Best Practices for SLP Assistants

Best Practices for SLP Assistants

Module 3

Clinical Considerations for the Speech-Language Pathology Licensed Assistant

Note Taking Guide

Learner Objectives:

Increase your understanding of IEPs.
Optimize your partnership with interpreters.
Assist you in managing behavior and providing feedback and reinforcement in your therapy sessions.
Help you plan for effective individual and group therapy sessions.

Individualized Education Programs (IEPs)

Individuals with Disabilities Education Act (IDEA)

· Federal Law, revised many times

· Governs education of children with a disability

Children have the right to a ______

in the ______.

Admission Review and Dismissal (ARD) Committee

ARD committee includes:

If the child qualifies, the ARD committee gathers to determine what programs would best address the child’s needs

Individualized Education Program (IEP)

ARD committee considers:

And writes an Individualized Education Program

The IEP Includes:

PLAAFP
Assessment participation
Transition services
Annual goals
Services -special education, related services
Supplemental aids and services
ESY services
LRE

Acronymity!

LEA

PLAAFP

FAPE

IDEA

LRE

ESY

ARD

Annual Goals

The special education process is:

· designed to meet the child’s needs

· so the child can progress in the curriculum

The IEP documents contain:

· Measurable goals and objectives

· How goals will be measured

You will provide therapy in accordance with the IEP

The IEP supplies specific information about the child that you will need in order to work with him successfully.

Your therapy is part of the school’s implementation of the IEP.

So what does this mean for me?

Begin to understand the legal requirements. CONGRATULATIONS!
Learn all you can about the child you are serving:

o Read carefully

o Discuss with your supervising SLP

o Clarify and plan your therapy in accordance with the IEP

Check out the links below to find more information about the IEP/ARD process.

Guide to the Admission, Review, and Dismissal Process:

http://fw.esc18.net/frameworkdisplayportlet/Documents/ARD%20Guide%20MAR%202010.pdf

Texas Education Agency:

http://www.tea.state.tx.us/special.ed/

US Department of Education Office of Special Education Programs:

http://idea.ed.gov/explore/home

Working with Interpreters

Ideally –the SLP is proficient in the same language as the child, but

If you are not fluent in the child’s language,
And the services of a therapist who is fluent cannot be obtained,

Then an interpreter may be used.

Interpreters must be trained!

Common Dilemmas

1) The therapist is not sure that the message is clearly conveyed

* what was interpreted to the child or parents

* how information was explained

* what or exactly how did the child or parents respond

2) The interpreter takes over as the therapist

* the therapist resorts to just telling the interpreter to explain therapy or ask questions

* the interpreter is not trained as a therapist or assistant and should remain neutral

Inappropriate Use vs. Appropriate Use of an Interpreter:

Language Status

English Language Learner:

Monolingual:

Bilingual:

Development of the Second Language

BICS / CALP

Language Acquisition/Bilingualism

· Receptive language develops before expressive language

· Simultaneous acquisition

· Sequential acquisition

Language Differences do not Equal Language Disorders!

Just because a child is not proficient in English does not mean he has a disorder!!

Selecting an Interpreter

Researchers Discuss Interpreter Skills:

Special Skills

An interpreter has to be able to:

· Convey your instructions, teaching strategy, or examples to the child in native wording so that the goal is addressed

· Convey to the SLP whether the child’s response is accurate

· Example of language difference:

o big ball = ball big

ASHA Guidelines

· ASHA offers some tips that will help you in selecting and working with an interpreter.

· What to do:

o Before therapy

o During therapy

o After therapy

Before Therapy

· The interpreter must be proficient in ______.

· The interpreter should have at least the ______of proficiency as the student.

· The interpreter and therapist should meet and review ______.

· The interpreter should take notes about the child’s ______.

During Therapy

· ______yourself

· Ensure the interpreter is ______.

· Allow time for the interpreter to ______.

· Talk directly with your ______.

· Build in ______for the session

After After

· Review student’s ______.

· ______on future sessions

· Preserve time to discuss ______.

