Speech Therapy

1. Speech Therapy In the Classroom?

2. What constitutes communication?

3. “A process by which information is exchanged between individuals."   There are two main reasons why we communicate: 1. To regulate other people's behavior, to ask other people not to do things (protests), & to obtain a desired object or event (requests). 2. To socialize (conversations), to comment or to share information (answering questions). http://www.educ.ttu.edu/edsp/burkhartproject Communication

4. A person's understanding of the language used by others. • We can combine words with gestures or pictures to enhance comprehension. http://www.educ.ttu.edu/edsp/burkhartproject Receptive Language

5. Using language to convey messages (thoughts, wants, needs). • Expressive language happens when the child decides to communicate with other people in his/ her environment. • A child also needs to independently regulate his/her own communication within an environment . http://www.educ.ttu.edu/edsp/burkhartproject Expressive Language

6. May include sign language, picture exchange systems, communication boards, and/or gestures that maximize communication. • Teaching nonverbal language maximizes the student’s functional communication. However, the language and symbols being taught to the child must match concepts from his/her natural environment. http://www.educ.ttu.edu/edsp/burkhartproject Nonverbal Language

7. When does a child need to be pulled out of class to address language and/or articulation deficits?

8. Although prognosis is individualized for each student, there must be evidence of: • An identified area of weakness (a discrepancy of 2 stanines on 2 or more language subtests) • A 2 stanine discrepancy? What is my SLP talking about? • Broad areas of language are: - Semantics (vocabulary) -Morphology/ syntax (sentences) -Auditory integration (listening) - Verbal reasoning (understanding language) http://www.asha.org/docs/html/GL2000-00053-T16.html Qualification for language services…

9. Although prognosis is individualized for each student, there must be evidence that: • The deficit is not being addressed by another special educator. • Often times SLP’s and special educators are working on the same thing • Close attention should be paid to the IEP to determine if duplication of services is occurring • If there is a duplication of service, service should be occurring in the least restrictive environment (e.g., special ed classroom or regular ed classroom) http://www.asha.org/docs/html/GL2000-00053-T16.html Qualification for language services cont…

10. Objective 1: Patrick will identify and explain the main idea and supporting details in the text or a portion of the text with 80% accuracy in four out of five samples as measured by data collection, work samples, and teacher made tests. • Objective 2: Patrick will answer inferential questions about a passage/story he has read with 80% accuracy in four out of five trials as measured by data collection, work samples, tests/quizzes. • Objective 3: Patrick will summarize a passage/story to include important details and events with all required elements in four out of five summaries as measured by data collection, work samples, and tests/quizzes. • Objective 4: Patrick will identify the genre of a story/passage correctly in four out of five trials as measured by work samples, data collection, and tests/quizzes. Reading Comprehension Goals

11. Objective 1: Patrick will be able to state the main idea of a paragraph or short story with 80% accuracy in 3/4 sessions as assessed by data collectiona and therapist observation. • Objective 2: Patrick will be able to state at least three details from a story/paragraph presented orally with 80 % accuracy in three out of four sessions as assessed by therapist observation and data collection • Objective 3: Patrick will answer indirect questions,state author's purpose, and make predictions for storys/paragraphs presented orally with 80% accuracy in three out of four sessions. • Objective 4: Patrick will follow oral directions using temporal concepts (before, after, first, second, next, last)given pencil/paper tasks given a set of ten directions at 90% accuracy in three out of four sessions as assesssed by data collection and therapist observation. • Objective 5: Patrick will follow oral directions using spatial concepts (in, on, under, near, far, on, below, beneath, above) given paper/pencil tasks at 90% accuracy in three out of four sessions as assessed by work samples data collections and therapist observation. • Objective 6: Patrick will identify which two words out of a set of four, are related and state the relationship given 15 sets of words with 90% accuracy in three out of four sessions Receptive Language Goals

12. Although prognosis is individualized for each student, there must be evidence of: • An adverse educational impact (may be academic or social) http://www.asha.org/docs/html/GL2000-00053-T16.html Qualification for speech/language services cont…

13. Although prognosis is individualized for each student, there must be evidence that: • The student’s cognitive level is sufficient to acquire a targeted skill. http://www.asha.org/docs/html/GL2000-00053-T16.html Qualification for speech/language services cont…

14. Although prognosis is individualized for each student, there must be evidence of: • Progress with previous services (Florida State Department of Education, 1995) http://www.asha.org/docs/html/GL2000-00053-T16.html Qualification for speech/language services cont…

15. IEP Meeting Date: 06/04/2004 • Objective: 1 John will produce an /s/ without a frontal lisping in the: 1. initial position 2. medial position 3. final position of short phrases (2-3 word phrases). Criteria: 80% accuracy 4 out of 5 sessions Evaluation: data collection teacher/therapist observation • Objective: 2 John will produce a /z/ without frontal lisping in the: 1. initial position 2. medial position 3. final position of short phrases (2-3 word phrases) Criteria: 90% accuracy 4 out of 5 sessions Evaluation: data collection IEP objectives from 2004 IEP..

