Helping Teachers: Success with Intensive Service Delivery Models in the Schools

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With increases in caseload size it can be difficult to organize and structure groups in order to ensure that our students get the most out of their therapy time. Join us as we discuss a pilot study that examines how to group multiple children with multiple disorders in short, intense therapy and produce great results.

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Helping Teachers: Success with Intensive Service Delivery Models in the Schools

  1. 1. Disclosure Statement:   Financial — Kara Anderson works with Bilinguistics. Bilinguistics receives royalties from product sales. Nonfinancial — None
  2. 2. The Origins of Our Pilot Study • We have large, diverse caseloads that grow throughout the school year. Questions: • Is there a more efficient way to serve our students and not sacrifice quality? • What are other academic areas doing to improve services? • Can academic models work within the framework of speech pathology?
  3. 3. Our Discussion Today • Identify successful intervention techniques and service delivery models. • Discuss research on improving clinical services • Review results of a clinic camp that tests these ideas for speech-language intervention • Apply these successes to the school setting • Provide therapy plans for implementing changes to how you provide intensity of services
  4. 4. Professional Constraints • Location of Service • Format of Service (group vs. Individual) • Dosage (Frequency, Intensity of Services) • Insurance • Federal Mandates ▫ IDEA ▫ Least Restrictive Environment
  5. 5. Do you need Continuing Education or want  to listen to this course live? Click here to visit  the online courses.
  6. 6. All of the documents and charts in this presentation  can be downloaded from our Free Resource Library. Click here to visit the Resource Library
  7. 7. What aspects of our profession influence intervention practices?
  8. 8. Improved Language Outcomes • Gillam and Loeb, (2010) reported that four components of language intervention were associated with successful language outcomes ▫ Intensity ▫ Active Attention ▫ Feedback ▫ Rewards
  9. 9. Increased Vocabulary • Repetition of Vocabulary words requires exposure of at least 15 times (Pui Fong, 2010 ) • Longer interventions • Teaching words through definitions and in context (Stahl & Fairbanks, 1986) • More word encounters • Active processing (Baumann et.al, 2003 and A. Graves, 1986)
  10. 10. Evidence-based Intervention Techniques • Literacy-based intervention • Imitation • Modeling • Cloze procedures • Binary choice • Expansion • Recast • Scaffolding
  11. 11. Why do we provide services for the amount of time that we currently do?
  12. 12. Mixed Results • Studies on the following topics found mixed results • Dosage (frequency) • Parent implemented vs. clinician administered • Classroom-based vs. Pull-out • School vs. Clinic ▫ (Schooling et. al., 2010)
  13. 13. Click for Audio‐over‐Powerpoint Presentation
  14. 14. ▫ 30/60 minutes twice a week ▫ direct service on average 2-4 kids per group ▫ Who ever decided on 30 minutes/week ? ?
  15. 15. Alternative Delivery Models ▫ Limited research on group intervention  Adults with aphasia  Hearing impairments  Stuttering  Very little addresses speech & language  Early-childhood intervention
  16. 16. Alternative Delivery Models • Recent Studies found intensity as a consistent factor that contributed to increased language outcomes ▫ Gillam et.al (2008) , Loeb et. al. (2009), Tomblin, (2007), Gillam and Loeb (2010)
  17. 17. Define “Intensity” • “The number of hours of intervention over a specific time period.” (Lovaas) • “The ratio of adult to children” (Graff et. al.) • “The quality and quantity of services in a given period of time.”(Barnett & Escobar) • “The number of specific teaching episodes per unit of time.” (Guralnick) From Ukrainetz et. al. 2008
  18. 18. How Much is Necessary? • How often should we use therapeutic techniques in a session? • Which techniques work best for working on specific goals? ▫ (Ukrainitz, et.al. 2008)
  19. 19. Research on intensity-over-time is contradictory • Intervention of more than 8 weeks was more effective than less than 8 weeks (From Ukrainitz et.al, 2008; Law et. al, 2004) Contradicted by: • Intensive 6 week service delivery model showed 5x the gains as a traditional 2-year service delivery model ( Gillam & Loeb, 2010) ▫ Number of delivery hours being equal
  20. 20. Study on Intensity • Could we do a study of intensity that applies to a public school population? • How does the Bilinguistics pilot study look different from the Gillam et.al. (2010) than the study? • How would we create a larger scale study in the public school setting?
  21. 21. Could we alter the frequency and intensity of speech therapy and get equal or greater results?
  22. 22. Applying a Pilot Study of Intensity to our Field. • Individual • Monolingual English • 1:40/day for 6 weeks • Literacy-based, computer program and academic program • Only enrolled children with language impairments • Group • Bilingual population • 2:00/day for 2 weeks • Literacy-based program • Children with speech, language, hearing, social and cognitive disorders enrolled in program Gillam Study Bilinguistics Study
  23. 23. Study Overview • The current study examined the efficacy of a short-term intensive group intervention program for both English and Spanish-speaking children ages 3-8 with all classes of disorders.
  24. 24. Methods  Participants-6 children per group  2 groups of 3-5 year old bilinguals  2 groups of 3-5 year old English speakers  1 group of 6-8 year old bilinguals  1 group 6-8 year old English speakers  Time  Two week sessions, 4 days per week  Intensity  2 hours per day  Disorders  All disorders (Autism, speech and language impairment, Down Syndrome)
  25. 25. Time Schedule Activity Goals 8:50-9:00 Arrival 9:00-9:15 Circle Time Greeting/ Attendance Clinician A 9:15-9:20 Jobs Clinician A 9:20-9:30 Calendar Clinician A 9:30-9:35 Music Clinician A 9:35-9:40 Language goal Clinician A
  26. 26. Time Schedule Activity Goals 8:50- 9:00 Arrival 9:00- 9:15 Circle Time Greeting/ Attendance Clinician A Name recognition: Clinician hold up name card and kids find the student. Clinician: Who’s name is on the card? Students: Jacob! Clinician: Where is Jacob? Students: Over there Clinician: That’s right, he is next to Keith Ok, Keith, where do I put you name, Under the boy or under the girl? 1. Phoneme identification 2. Who question 3. Where questions 4. Joint attention 5. Spatial concepts 9:15- 9:20 Jobs Clinician A Six jobs: Capitan Energy (lights), Super sponge (clean- up), Fantastic furniture ( 1. Who questions 2. Responsibility 3. Object-action
  27. 27. Time Schedule Activity Goals 9:15- 9:20 Jobs Clinician A Six jobs: Capitan Energy (lights), Super sponge (clean- up), Fantastic furniture (tables and chairs are put up), Time machine man (calendar helper), Line leader, Snack helper. Give out badges for each job. 1. Who questions 2. Responsibility 3. Object-action 9:20- 9:30 Calendar Clinician A 1. Go over months in a year and then dance the Macarena to the songs (January, February, etc.). 2. Review Days of the weeks, snap the Days of the week song. 1. sequences 2. numbers 3. categories 4. verb tense 9:30- 9:35 Music Clinician A Children choose two songs to dance to 1. Increase sentence length 2. Which questions 3. sequence
  28. 28. Time Schedule Activity Goals 9:00- 9:15 Circle Time Greeting/ Attendance Clinician A Name recognition: Clinician hold up name card and kids find the student. 1. Phoneme identification 2. Who question 9:15- 9:20 Jobs Clinician A Six jobs: Capitan Energy (lights), Super sponge ( 1. Who questions 2. Responsibility 3. Object-action 9:20- 9:30 Calendar Clinician A 1. Go over months in a year and then dance the Macarena to the songs (January, February, etc.). 2. Review Days of the weeks, snap the Days of the week song. 3. Review the date. Today is X. Yesterday was X. Tomorrow will be X. 1. sequences 2. numbers 3. categories 4. verb tense
  29. 29. Time Schedule Activity Goals 9:20- 9:30 Calendar Clinician A 1. Go over months in a year and then dance the Macarena to the songs (January, February, etc.). 1. sequences 2. numbers 3. categories 4. verb tense 9:30- 9:35 Music Clinician A Children choose two songs to dance to Clinician: Which songs do you want to hear? Pick two songs. Student: I want the animal song and the Hokey Pokey song. Provide visual choices. After student picks the songs, place the pictures on a board that say First, then. 1. Increase sentence length 2. Which questions 3. sequence 9:35- 9:40 Language goal Clinician A Clinician: Today we are going to learn about our body parts and why we need them. We use our nose to smell, eyes to see, etc. 1. Object-action 2. Category generation
  30. 30. Time Schedule Activity Goals 9:30- 9:35 Music Clinician A Children choose two songs to dance to Clinician: Which songs do you want to hear? Pick two songs. Student: I want the animal song and the Hokey Pokey song. 1. Increase sentence length 2. Which questions 3. sequence 9:35- 9:40 Language goal Clinician A Clinician: Today we are going to learn about our body parts and why we need them. We use our nose to smell, eyes to see, etc. Draw a word map and ask the kids to label their body parts. Clinician: What do we do with our eyes? 1. Object-action 2. Category generation 9:40- 9:45 Phonological goal Clinician A Clinician: We are also going to learn about the letter /s/. It makes a sound like a snake. 1. final /s/
  31. 31. Time Schedule Activity Goals 9:35- 9:40 Language goal Clinician A Clinician: Today we are going to learn about our body parts and why we need them. We use our nose to smell, eyes to see, etc. Draw a word map and ask the kids to label their body parts. Clinician: What do we do with our eyes? 1. Object-action 2. Category generation 9:40- 9:45 Phonological goal Clinician A Clinician: We are also going to learn about the letter /s/. It makes a sound like a snake. 1. final /s/ 9:45- 9:55 Literacy Center Clinician B Read the book: From Head to Toe, By Eric Carle. Use scaffolding techniques while reading the book with the students. Focus on language target. 1. Object actions 2. Final /s/
  32. 32. Time Schedule Activity Goals 9:40-9:45 Phonological goal Clinician A Clinician: We are also going to learn about the letter /s/. It makes a sound like a snake. 1. final /s/ 9:45-9:55 Literacy Center Clinician B Read the book: From Head to Toe, By Eric Carle. Use scaffolding techniques while reading the book with the students. Focus on language target. 1. Object actions 2. Final /s/ 9:55-10:25 Stations: Each children rotates 10 minutes at each station Station 1 (Undergrad) :Auditory bombardment/Pho nological awareness with student clinician Station 2: (Clinician B) language station with SLP Station 3 (Clinician A): speech station with SLP
  33. 33. Time Schedule Activity Goals 9:55- 10:25 Stations: Each children rotates 10 minutes at each station Station 1: (Undergrad) Auditory bombardment /Phonological awareness with student clinician Station 2: (Clinician B) language station with SLP Station 3 (Clinician A): speech station with SLP 1. Words with final /s/. Students will have materials to color while listening to the words. 2. The phonological awareness activity is a matching game with words that rhyme (eyes, ties; nose, toes; hand, sand) Ball game: Do you want to throw the ball with your hands or kick the ball with your feet? Trace the student’s body on butcher paper. Draw the parts of the body and practice the final /s/.