Review the Videos. Make a list of the differences:

Check out the links below to find more information about working with interpreters

• http://www.asha.org/practice/multicultural/issues/interpret.htm

• http://www.aphasia.org/naa_materials/WorkingWithTranslators.pdf

• http://multiculturalspeechtherapy.com/?p=73

• http://www.csha.org/documents/positionpapers/PositionPaperInterpretorsFinalDraft.pdf

Managing Behavior and Providing Feedback

TARGET SPECIFIC feedback and reinforcement:

REINFORCEMENT:

FEEDBACK:

Examples of Feedback:

Child produces a lateralized /s/

Feedback from SLP Assistant: That /s/ came out the sides of your mouth instead of the front.

Child attempting to say “stop” says “sop”.

Feedback from SLP Assistant: I heard the /s/ but I didn’t hear the /t/

Child says: I left my coat in the locker.

Feedback from SLP Assistant: You remembered to tell me “where”!

Examples of Reinforcement:

Child produces a lateralized /s/

Reinforcement from SLP Assistant: “That was a great try. “

Child attempting to say “stop” says “sop”.

Reinforcement from SLP Assistant: “you are really working hard.”

Child says: “I left my coat in the locker.”

Reinforcement from SLP Assistant: “You finished all your work! Congratulations!!!”

Feedback and Reinforcement Together:

“You forgot to put on the tail sound, but you are sure trying hard!"

"Wow! Every answer was correct! Awesome work!"

But What If . . .?

· A child doesn’t like stickers?

· A child doesn’t like to be touched?

· A child doesn’t care about social approval?

· A child doesn’t want to work unless he gets food or a toy?

Reinforcement is______.

Primary and Secondary Reinforcement

The responses that are reinforcing differ from child to child. There are two main types of positive reinforcement:

Primary:

Secondary:

Schedules of Reinforcement

· After every response

· Intermittent reinforcement.

o Fixed

o Variable

· Real-life Schedule of Reinforcement

o Variable intermittent: Boss says, “Nice job on that contract!”

o Fixed interval reinforcement: Paycheck

Reinforcement Video Match Up

• Watch each video clip. Then select the best description of the demonstrated reinforcement from the choices below.

A. Social reinforcement through imitation

B. Primary reinforcement

C. Social and token reinforcement

D. Progress reinforcement

E. Verbal Imitation of target with social reinforcement

Video 1: ______

Video 2: ______

Video 3: ______

Punishment

· To decrease a behavior, such as hitting

· Might be verbal

o “NO!”

· Might be removal from fun activity

o Time-Out

· Use punishment rarely and cautiously

· Punishment can increase anger or aggression

Behavior disordered

· Severe behavior problems

· District behavioral intervention plan (BIP)

o Problem behaviors

o Appropriate responses

· Follow the behavioral plan throughout the day including during speech therapy

o Chart behaviors

o Know sequence of procedures BEFORE you need them

Training in Positive Behavior Support

To get more information about training in positive behavior support for children with disabilities in Texas public schools, go to this website: http://www.txbehaviorsupport.org/

Child-Led Therapy

• For some children, you will not direct the child’s activities, you will follow the child’s lead.

• YOU are still in charge of therapy because you set the environment to create the learning experiences.

– Goal: verbal requesting or pointing

– Environment: the things the child wants are visible but not accessible without your help (Toys on shelf out of reach or in a clear bag he cannot open himself (e.g., a Ziplock baggie).

Interactions are not power struggles. You are a teacher, not a friend or drill sergeant.

ORDERS vs. INVITATIONS

Orders:

"Clean your room, empty the trash, make your bed, put your clothes in the dryer, feed your dog, brush your teeth, eat your breakfast, put your dishes up, name these pictures, say the /s/ sound,….”

Invitations:

"Do you want to do your work?" or "Do you feel like doing your work now?"

Choices Within Limits

5 Year Old:

8 Year Old:

15 Year Old:

The temptation might be to argue or assert that he will do as you say. A better answer in most cases is to drop the choices down a level.

Empathy

If you don’t empathize, you ______.

If you empathize, you ______.

Empathize and Get the Work Done!

Make them Feel Good

· Act happy to see them!

· Don’t be afraid to deliver honest compliments.

· Be sure compliments are specific

o Don’t say: “You’re such a good boy.”

o Say: “I love how you drew that dinosaur.”

· Specific compliments serve as reinforcers and help them reach therapy goals.

o “You finished every one today!!”

