Speech-Language Intervention in the Schools

1. Speech-Language Intervention in the Schools An overview of what to expect from your child and your school system. Stephanie Bailey, M.A., CCC-SLP Stephanie Lucy, M.S., CCC-SLP

2. Understanding Normal Speech and Language Development • Parents should discuss early speech and language development, as well as other developmental concerns, with their child's doctor at every routine well-child visit. Developmental norms help guide parents and doctors to determine if speech and language are developing as expected.

3. Before 12 months • Cooing • Babbling Babies are using their voices to relate to their environment. At about 9 months of age, they begin to string sounds together, incorporate the different tones of speech, and say words like "mama" and "dada" (without really understanding what those words mean).

4. What if my child doesn’t attend to sound? • If a baby is attentive to you but doesn’t seem to be startled by loud noises, he may be demonstrating a hearing loss. • Hearing screen.

5. 12-15 months • Wide range of speech sounds in their babbling. • At least one or more true words. • Nouns are usually first. • Should also be able to understand and follow single directions ("Please give me the toy”)

6. 18-24 months • Vocabulary of about 20 words by 18 months. • 50 or more partial words by the time they turn 2. • Combine two words, such as "baby crying" or "Daddy big." • A 2-year-old should also be able to follow two-step commands (such as "Please pick up the toy and bring me your cup").

7. 2-3 years of age • An "explosion" in their child's speech occurs at this time. • Expressively: -Large vocabulary -Routinely combine three or more words into sentences.

8. 2-3 years of age • Receptively: - Should begin to understand what it means to "put it on the table" or "put it under the bed." - Should also begin to identify colors and comprehend descriptive concepts (big versus little, for example).

9. Speech sound developmentIowa-Nebraska Articulation NormsSmit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798. • Phoneme Age of Acquisition Age of Acquisition Females Males /m/ 3.0 3.0 /n/ 3.6 3.0 /ng/ 7.0 7.0 /h-/ 3.0 3.0 /w-/ 3.0 3.0 /j-/ 4.0 5.0 /p/ 3.0 3.0 /b/ 3.0 3.0

10. Speech sound developmentIowa-Nebraska Articulation NormsSmit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798. • Phoneme Age of Acquisition Age of Acquisition females males /t/ 4.0 3.6 /d/ 3.0 3.6 /k/ 3.6 3.6 /g/ 3.6 4.0 /f-/ 3.6 3.6 /-f/ 5.6 5.6 /v/ 5.6 5.6 Voiceless th 6.0 8.0 Voiced th 4.6 7.0

11. Speech sound developmentIowa-Nebraska Articulation NormsSmit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798. • Phoneme Age of Acquisition Age of Acquisition females males /s/ 7.0 7.0 /z/ 7.0 7.0 /sh/ 6.0 7.0 /ch/ 6.0 7.0 /dg/ (j) 6.0 7.0 /l-/ 5.0 6.0 /-l/ 6.0 7.0 /r-/ 8.0 8.0 /er/ 8.0 8.0

12. Speech sound developmentIowa-Nebraska Articulation NormsSmit, Hand, Freilinger, Bernthal, and Bird (1990). Journal of Speech and Hearing Disorders, 55, 779-798. • Phoneme Age of Acquisition Age of Acquisition females males /tw kw/ 4.0 5.6 /sp st sk/ 7.0 7.0 /sm sn/ 7.0 7.0 /sw/ 7.0 7.0 /sl/ 7.0 7.0 /pl bl kl gl fl/ 5.6 6.0 /pr br tr dr kr gr fr/ 8.0 8.0 /thr/ 9.0 9.0 /skw spl/ 7.0 7.0 /spr str skr/ 9.0 9.0

13. Mom and Dad’s role in all of this: • STIMULATE STIMULATE STIMULATE TALK TO YOUR CHILD LABEL OBJECTS AND ACTIONS READ TO YOUR CHILD PLAY GAMES WITH YOUR CHILD

14. Mom and Dad’s role in all of this: • Consistency is key—read the same books over and over, play with the same toys and use the same words or phrases over and over. This will help your child to know the “routine.” • Once the child knows the routine, then you can leave out the word that goes with a particular action. The goal is for the child to begin to add to the activity by saying a word or by participating in the activity at a different level—adding to an activity or expanding on an activity.

15. What Are Some Warning Signs of a Possible Problem? • An infant who isn't responding to sound or who isn't vocalizing is of particular concern. Between 12 and 24 months, reasons for concern include a child who: -isn't using gestures, such as pointing or waving bye-bye by 12 months -prefers gestures over vocalizations to communicate by 18 months -has trouble imitating sounds by 18 months

16. For the child over 2 years, you should seek an evaluation if he or she: • Doesn't produce words or phrases spontaneously – only imitates. • Only certain sounds or words repeatedly. • Can't use oral language to communicate more than his or her immediate needs • Can't follow simple directions • Has an unusual tone of voice (such as raspy or nasal sounding) • Is more difficult to understand than expected for his or her age. Parents and regular caregivers should understand about half of your child's speech at 2 years and about three quarters of your child's speech at 3 years. By 4 years old, your child should be mostly understood, even by people whom your child doesn't know.