  34. 34. Time Schedule Activity Goals 9:55- 10:25 Stations: Each children rotates 10 minutes at each station Station 1 (Undergrad) :Auditory bombardment/P honological awareness with student clinician Station 2: (Clinician B) language station with SLP Station 3 (Clinician A): speech station with SLP 10:25- 10:40 Snack time Clinician A Cheese sandwiches. Students make sandwich. Place two raisins for eyes, one for a nose. Lettuce for hair, tomato for lips. 1. sequence 2. body parts 3. object-action 10:40- 10:50 Literacy Center Clinician B Group activity- Read the book again and act out the actions. Stomp with my feet, etc. 1. object-action 2. final /s/
  35. 35. Time Schedule Activity Goals 10:25- 10:40 Snack time Clinician A Cheese sandwiches. Students make sandwich. Place two raisins for eyes, one for a nose. Lettuce for hair, tomato for lips. 1. sequence 2. body parts 3. object-action 10:40- 10:50 Literacy Center Clinician B Group activity- Read the book again and act out the actions. Stomp with my feet, etc. 1. object-action 2. final /s/ 10:50- 11:00 End of the day Clinician A Review the language target and phonological target. Today we learned what our body parts can do. We also learned that some of the words end in /s/ because there are two of them. Play end of the day music.
  36. 36. Time Schedule Activity Goals 10:40- 10:50 Literacy Center Clinician B Group activity- Read the book again and act out the actions. Stomp with my feet, etc. 1. object-action 2. final /s/ 10:50- 11:00 End of the day Clinician A Review the language target and phonological target. Today we learned what our body parts can do. We also learned that some of the words end in /s/ because there are two of them. Play end of the day music. Students gather their back packs and form a line at the door
  37. 37. Time Schedule Activity Goals 10:40- 10:50 Literacy Center Clinician B Group activity- Read the book again and act out the actions. Stomp with my feet, etc. 1. object-action 2. final /s/ 10:50- 11:00 End of the day Clinician A Review the language target and phonological target. Today we learned what our body parts can do. We also learned that some of the words end in /s/ because there are two of them. Play end of the day music. Students gather their back packs and form a line at the door
  38. 38. Therapy Planning-Caseload 50 across 2 schools • Intensity ▫ Students will receive 8 hours of therapy every six weeks • Forming groups ▫ Groups classified by disorder or age? • Alternating schedule ▫ 3 groups of 16 students (1,2,3) ▫ Each group will have an rotating schedule (a, b, c, d,e) ▫ Group are rotated through two week cycles along with alternating daily schedule
  39. 39. Therapy Planning-Caseload 50 across 2 schools Monday Tuesday Wednesday Thursday ARD day 8:00‐9:00 Group a Group e Group d Group c 9:05‐10:05 Group b Group a Group e Group d 10:10‐11:10 Group c Group b Group q Group e 11:10‐11:40 lunch lunch lunch lunch 11:40‐1240 Group d Group c Group b Group a 12:40‐1:40 Group e Group d Group c Group b 1:45‐2:45 Flexible  hour 1 Rotation of a two week session
  40. 40. Schematic of a Therapy Session ▫ Introduction – greeting ▫ Pre-Reading ▫ Reading ▫ Post reading ▫ Direct Therapy ▫ Closing
  41. 41. Choosing Books and Music • Songs and the Books Remained the Same • Repetition builds vocabulary and knowledge • Books varied by: ▫ Complexity ▫ Length ▫ Interest ▫ Child’s progress
  42. 42. Group Size and Behavior • One adult per station ▫ 6-9 children in total group ▫ Auditory Bombardment • Positive Behavior Management ▫ Rewarded students in front of everyone ▫ Extremely consistent • Post Process Review ▫ Discussed what we did well ▫ Discussed how to improve the next session
  43. 43. Younger Group-Spanish
  44. 44. Younger Group-Spanish Review
  45. 45. How can I adapt therapy to take advantage of changes in intensity?
