Making a Difference Through Everyday Routines in Preschool Service Delivery

1. Making a Difference Through Everyday Routines Preschool Service Delivery

2. FINANCIAL DISCLOSURE • Libby Simmons, MA, CCC/SLP is an employee of the West Virginia Department of Education.   • There are no other financial relationships to report. 

3. LEARNER OUTCOMES At the conclusion of this training: 1. Participants will be able to list three communication goals for three daily preschool routines. 2. Participants will be able to explain how visual supports within the routines can assist in developing language skills.

4. PRESCHOOL IS A BRIDGE

5. IMPORTANCE OF PRESCHOOL • Children who enter kindergarten with speech sound production problems and poor PA are at significant risk for literacy problems. SLPs must consider the specific sound errors*. (Preston, 2010) • Phonological Awareness, vocabulary and comprehension are among the five components of effective reading education (Powell, 2018).

6. BUILDING BLOCKS OF PRESCHOOL Embedded Learning Opportunities Curriculum Modifications Rich Emergent Literacy Environment Evidence-Based Curriculum Collaboration

7. PREDICTORS Emergent skills that best predicted later success in literacy were: • Alphabet knowledge (both name and letter-sound recognition) • Phonological awareness • Rapid automatic naming of letters/digits and objects/colors • Writing letters/own name • Remembering verbal information (phonological memory) Expressive Language Skills also play a role in predicting literacy skills, particularly grammar, word definitions and listening comprehension. NELP (2008)

8. COMMUNICATION ELA.PK.32 With prompting and support, ask and answer questions in order to seek help and get information. ELA.PK.35 Use non-verbal communication or spoken language to express ideas, needs, and feelings

9. COMMUNICATION • Communicate clearly enough to be understood by adults across a range of situations. • Pronunciation errors and grammatical errors are isolated and infrequent. • Show proficiency with prepositions, regular/irregular past tense, verb, possessives, and noun-verb agreement. • Show an understanding of a variety of sentences.

10. STORY TIME ELA.PK.31 ELA.PK.1 Retell familiar stories from text with some accuracy and details. With prompting and support, confirm understanding of a text read aloud or information presented orally or through other media by answering questions about details.

11. STORY TIME ELA.PK.II Phonics Phonological Awareness Identify sounds or spoken words in the environment. Recognize and produce rhyming words. Separate words into syllables. Replicate the beginning sound in a word. • Know the sounds associated with several letters.

12. PLAY • Engage in cooperative play. • Take turns with materials and during experiences. • Participate in a variety of classroom activities and tasks. • Follow basic rules and routines • Manage transitions and begin to adapt to changes in routines. • Develop positive relationships with children and adults.

13. LANGUAGE IS THE FOUNDATION Reading Reading

14. LANGUAGE

15. PRINCIPLES • Services should be provided in the child’s natural environment. • Typical routines serve as meaningful and functional opportunities for learning communication, social interaction and other developmental skills. • Children practice skills as they communicate what they see, do and enjoy through out the day. • Children attend best when they are actively engaged.

16. THE SLP’s ROLE IN EARLY INTERVENTION Early speech and language skills are acquired and used primarily for communicating during social interactions. Therefore, optimal early communication intervention services are provided in natural environments, which offer realistic and authentic learning experiences (i.e., are ecologically valid) and promote successful communication with caregivers. Authentic learning can maximize children's acquisition of functional communication skills and generalizationof newly mastered behaviors to natural, everyday contexts. (ASHA)

17. PREACHING TO THE CHOIR

18. OF ALTOS, SOPRANOS, TENORS AND BASES

19. WHAT’S ON YOUR MIND? IEPs Data Child Outcome Summaries Meetings Progress Reports Behavior Plans

20. WHO HAS ENOUGH TIME? PRESCHOOL STAFF SLP See all of the preschool students for speech therapy? • Work on speech/language goals targeted by SLP?

21. COLLABORATION AND TEAMING • Time • Differences in Perspectives • “Experts” • ”Another person in the room” • Change • Coaching • Not trained to manage groups

22. CHORUS CONCEPTS AND TEAMING • Can’t do it alone. Need all of the “voices”. • All sing from the same page. • Listen to each other. • Practice together. • Learn from each other. • Need to be organized as a group. • Need a choir director, a time keeper and a recorder

23. PRINCIPLES • Don’t move the clinic into the home or classroom—use the child and family’s environments as the context for intervention. • Consultation-based delivery of supports and services—STEPS • Some children will need individualized instruction...some of the time.

24. STEPSSPEECH THERAPY EDUCATION AND PREVENTION FOR SUCCESS

25. SLP’S ROLE IN PREVENTION • Identifying students who would benefit from early intervention/prevention is part of our scope of practice now • Bypasses the "wait to fail" model that has been used in the past for identifying students for special education • Can be done without the confines of an IEP

26. STEPS UP TO SUCCESS A multi-tiered, pre-referral, early intervention program which provides speech and language assistance to students who are "at risk", but have not been identified or suspected as having a communication disability that impacts educational performance.

27. POSSIBLE CANDIDATES FOR STEPS UP • Students who are stimulable for age appropriate sound or language skill • Students with one or two developmental sound errors (mild articulation disorder) • English Learners (EL) • Students who may appear delayed but may benefit from exposure to preschool activities • Students with mild, inconsistent dysfluencies • Students with mild, developmentally inappropriate social skills

28. SERVICES • Should be: • Effective • Efficient and • Evidence-Based

29. EFFECTIVE “The fact that a service has been provided does not mean that a positive outcome has been achieved.”  (Moore & Montgomery, 2018)​ • Does our therapy data relate to academic outcomes?​ • Do teachers, parents and the student see a change?​ • Is progress due to maturation or therapy?​ • Is therapeutic success important or trivial?​ • Is therapeutic success real, not random?