· Even if they miss the target, you reinforce the effort.

o “That was So CLOSE! We just need…”

o “Nice try!” (Be sure to give feedback!)

Don’t forget to compliment children who are exhibiting good behavior!

NEVER Crush a Child’s Self-Esteem

Make sure that you do not belittle or humiliate the child.

“I didn’t hear what you said”

Which answers do you think are the most likely to get the child engaged in the task.

What response might you use?

Which responses should you NEVER use?

Give him Success

· Be sure he is successful (at least partially) at SOMETHING every session.

· Goals, objectives, and activities must be reachable/appropriate for that child.

· Behavior problems occur when a child is asked to do the impossible or the unreasonable.

· Change the task, the level of support, the visual cues or whatever will cause him to succeed.

Give them the level of support they need.

· Picture Cues

· Written words

· Symbols

· First Sound Cues

Reduce the Cues as they are able to succeed without them.

Activity

· Motor research has shown that many children learn best when moving!

· Do NOT expect a child to sit at a table for 30 minutes.

o Let them move!!!!!!! Use it!

· Vary what you do – Don’t expect children to stay with an activity more than 5+ minutes (depending on age).

Visual Cues

· A letter or object can represent a sound

· That cue can help the child associate that with his target.

· Final Consonant Deletion… “tail sound”

To Do List

· SHOW the child what must be done.

o Use Schedule Boards,

o Job Charts

o Check-Off Lists

· Giving the child a visual representation of your expectations helps help him understand the scope of the task.

Manipulate the Schedule

Using a chart that displays the therapy tasks

Having the day’s activities in separate boxes

Having a list the child checks off

Behaviors

What behaviors interfere with therapy??

Which ones can we ignore?

Bottom line: Is the work getting done?

Example: Donald Duck voice

Don’t violate the Code of Ethics: You MUST hold paramount the welfare of the child

· Report neglect & abuse

· Change SOMETHING if he is not achieving the objectives. (Change the task, the materials, the method, the group, the time, etc.)

· Don’t let him hit or hurt you or himself.

Group Therapy

Scheduling

· Must comply with IEP

· Set most effective schedule for the child

· 60 minutes a week

o 10 x 6

o 15 x 4

o 20 x 3

o 30 x 2

o 60 x 1

· More frequent, shorter sessions may be more effective.

Schedules in General

Typically:

· shorter and more frequently for younger and more involved children

· longer and less frequently for older children who can attend well

· cyclical for children who seem to be improving on a goal after we “jump started” them

Therapy Composition

· Pullout therapy – the child leaves his regular classroom for instruction in the therapy room.

· Inclusion therapy – the child’s therapy occurs in his regular classroom.

· Individual therapy – the child is seen by the therapist individually.

· Group therapy – several children participate in the session at the same time, typically 2-6 children.

Advantages and Disadvantages of Group Therapy

Advantages

· opportunity for interactive communication

· opportunity for self-monitoring

· recognition that others have similar problems

Disadvantage

· some children might be held back because others in the group are not progressing as fast as others

· some children require longer response intervals

· some children need more examples or explanations than others.

Group therapy is NOT individual instruction within a group of people, where each child has a turn while the others wait.

Non-Example of Group Therapy vs. Better Example:

See if you found any of the following in the video:

ð The therapist directed comments to both children

ð Both children consistently listened to each other

ð The therapist used stimuli applicable to both

ð Both children made judgments concerning accuracy for themselves and the other child

ð Both children produced words at the same time (in unison)

ð One child began a sentence and the other completed it

ð Both children were actively engaged throughout the session.

ð Learning was taking place for both children.

Successful Group Therapy

· Successful intervention can take place with an entire class, a small group, on an individual.

· Typically, children in a group are similar in age and skill level, though they may have different goals.

· Be sure that you involve all of the children in the group during the entire session

· Make sure you utilize activities in which the children monitor and reinforce each other, serve as models, or listen to see if communicative intent was achieved.

· Select procedures which require the active participation of all members.

· Present a stimulus or ask a question, then pause before selecting the member who will respond. Everyone has to prepare a response.

· Students can take turns modeling responses for other students to repeat in unison.

· Students can also evaluate the performance of another child.

· Students can stimulate progress in each other.

Different Goals, Same Group: