHA, literacy instruction is also within the scope of practice for speech-language pathologists. However, SLPs will need continued education training in literacy assessment and intervention. Over time, SLPs may specialize in certain areas within the field of speech-language pathology. In doing so, they are able to enhance their delivery of quality speech-language therapy services).
CHILDHOOD APRAXIA OF SPEECH:
Integral Stimulation (IS)- *EB This intervention approach requires a child to imitate utterances modeled by the speech-language pathologist. It requires both auditory and visual attention to improve speech motor movements. IS is often referred to as the “listen to me, watch me, do what I do” approach.
Dynamic Temporal and Tactile Cueing (DTTC)- *EB This intervention approach is based on foundational principles of Integral Stimulation and a hierarchy of cueing that varied the relationship between the stimulus and response. It typically begins with simultaneous production of the utterance and later the child will be cued to directly imitate speech motor movements after a set criteria of mastery was met. As a child’s speech sound production and intelligibility improves, certain cues are faded out.
*EB There is additional research evidence to support intervention programs that incorporate combining motor planning and sensory cueing. The researchers reviewed 23 single-case experimental studies and concluded the following to be evidence based:
DTTC (Dynamic Temporal and Tactile Cueing) – *EB effective with clients with more severe CAS
Integrated Phonological Awareness Intervention-*EB effective with kids ages 4–7 years with mild to severe CAS
ReST (Rapid Syllable Transition Treatment) -*EB effective with kids ages 7–10 years with mild-to-moderate CAS
Murray, E., McCabe, P., et al. (2014). A Systematic Review of Treatment Outcomes for Children with Childhood Apraxia of Speech; American Journal of Speech-Language Pathology, 23, 486-504.
PROMPT- *limited EB CERTIFICATION AVAILABLE promptinstitute.com, entwellbeing.com.au
Beckmann Oral Motor Intervention- NOT EB CERTIFICATION AVAILABLE
Cycles Approach by Hodson- *EB This is used to reduce and eliminate the occurrence of phonological processes such as final consonant deletion and cluster reduction in a systematic manner.
PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets)- NOT EB It provides a tactile-kinesthetic therapy technique to improve speech pronunciation. This is not a proven EB program for phonological disorders. CERTIFICATION AVAILABLE
*A child who has auditory memory difficulties usually has other receptive language or literacy areas of need.
HearBuilder- *EB This is an online program that teaches, provides practice opportunities, and tracks a child’s performance in a hierarchy of memory skills.
AUGMENTATIVE & ALTERNATIVE COMMUNICATION:
iPad used as a Speech Generated Device (SPD) – *EB
The researchers reviewed 15 studies about the use of SPD, manual signs, and PECS with people with autism and other developmental disabilities. Tablet-devices such as the iPad were found to be highly effective in increasing communication skills in these populations. Caregivers also had positive perceptions about the use of the iPad with specific apps such as Proloque2Go
Alzrayer, N., Banda, D.R. & Koul, R.K. Rev J Autism Dev Disord (2014) 1: 179.
EARLY INTERVENTION/PARENT TRAINING:
Hanen It Takes Two to Talk – *EB Parents of children birth to 5 years old are taught strategies to increase communication skills in their children with language delays.
http://www.hanen.org/Helpful-Info/Research/It-Takes-Two-to-Talk-Parent-Research.aspx CERTIFICATION AVAILABLE
INFANT & CHILD FEEDING:
Beckmann Oral Motor Intervention- not EB; However Debra Beckman, M.S., CCC-SLP indicates this is warranted when an oral motor deficit has been determined via an assessment
Behavioral Intervention- *EB Various types of behavioral interventions such as differential attention, positive reinforcement, escape extinction/escape prevention, stimulus fading, simulatenous presentation, differential reinforcement of alternative behavior (DRA), and use of a flipped spoon as a presentative method have been found to be effective in increasing food intake for children with severe feeding problems. This is specifically geared towards infants, children, and adolescents with oral feeding problems, chronic food refusal, selectivity, failure to advance texture, and inappropriate mealtime behaviors such as throwing food and temper tantrums. Behavioral intervention is not indicated for pre-term babies with oral motor immaturity or children with eating disorders such as anorexia or bulimia.
(University of Cincinnatti- Best Clinical Evidence Statement)- Retrieved May 31, 2007. Scroll down to Feeding. https://www.cincinnatichildrens.org/service/j/anderson-center/evidence-based-care/recommendations/topic
* EB Overall, phonological awareness training paired with letter knowledge training has positive effects on phonological processing and early reading & writing skills.
FastForward- *EB for phonemic awareness, not EB for reading fluency, mixed outcomes for reading comprehension https://ies.ed.gov/ncee/wwc/EvidenceSnapshot/172
LIPS by Lindamood Bell- *EB Research indicates positive outcomes on alphabetics and reading fluency https://ies.ed.gov/ncee/wwc/EvidenceSnapshot/279 CERTIFICATION
Lively Letters by Reading TLC- *EB CERTIFICATION AVAILABLE
Fundations by Wilson Reading System- NOT EB. This is a reading program for K-3rd grade that is often used in schools to remediate print knowledge, phonological awareness, phonemic awareness, decoding, spelling. However, many special education teachers report that students make reading gains using this program.
Social Thinking Training Program- not EB (Leaf et al. 2016) However, creators report that it is a therapeutic methodology based on research based practices such as modeling and naturalistic intervention). CERTIFICATION AVAILABLE
RECEPTIVE & EXPRESSIVE LANGUAGE:
Expanding Expression Tool (EET)- *EB This is a multisensory tool that teaches kids how to improve their descriptive language skills. Research shows gains in oral language and written expression. expandingexpression.com
Narrative Intervention with Macrostructure and Repeated Retell- *EB http://www.asha.org/articlesummary.aspx?id=8589954067
*Review of 9 research studies confirm that direct narrative instruction in speech-language therapy leads to gains in story grammar elements of character, setting, initiating event, internal response, plan, attempts, direct consequence and resolution (macrostructure). It also leads to gains in language structure (microstructure) of clauses, elaborated noun phrases, cohesive ties, mental state verbs (e.g. remember, think, know, realize), linguistic verbs (e.g. exclaimed, whispered), and adverbs.
Story Grammar Marker by MindWing Concepts, Inc.- *EB mindwingconcepts.com
Talkies by Lindamood Bell- *EB CERTIFICATION AVAILABLE
Visualizing and Verbalizing by Lindamood Bell- *EB http://lindamoodbell.com/article CERTIFICATION AVAILABLE
SPEECH FLUENCY/PARENT TRAINING:
Demands & Capacity Model- *EB
Lidcombe- *EB CERTIFICATION AVAILABLE
The Lidcombe program has been found to be effective in decreasing stuttering for children 2-6 years old. It is a fluency shaping program that emphasizes parent training to reduce their child’s stuttering at home. You can read more about it here.Read this ASHA presentation information about the effectiveness of the Lidcombe program here.
Pharmaceuticals with Speech Fluency Therapy- NOT EB
“The treatment of stuttering in children between the ages of six and thirteen years should be based on a treatment plan that contains all ICF [International Classification of Functioning] elements and focuses on the types of behaviors, emotions and cognitions that have been identified, in collaboration with the child who stutters and his parents during assessment.”
“Use of pharmaceuticals in the context of stuttering therapy is not recommended. Where there is co-morbidity and stuttering, it is recommended that an appropriate choice and dose of pharmaceuticals is sought in consultation with the PWS (and their direct environment) and the prescriber.”
Pertijs, M.A.J., Oonk, L.C., Beer, de J.J.A., Bunschoten, E.M., Bast, E.J.E.G., Ormondt, van J., Rosenbrand, C.J.G.M., Bezemer, M., Wijngaarden, van L.J., Kalter, E.J., Veenendaal, van H. (2014). Clinical Guideline Stuttering in Children, Adolescents and Adults. NVLF, Woerden
“It is recommended that Speech-language pathologists (SLPs) provide services with a home program component for preschool and school age children who stutter to reduce their percent stuttered syllables (%SS)”
Best Evidence Statement (BESt). Evidence Based Practice for Stuttering Home Programs in Speech-Language Pathology
Mewherter, M., & Cincinnati Children’s Hospital Medical Center. (2012). Cincinnati (OH): Cincinnati Children’s Hospital Medical Center, (BESt 137), 1-7.
Earobics – *EB https://ies.ed.gov/ncee/wwc/EvidenceSnapshot/158
Research has shown that this program can benefit at-risk students, students in general and special education classes, and ESOL students. Research confirms positive effects on phonemic awareness, phonics, and reading fluency.
Edmark- NOT EB; However, special education teachers report reading gains with children with cognitive impairment and learning challenges
Fountas & Pinnell Intervention Kit- *EB
Great Leaps- *EB http://sosaschool.com/files/GreatLeapsReport.pdf
Orton Gillingham- *EB CERTIFICATION AVAILABLE
Read 180- *EB Positive effects on reading fluency and comprehension for children 2 or more grade levels behind https://ies.ed.gov/ncee/wwc/EvidenceSnapshot/172
Reading Workshop (application for SLPs) * EB- See last blogpost
Seeing Stars by Lindamood Bell- *EB CERTIFICATION AVAILABLE
SPIRE- *EB for Special Education and English Language Learner (ELL) http://eps.schoolspecialty.com/EPS/media/Site-Resources/Downloads/research-papers/SPIRE-effectiveness.pdf
Wilson’s Reading- *NOT EB; although special education teachers report students’ reading gains https://ies.ed.gov/ncee/wwc/EvidenceSnapshot/547
Why is this important to SLPs? SLPs may refer clients and their families to seek skilled behavior therapy to enhance their life success at home, school, and in the community.
ABA Therapy- *EB
It is an evidence based allied health approach to assess behaviors and develop individualized intervention plans to decrease challenging behaviors, increase functional communication for children with complex communication needs, increase task compliance while monitoring clients’ performance and providing positive reinforcement.
This intervention is often provided to children and adolescents with autism and other developmental disorders. It can be provided by the following trained staff:
Board Certified Behavior Analyist (BCBA)- Master’s level clinician
Board Certified Assistant Behavior Analysis Assistant (BCaBA)- Bachelor’s level clinician
Registered Behavior Technician (RBT)- Minimum of High School Diploma and 40 hours of training, pass the RBT Competency Assessment, paraprofessional under the close supervision of a BCBA or BCaBA
http://www.asha.org/Evidence-Maps/ All Communication Disorders
ASHA provides the most current research for speech-language pathologists on a variety of communication disorders.
http://www.asha.org/articlesummary.aspx?id=8589953616 Childhood Apraxia of Speech
Practicalaac.org (PrAACtical Conversations: Nonspeech Oral Motor Exercises) http://praacticalaac.org/praactical/praactical-conversations-nonspeech-oral-motor-exercises/ Oral Motor/Articulation
http://bacb.com ABA Therapy
http://www.asha.org/EvidenceMapLanding.aspx?id=8589942945&recentarticles=false&year=undefined&tab=all Alternative and Augmentative Communication
http://www.asha.org/articlesummary.aspx?id=8589960659 Speech Fluency Home Programs
The IRIS Center is funded by the U.S. Department of Education’s Office of Special Education Programs (OSEP). It is located at Vanderbilt University in Nashville, Tennessee and Claremont Graduate University in Claremont, California. The center creates resources about evidence-based practices for professional development.
https://ies.ed.gov/ncee/wwc/EvidenceSnapshot/196 Phonologial Awareness: Fundations by Wilson
lindamoodbell.com Talkies, LIPS, Visualizing and Verbalizing Programs Phonological Awareness, Phonemic Awareness, Receptive/Expressive Language
mindwingconcepts.com Story Grammar Marker Narrative Development
socialthinking.com Pragmatic Language/Social Cognitive Deficits Autism
http://www.hanen.org/Programs/For-Parents/It-Takes-Two-to-Talk.aspx Early Intervention
http://www.fcrr.org/resources/resources_vpk.html Florida Center for Reading Research Vocabulary and Learning Resources
The Florida Center for Reading Research was established in 2002 to conduct basic research on reading, reading growth, reading assessment, and reading instruction that will contribute to the scientific knowledge of reading and benefit students in Florida and throughout the nation. There are three other centers, one at the University of Colorado (http://ibgwww.colorado.edu/cldrc/), Texas Center for Learning Disabilities at the University of Houston (http://www.texasldcenter.org/) and the Center for Defining and Treating Specific Learning Disabilities in Written Language at the University of Washington (https://education.uw.edu/faculty-and-research/centers).
http://www.coe.fau.edu/centersandprograms/card/documents/EducationalResourcesManual.pdf Educational Resources for Children With Autism (Compiled by University of Miami and NovaSoutheastern University
https://www.expandingexpression.com/ Expanding Expression Tool