  46. 46. Results • Complete data sets on 13 students • (4 Spn, 9 Eng) • Standardized testing • Narrative language sample ▫ Phonological errors ▫ Word/utterance errors ▫ Type-token ratio ▫ MLU ▫ Story grammar components
  47. 47. MLU in Words 0 1 2 3 4 5 6 7 IS CL RG BE IG JF NC AC IR English Mean Length of  Utterance Pre‐MLUW 0 1 2 3 4 5 6 AG AA JR KV Spanish Mean Length of  Utterance Pre‐MLUW Post‐MLUW
  48. 48. Total Number of Words 0 50 100 150 200 250 300 350 400 IS CL RG BE IG JF NC AC IR English Total Number of Words Pre TNW Post TNW 0 50 100 150 200 250 300 350 400 450 AG AA JR KV Spanish Total Number of Words Pre TNW Post TNW
  49. 49. Number of Different Words 0 20 40 60 80 100 AG AA JR KV Spanish Number of Different  Words Pre NDW Post NDW 0 20 40 60 80 100 120 140 IS CL RG BE IG JF NC AC IR English Number of Different  Words Pre NDW Post NDW
  50. 50. Number of Word Errors 0 5 10 15 20 25 30 35 40 45 50 IS CL RG BE IG JF NC AC IR English Word Errors PreWord Errors PostWord Errors 0 5 10 15 20 25 30 AG AA JR KV Spanish Word Errors PreWord Errors PostWord Errors
  51. 51. Implications - Summary • Short-term intensive intervention is beneficial for speech and language development • Children can benefit from intensive group intervention • This could have implication for service delivery in the schools
  52. 52. • Dickson, K., Marshall, M., Boyle, J., McCartney, E., O’Hare, A., Forbes, J. (2009). Cost analysis of direct versus indirect and individual versus group modes of manual-based speech and language therapy for primary school-age children with primary language impairment. International Journal of Language & Communication Disorders, 44, 3, 369- 381. • Edgar, D. L., Rosa-Lugo, L. I. (2007). The critical shortage of speech-language pathologists in the public school setting: Features of the work environment that affect recruitment and retention. Language, Speech, and Hearing Services in Schools, 38, 31-46. • Gillam, R. B., Love, D. F., Hoffman, L. M., Bohman, T., Champlin, C. A., Thibodeau, L., Widen, J., Brandel, J., Friel-Patti, S. F. (2008). The efficacy of Fast ForWord Language Intervention in school-age children with language impairment, A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 51, 97-119. • Schooling, T., Venediktov, R., Leech, H., EB Evidence-Based Systematic Review: Effects of Service Delivery on the Speech and Language Skills of Children From Birth to 5 Years of Age ASHA October 2010 • Loeb, D. F., Gillam, R. B., Hoffman, L., Brandel, J., Maruis, J. (2009). The effects of fast forword language on the phonemic awareness and reading skills of school-age children with language impairments and poor reading skills. American Journal of Speech- Language Pathology, 18, 376-387.
  53. 53. • Peters-Johnson, C. (1996). Action: School Services. Language, Speech, and Hearing Services in Schools, 27, 185-187. • Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, S., & O’Brien, M. (1997). Prevalence of specific language impairment in kindergarten children. Journal of Speech, Language, and Hearing Research, 40, 1245-1260. • Schooling, T., Venediktov, R., Leech, H.,(2910) EB Evidence-Based Systematic Review: Effects of Service Delivery on the Speech and Language Skills of Children From Birth to 5 Years of Age ASHA October 2010 • Stahl, S.A. & Fairbanks, M.M. (1986). The effects of vocabulary instruction: A model-based meta-analysis. Review of Educational Research, 56(1), 72- 110.Ukrainetz et. al. 2009 • Ukrainetz, T., Proctor-Williams, K., Baumann, J., Allen, M., Hoffman, L., Justice, L (2008). How Much is Enough? The Intensity Evidence in Language Intervention. Presentation at the American Speech Language Association Annual Convention, Chicago • Pui Fong, Kan(2010). Vocabulary Development and Function in Bilinguals: Comparison Across the Life span. Presentation at the American Speech Language Association Annual Convention, Philadelphia
  54. 54. Click to visit www.bilinguistics.com
  55. 55. Difference or Disorder?  Understanding Speech and Language  Patterns in Culturally and Linguistically  Diverse Students Rapidly identify speech‐language  patterns related to second language  acquisition to  distinguish difference from disorder.

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