16. 02/15/2008 • John will produce /s/ in the initial position of words in sentences with an average of 80% accuracy over the course of 4 therapy sessions. • John will produce the /s/ sound in the medial position of words in sentences with an average of 80% accuracy over the course of 4 therapy sessions. • John will produce the /s/ sound without lisping in the final position of words in sentences with an average of 80% accuracy over the course of 4 therapy sessions. • John will produce the /z/ sound without lisping in the final position of words in sentences with an average of 70% accuracy over the course of 4 therapy sessions • John will produce the /z/ sound in the medial position of words in sentences with an average of 80% accuracy over the course of 4 therapy sessions. IEP Objectives for 2008 IEP…

17. Additional considerations for articulation therapy: • Is there a 1 year delay in speech sound development? (ex., a 5 year old with difficulty producing later developing sounds--/r/ would not qualify for services) • Does the speech pathologist feel that motor patterns are set? • Is there evidence that motor patterns are set and will not change with therapy? (ex., a down syndrome child who has been working on the same sounds for years with no progress or progress in the therapy room and no carry over into spontaneous speech Qualification for speech services…

18. Be consistent! If we bend the rules for one student or parent, we will have to bend the rules for others in the future. • Qualification is a team decision. However, the SLP’s expertise in this area should be weighed heavily. • Like all other diagnoses, students must meet all criteria to qualify as speech/language impaired (04). It is not a dumping ground for students who do qualify LD. • Our long-range goal is improved communication. How can we achieve that goal through therapy? Final thoughts about qualification for services…

19. Even if a student meets all of these criteria, there are still alternate service delivery options to consider.

20. Monitor: The speech-language pathologist sees the student for a specified amount of time per grading period to monitor or “check” on the student’s speech and language skills. Often this model immediately precedes dismissal. • Collaborative Consultation: The speech-language pathologist, regular and/or special education teacher(s), and parents/families work together to facilitate a student’s communication and learning in educational environments. This is an indirect model in which the speech- language pathologist does not provide direct service to the student. • Classroom-Based: This model is also known as integrated services, curriculum-based, transdisciplinary, interdisciplinary, or inclusive programming. There is an emphasis on the speech-language pathologist providing direct services to students within the classroom and other natural environments. Team teaching by the speech-language pathologist and the regular and/or special education teacher(s) is frequent with this model. • Pullout: Services are provided to students individually and/or in small groups within the speech-language resource room setting. Some speech-language pathologists may prefer to provide individual or small group services within the physical space of the classroom. • Self-Contained Program: The speech-language pathologist is the classroom teacher responsible for providing both academic/curriculum instruction and speech-language remediation. http://www.asha.org/docs/html/GL2000-00053-T16.html Service Delivery Options

21. It is a more naturalistic form of intervention. • Naturalistic interventions usually result in greater spontaneous language and generalization to non-treatment situations than do the more directive interventions. • Some functional aspects of language (such as social context and conversational turn-taking) cannot be established through directive intervention and need to be learned using more naturalistic approaches. • Parents and teachers can be trained to implement naturalistic interventions with ongoing monitoring. http://www.health.state.ny.us/community/infants_children/early_intervention/disorders/appendix_c.htm#directive Why are we moving toward collaborative consultation?

22. Classroom teachers have an opportunity to integrate functional communication into a variety of daily activities. • Communication occurs in a natural setting with multiple conversational partners. • Optimal student-teacher ratios in the regional programs. • Classroom-based approaches may enhance skill generalization through their emphasis on naturalistic routines and materials, the involvement of peers as both conversational models and partners, and the involvement of teachers who can extend language instruction throughout the day (Wilcox, Kouri, & Caswell, 1991). Why are we moving toward collaborative consultation?

23. EXPRESSIVE LANGUAGE: Kyle will demonstrate improvements in expressive language skills as assessed by mastery of the following short term objectives. Objectives • Objective: 1 When shown a picture, Kyle will formulate a sentence of at least 4 words to describe that picture. Criteria: an average of 80% accuracy or higher over the course of 4 therapy sessions. Evaluation: therapist observation, data collection • Objective: 2 When shown a picture and given an adjective, Kyle will formulate a sentence of at least 4 words using that adjective. Criteria: an average of 80% accuracy or higher over the course of 4 therapy sessions. Evaluation: therapist observation, data collection • Objective: 3 Kyle will ask a wh- question (what, when, where, who, why) that is grammatically correct in structure. Criteria: an average of 80% accuracy or higher over the course of 4 therapy sessions. Evaluation: therapist observation, data collection Could these be addressed in the functional skills classroom?

24. Give the teacher specific suggestions for ways to practice and apply skills and strategies being taught in therapy. To accomplish this task, identify recurring or special events that could be used to target speech and language objectives (e.g., weekly presentations, book reports, the class play.) For example, Ms. Barrett has a puppet theater in her classroom. Students take turns in presenting short plays. This is an excellent opportunity for the speech students to practice their individual speech-language targets. Make suggestions for a learning center and perhaps assist in preparing materials to be used in it. The SLP, for example, might review the classroom schedule with Ms. Sampson and identify times during the week when students who have syntax objectives on their IEPs could work at a communication station to practice constructing complex clauses in written language. Inform teachers of verbal and nonverbal cues that have been found useful for prompting students to use targeted skills and strategies. Then provide sticky notes for the teacher to attach to lesson plans or materials as reminders to prompt specific responses. For example, the SLP might give Ms. Barrett a sticky note that says, “Cue Johnny to use the word retrieval strategies he has learned” to place in her copy of the reading materials he will be reading orally. http://www.glrs.org/SLParticles/sharing%20responsibility%20for%20student%20success%20tchr%20and%20slp.pdf SLP assistance is still available with the collaborative model!

25. Speech-language pathologists provide intervention for both congenital and acquired cognitively based communication impairments. Impairments of cognitive processes may contribute to deficits in the syntactic, semantic, phonologic, and/or pragmatic aspects of language. Speech-language pathologists engage in interventions for cognitive communication impairments such as: • determining the appropriateness of intervention on the basis of potential for functional improvement in a reasonable and generally predictable period of time • selecting or designing appropriate tasks, stimuli, and methods—including such advances as the use of computers and augmentative devices • implementing individual and group programs specifically designed to treat cognitive-communication deficits • training and counseling students, family members, and educators in adaptive strategies for managing cognitive-communication disorders SLP role in cognitive-communication disorders

26. Visual strategies are instructional techniques or tools that provide a visual representation of information being delivered to the child with autism. These tools are designed to enhance the child’s understanding and increase his/her participation in the learning and communication process. Visual strategies may include daily schedules, work systems, communication systems, furniture and material arrangement, signs and labels, written messages, choice boards, and written directions. They may also include body language, natural environmental cues, traditional tools for organization and giving information, and specially designed tools to meet specific needs. • Body Language-interpreting facial expressions, body orientation/proximity, body stance, movement of body, reaching, touching, pointing, eye contact, eye gaze, and gaze shift. • Natural Environmental Cues: It is important to be able to interpret the meaning of the visual information in the environment in order to function effectively and independently. • Traditional Tools for Organization and Giving Information: In order to organize their lives people may use one or more of the following strategies: calendars, planners, schedules, TV guides, lists, notes, signs, maps, checkbooks, telephone/address books. • Specially Designed Tools to Meet Specific Needs: Many of the tools are individualized for each child in order to give the structure and information necessary to handle specific problems or situations. Visual Strategies

27. Give students full attention when they are speaking • Show that you understand what a child is saying and then fulfill requests if appropriate • Pause after speaking • Provide a script to help children put feelings into words • Encourage children to give directions (don’t always tell students what to do) Using Language in the Classroom

28. Encourage choice making • Allow children to verbally disagree in appropriate ways • Play games • Ask “wh” questions and provide time for responses • Model clear assertive communication More ways to use language in the Classroom

29. Language skills are an important ingredient in establishing social relationships. Typically developing children employ their language skills to share information, express feelings, direct behavior, and negotiate misunderstandings as they interact with others. Students with speech and language impairments, however, have been shown to exhibit poorer social skills and fewer peer relationships than their normally developing peers (Fujiki, Brinton, & Todd, 1997). The responsibilities specific to developing social-emotional communication skills are to: • provide information to the instructional staff regarding the role of pragmatics and dynamics of communication when dealing with social-emotional problems in the school • assist in the training of educational staff on the effective use of verbal and nonverbal communication in conflict resolution and discipline • collaborate with educational staff and parents to determine the communication intent of the child's obvious and subtle behaviors, and to facilitate the use of socially appropriate communication • collaborate with the school staff, as a member of a school peer mediation team, to enhance students' self-esteem by increasing their skills as effective communicators • demonstrate lessons, team teach, and model techniques to enhance pragmatic communication skills in the areas of problem solving, social communication, and coping skills • provide consultative services that address development of vocabulary to enhance emotional expression and control. SLP role in social-emotional communication disorders

30. Joint action routines are used to teach two or more students to participate in activities with a set theme or purpose. They typically occur during classroom and social routines that are familiar to the child. They are also done in conjunction with recurring events including leisure, play time, snack time, and mealtime. Themes are used in order to make the activity more meaningful and recognizable to the child. It is recommended that activities have a logical and predictable sequence with a structure for turn-taking. There are generally three types of joint action routines including the following: • Routines that include an outcome or end product such as setting the table • Routines that are developed around a story line such as shopping at a department store • Routines that involve turn-taking such as playing a board game Joint action routines may require alteration of the environment in order to increase the child’s ability to respond socially and communicatively. These activities have been found to enhance language and desired social responses. Overall, they provide contexts for enhancing meaningful communication. Given a familiar and predictable routine, teachers or parents can encourage communication by providing frequent repetition and rehearsal of target language within a functional or motivating activity. Joint Action Routines

31. Vocabulary is frequently best addressed by the classroom teacher • General education teachers and special education teachers can teach vocabulary related to the content being taught in the classroom thus making vocabulary development more meaningful Vocabulary in the Classroom…

32. Is there evidence that the missed sessions have negatively impacted the student academically? • What could we defend in court? What evidence would we need to provide in court? Missed sessions? Tough decisions.