30. EFFICIENT • Intensity and Duration​ • ​ • Number of responses in a session (dose)​ • Number of sessions in a week (dose frequency)​ • Time period over which the intervention is presented (Total intervention duration)​ • ​ • (Moore & Montgomery, 2018)

31. CUMULATIVE INTERVENTION INTENSITY​(Example) Product of dose x dose frequency x total intervention duration.​ ​ 20 productions per session​   x 1 session per week​   x 28 weeks​ =560 productions (or teaching episodes)

32. IMPORTANCE OF PRACTICING A SKILL • The typical time to change a speech difference is 15 to 20 hours (Jacoby, et. al., 2002).​ • Massed practice is essential to progress – each student should produce approximately 150 correct speech sound productions per session – no more than four in a group . (Skelton, 2004). • Comparison of speech therapy progress of two boys. One received direct therapy one hour a week and another embedded language intervention 25 hours per week. (Woods & Goldstein, 2007)

33. EVIDENCE-BASED In order to learn a new word, you need to encounter it 15-20 times. During interactive book learning, the most significant gain in word learning was after 36 exposures. (Storkel, H. et al, 2017)

34. LANGUAGE AND READING BOOKS • Shared book reading • Interactive book reading—pointing to pictures, labeling, making sound • Dialogic Reading—Adult reads to the child and asks open-ended questions • Child-led literacy embedded in play • Getting into the Child’s ZONE of Proximal Development • Being exposed to “Pretend Talk”—Enacting roles and scripts • Following the lead of the child with literacy in mind

35. SKILL—SUPPORTING KNOWLEDGE IN LANGUAGE AND LITERACY • Basic language and literacy skills that underlie listening and reading comprehension are critical for students’ success in foundational literacy tasks. These skills include: • engagement in group reading • activities, • individual reading, • comprehension, • recalling details from text, • retelling stories and • using new vocabulary.

36. STORY CHAMPS • Story Champs • Is a multi-tiered language intervention curriculum • Promotes academic language • Oral Narratives • Informational Discourse • Syntax

37. LIPS Lip Poppers Tongue Coolers Lip Coolers Tip Tappers Scrapers Skinny Sounds Noisy Brother

38. THINKING ABOUT ROUTINES

39. ROUTINES Are meaningful contexts for young children to learn new skills because they are: • Predictable • Functional • Occur numerous times throughout the day (repetition) ( Woods, Kashinath & Goldstein, 2004)

40. ADVANTAGES OF EMBEDDED LEARNING OPPORTUNITIES (ELO) • Minimum changes to classroom activities. • Motivation to learn and participate. • Behaviors are used in a natural setting and usual contexts. • Behaviors are used with a variety of people and materials, enhancing generalization. (Trainer’s Guide to Building Blocks)

41. RESEARCH • Embedded instruction is effective for teaching a variety of valued skills to young children (Horn, et al., 2000). • A variety of instructional strategies have been embedded effectively (e.g. McBride & Schwartz, 2003). • Embedded instruction seems to enhance generalization (Wolery et al, 2002). • Teachers assess embedded instruction favorably (Horn, et al, 2000) (Trainer’s Guide to Building Blocks)

42. NATURAL ROUTINES Basing developmental interventions on children’s routines is the core feature of service delivery in natural environments. Targeted interventions are infused into the activities. (Dunst, Bruder, Trivette, Raab & McLean, 2001)

43. ROUTINEConcepts and Criteria for Early Intervention Strategies Routine-Based—Intervention strategies fit into the routines Outcome-Based Understandable Transdisciplinary Implemented by all Nonjudgmental—shared roles and responsibilities Evidence-Based (Jung, 2007)

44. ACTIVITY-OBJECTIVE MATRIX

45. SS-OO-PP-RR Setting the Stage Observation and Opportunities to Embed Problem Solving and Planning Reflection and Review

46. SETTING THE STAGE • Child’s favorite activities • Frequently-Occurring Activities • Priority Activities

47. OBSERVATIONS AND OPPORTUNITIES TO EMBED • Observe the routines and identify opportunities for embedding and repetition of practice. • Work together during the activity to establish opportunities for targeted interventions. • Determine the most effective interventions.

48. PROBLEM SOLVING AND PLANNING • Brainstorm how to expand participation in current routines. • Discuss what is working and what is not working. • Discuss steps to revise or expand participation.

49. REFLECTION AND REVIEW • Reflect/review with team strengths and possible challenges. • Review plan for expansion of instruction to other routines and partners. • Review connection to long range goals. • Develop a backup plan.

50. DATA COLLECTION • Tally • Benefits • Objectivity • Useful across a variety of behaviors • Possible Drawbacks • May seem unnatural • Requires skills • Takes time to summarize • Note Taking • Benefits • Helps in understanding why behaviors occur and under what conditions • Possible Drawbacks • May be time consuming • May rely on teacher’s memory • Takes time to summarize • Work Samples • Benefits • Created from natural child’s play • Appeals to families • Possible Drawbacks • Not always products • Need repeated samples • Storage • Takes time to summarize (Building Blocks, 2010)