17. What if I suspect difficulties in speech or language? • Anyone can refer a child for speech and language services: • Parents • Teachers • Speech Pathologist • Other supporting staff

18. Screening process • All children are screened at the Pre-K or Kindergarten level for speech and language development. • This can be done by the teachers or the school speech pathologist. • A child who does not “pass” the screen may be referred for evaluation or another course of action may be pursued (i.e., offer guidance to parents or refer to teacher assistance team).

19. Referral • Designee – records the date, reason for referral, and name of person making referral. • Procedural safeguards notice • Confidentiality • Child Study Team meets.

20. Child Study • Child Study team members: • Parent • Speech Pathologist • Classroom teacher • Designee (principal, asst principal, other) Reviews information the school already has: classroom test scores, observations by school staff, previous evaluation reports, classroom performance as reported by teacher, etc.

21. TIMELINE • Evaluation must be completed and the child’s eligibility determine within 65 business days of the date the referral is received.

22. Evaluation Report • Analysis of child’s strengths and weaknesses. • Assessment results fully explained. • Indicates the existing and predicted impact of any speech-language impairment on the child’s ability to access and progress in the general educational curriculum.

23. ELIGIBILITY • Based on the presence of a disability that results in the child’s need for special education and related services, • Not the potential benefit from speech-language services. • The team must be able to document the adverse educational impact of a student’s speech and language skills on performance. • Is there a need for specially designed services

24. The bottom line… A student can demonstrate communication differences, delays, or even impairments, without demonstrating an adverse affect on educational performance. Virginia Dept of Education (2005). Speech Language Pathology Services in Schools: Guidelines for Best Practice, p.15.

25. Educational Impact Of a Speech-Language Impairment • How does the disability affect the progress and involvement of the student in the general curriculum; for preschoolers, the effect on their ability to participate in appropriate activities. • Academic • Social • Vocational

26. Academic • Reading • Math • Language Arts • Difficulty with language-based activities • Difficulty comprehending orally presented information and/or difficulty conveying information orally.

27. Social • Interference with the ability of others to understand the student • Peers teasing the student about his/her speech-language disability • The student having difficulty maintaining and terminating verbal interactions • The student demonstrating embarrassment and/or frustration regarding his speech-language skills.

28. Vocational • Job-related skills that the student cannot demonstrate due to speech-language impairment • Inability to understand/follow oral directions • Inappropriate responses to coworkers’ or supervisors’ comments • Inability to answer and ask questions in a coherent and concise manner

29. Children not eligible for Special Education • “The Virginia Special Education Regulations require whenever a child is found ineligible for services, the eligibility committee should prepare useful information for the classroom teacher and the parent about steps they can take to facilitate the child’s development.” Virginia Dept of Education (2005). Speech Language Pathology Services in Schools: Guidelines for Best Practice, p.18.

30. When a child is found eligible • IEP (individualized education program) • Within 30 calendar days of the eligibility date. • Describes the services necessary to meet the unique educational needs of the child, as identified by the assessment. • Consider: strengths, parental concerns, results of most recent evaluations, performance on any state or division-wide assessments.

31. Addresses 3 questions: • Where are we now? • Where are we going? • How will we get there?

32. PLOP • Present Level of Performance • What would I want to know about this student if he or she were going to be in my classroom next year? (Virginia Institute for Developmental Disabilities, 2001)

33. Annual Measurable Goals • What do we want the child to be able to do in a year? • Be realistic • Prioritize • Measurable terms: • Who will achieve? -- What is the skill or behavior to be achieved? • How can the skill be -- Where will the student measured? use the behavior? -- When will the skill be used or goal be accomplished?

34. Service Delivery • Direct services • When speech and language services are indicated, the service delivery and clinical methods must focus on achieving the goals in the child’s IEP. • Pull-out therapy (individual or small group) • provided in an individual or small group setting (speech therapy room, classroom, cafeteria, or other school setting)

35. Service Delivery • Integrated Therapy • Individualized service in a least restrictive setting and does not remove the child from the general or special ed. Classroom. • Direct services while continuing to receive classroom instruction. Classroom teachers are an integral part of the process. Collaborative effort. • Paraphrases information, • creates graphic organizers, • teaches strategies for vocabulary learning, • teaches strategies for sequencing, • teaches strategies for developing a narrative, • cues and prompt the student, • modifies the language level of instruction to meet students’ needs.

36. Indirect Services • Consultative • Specifies support for school personnel as a part of the accommodations, modifications, or supplemental support services provided to a teacher on behalf of the student. • Include providing information and demonstrating effective instructional and facilitation procedures. • SLP monitors student’s progress. • Appropriate for students nearing dismissal from speech-language services or students whose teachers require additional support to create materials, implement specific communication strategies, or modify AAC equipment.

37. Indirect Services continued • Indirect services include: • Providing information and demonstrating effective instructional materials and facilitative procedures. • While providing consultative services on behalf of a child, the speech-language pathologist will monitor the student’s progress. • Consultative services usually do not involve the direct provision of therapy to the student.

38. Services Available at School • Effective service delivery is dynamic and changes with the needs of the student. • Services may be provided directly to the student or indirectly through consultation with educators and families. • Decisions are based upon the child’s present level of performance, progress made in services received to date, assessment results, IEP goals, and any objectives/benchmarks.

39. Speech Language Intervention includes: • Articulation / phonology • Increase Intelligibility of child’s speech. • Reduce use of phonological processes. • Stimulability of sound production.

40. Speech Language Intervention includes: • Expressive and Receptive Language • Syntax • Morphology • Organization • Vocabulary • Pragmatics • Semantics • Verbal comprehension • Figurative Language skills

41. Speech Language Intervention includes: • Fluency • Repetitions (sounds, syllables, part words, whole words, phrases) • Pauses • Prolongations Differ in number and severity from those of normally fluent individuals.

42. Speech Language Intervention includes: • Voice • Pitch • Loudness • Quality Calls attention to itself rather than to what the speaker is saying. Before a child may be found eligible for services for a voice impairment, the child should receive a medical examination from an otolaryngologist (ENT), clearing the child for intervention.

43. What Can Parents Do at Home? • For mild developmental errors try these: • Repeat the sound slowly and correctly over and over in lots of natural conversations while facing your child directly. • Work on one sound at a time for no more than 15 minutes at least three times a week. • Five trials at a time. Parent model and child tries to match it. Give praise – positive reinforcement. • Make it a game, color something together. • Stickers! Quick Communications, P.O. Box 27891, St.Louis, MO 63146

44. Suggestions that Parents Can Do at Home. • For mild developmental errors try these: • Model proper grammar during conversation • Correct a child’s grammar during spontaneous speech no more than once a day. We want enthusiasm for natural speech. • Respond with lots of encouragement and praise for trying. • Refer your child to the word in which he can produce the sound correctly. (i.e., I like your /r/ in ‘run’.) Quick Communications, P.O. Box 27891, St.Louis, MO 63146

45. Suggestions that Parents Can Do at Home. • Aiding your child’s language development. • Read longer and longer stories and see if he/she can remember what happened first, second, third, etc. Have him tell the story back to you. This promotes memory improvement. • Make category scrapbooks – select categories for each page. Have child find and glue magazine pictures for each category. This promotes logic and logical language. Quick Communications, P.O. Box 27891, St.Louis, MO 63146

46. Suggestions that Parents Can Do at Home. • Aiding your child’s language development. • Encourage complete sentences. When your child uses just a few words, repeat them and put them into a short sentence. Provide sentences with additional phrases as your child grows older. This expands sentence length naturally. • Embrace opportunities to incorporate language concepts: descriptive (big); spatial (under) ,etc.. Quick Communications, P.O. Box 27891, St.Louis, MO 63146

47. Suggestions that Parents Can Do at Home. • Aiding your child’s language development. • Play “what if-” games: • “What if we ran out of gas, what would you do?” • Ask questions of why, what, how & where. • Use riddles. This promotes problem solving skills. Quick Communications, P.O. Box 27891, St.Louis, MO 63146

48. Suggestions that Parents Can Do at Home. • Language is best learned while doing, so let your child participate in household and neighborhood routines whenever possible. • Describe what you are doing and what will happen next. • Give him/her a chance to ask questions. Quick Communications, P.O. Box 27891, St.Louis, MO 63146

49. Suggestions that Parents Can Do at Home. • What if my child stutters? • Start with improving your own listening skills. What is your child really trying to tell you? • Provide an appropriate speech model for you child. • Make efforts to talk a little more slowly. • Try using simpler and shorter sentences at times. • Give your child time to talk without interruption. • Act and speak patiently. Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America

50. Suggestions that Parents Can Do at Home. • What if my child stutters? • Provide pleasurable and rewarding speech experiences. • Singing • Word games • Teach riddles and jokes • Read or tell stories • Speech is not always for scolding and reprimanding. Adapted from If Your Child Stutters: A Guide for Parents; The Speech Foundation of America