ILO 3 - Lesson 13: Overview of

Management

From the figure you can see that as clinicians we need to consider the
following components:
1. intervention settings and agents.
2. intervention aims and approaches.
3. intervention materials and activities.
4. intervention techniques and strategies.
5. documentation of success.
we will look at each of these components in more detail.
However, it is important at this stage to point out that we may decide to
intervene at any or all the areas of language which we learnt how to assess in
the previous ILO’s:
Semantics (language content)
Morphology and syntax (language structure)
Pragmatics (social use of language)
Lesson Objectives
Name the different management approaches
Listone intervention aim in each of the 3 areas (semantics, syntax/grammar
and pragmatics)
List the service delivery models available to communication therapists
Name some potential intervention agents who we can collaborate with
Today’s Lesson
1. Management approaches: Child-directed, Clinician-directed, Hybrid
2. Intervention aims
3. Intervention strategies
4. Service delivery models
5. Intervention agents with whom we can collaborate
Management Principles (regardless of approach used)
Roth and Worthington (2015) identify a number of basic principles of
effective intervention regardless of client age or disorder. These include:
teaching strategies for facilitating communication rather than teaching
isolated behaviours
provide intervention that is dynamic in nature and includes ongoing
assessment of the child's progress in relation to his or her goals,
modifying them as necessary
provide intervention that is individualized, based on the nature of a
child's deficits and individual learning style
tailor treatment goals to promote a child's knowledge, one step beyond
the current level (Zone of Proximal Development)
Management Approaches
Most language intervention programs under one of the following intervention
approaches:
Clinician-Oriented/Clinician-Directed Approach
Child-Oriented/ Child-Directed Approach
Hybrid Approach
Clinician-Oriented/Clinician-Directed Approach
The clinician selects the goals.
The clinician selects the treatment setting.
The clinician chooses the stimuli.
The clinician chooses the type and schedule of reinforcement.
These approaches utilize behavioural principles such as repeated practice
items/drill and reinforcement/rewards
 Widely used in pre-school and school settings.
Child-Oriented/Child-Directed Approaches
The clinician follows the child’s lead - ‘simply playing with the child’
The clinician utilizes indirect language stimulation
techniques/strategies
The clinician uses more natural, everyday settings and activities to
stimulate language growth
Clinicians use principles from constructivism including scaffolding and zone
of proximal development in their intervention planning
These approaches are typically used with young children or children with
established disabilities
Hybrid Approaches
Similar to the child-centred approach, but the clinician retains some
control over the environment and may set the environment up to elicit
and prompt for certain language forms or targets.
Similarly to the child-centred approach, the hybrid approach is usually used
with young children or children with established disabilities.
Clinicians use principles from constructivism and behaviourism in their
intervention planning
Hybrid approach key strategy: focused stimulation – the clinician repeats a
word or phrase multiple times in a conversation to facilitate comprehension
and possible language production. The child is not asked to respond.
Intervention aims
Language intervention programs can target specific language skills such as:
Semantics (language content, vocabulary)
Morphology and Syntax (language structure/form, grammar)
Pragmatics (social use of language)
OR
Language intervention can be more holistic in nature, targeting a broader
range of language and communication skills such as:
Expressive language skills
Receptive language skills
Long-term Intervention Aims: Semantics
Long-term Intervention Aims: Morphology
To facilitate the acquisition and use of age-appropriate grammatical
morphemes, in particular Brown’s 14 morphemes e.g., auxiliary verbs,
articles, past tense markers, possessive ‘s etc.
To learn irregular past tense verbs e.g. ran, drank, wrote
To learn irregular plurals e.g. feet, geese, mice
To learn key prefixes/suffixes/root words to increase vocabulary.
Long-term Intervention Aims: Syntax
To increase mean length of utterance (MLU)
To increase the complexity of sentences a child understands and can us:
Embedding information e.g. adjectives, adverbs (When? Where? How?)
Combining sentences e.g. The man had a hat. The man sat down. The
man with the hat sat down
Using conjunctions (e.g. The Audiology student was tired because he
went out last night)
To increase the variety of sentence types a child understands and can use
(e.g. declarative/statement, interrogative/question, passive voice)
Long-term Intervention Aims: Pragmatics
To improve a child’s conversational skills, including
initiating and maintaining communication;
turn taking, topic maintenance, and topic shifts;
requesting and making conversational repairs;
To develop a child’s narrative skills
To increase a child's ability to adapt their language use in various contexts
and with various partners
 To increase a child’s ability to use the language that they have to build and
maintain social interactions with others
Intervention Strategies -
Strategies to Target Receptive Language
Modelling – the adult provides the correct model of language. This can be
done through self-talk (‘I am washing the doll’) or parallel talk (’You are
washing the doll’).
Expanding – the adult repeats the child’s utterance while adding additional
information to the utterance. (‘doll’à ‘washing doll’)
Recasts – the adult repeats the child’s utterance but corrects the error (‘he
goed upstairs’ à ‘he went upstairs’)
Build-ups and breakdowns – the child's utterance is first expanded (built
up) and then broken down into grammatical components (break down) and
then built up again to its expanded/corrected form (‘washing doll’ à ‘You are
washing the doll’s leg’ à ‘washing in the doll’ à ‘the doll’s leg’ à ‘You are
washing the doll’s leg’)
Strategies to Target Expressive Language
Vertical structuring and expansion
Vertical structuring = asking questions to elicit information (‘Who is in
the picture?’)
Expansion = expanding the child's response into a well-formed sentence
Prompting – the clinician tells the child what to say: Tell me what you want…
you want to ….? [pointing to the closed lid on the box of blocks]
Time delay strategies – the clinician sets up the environment to elicit
certain targets (i.e. requesting for assistance)
Examples of Time Delay Strategies
False assertions e.g. Pointing to a cow and saying “Look at that elephant!”
Feigned misunderstandings e.g. “You said put it here, right?” (and make a
deliberate error)
Forced choices e.g. “Do you want the [red] car or the [blue] car”
Violating routines e.g. Put a child in the bath without taking their socks off
Violating object functions e.g. Stir a cup of tea with a knife instead of a
spoon
Withholding objects/turns – use sparingly and not if it increases child’s
aggressive behaviour e.g. Withhold the last piece of the train track that the
child is about to complete
 Brief portions/turns aka piece by piece e.g. Put out 3-4 beads (for
necklace) and have the rest in a container out of reach but where the child
can still see them
Service Delivery Models/Options
In addition to determining the goals, activities and strategies for intervention,
SLPs must consider other service delivery variables that may impact
treatment outcomes.
Format: whether a person is seen for treatment one-on-one (i.e.,
individual) or as part of a group
Provider: the person providing treatment (e.g., therapist, trained
volunteer, caregiver, teacher, or peer)
Dosage: the frequency, intensity, and duration of service
Timing: the timing of intervention relative to the diagnosis
Setting: the location of treatment (e.g., home, community-based, school)

Service Delivery Options

In addition to determining the goals, activities and strategies for intervention,
SLPs must consider other service delivery variables that may impact
treatment outcomes.
Format: one-on-one (i.e., individual), pairs, group, class
Provider: the person providing treatment (e.g. therapist, parent, teacher,
peer)
Dosage: the frequency, intensity (session length), and duration (length of
treatment)
Timing: the timing of intervention relative to the diagnosis
 Setting: the location of treatment (e.g., home, community-based, school,
clinic)
Intervention agents with whom we can collaborate
Think about which other professionals would you need to collaborate with
when starting language therapy management with a child.
Need to engage with a variety of intervention agents to ensure carryover of
skills (generalization) targeted in therapy across various contexts and people.
Consultation with various intervention agents will also give you insight into
areas to be targeted in therapy (i.e. the class teacher will give you guidance
as to which vocabulary themes can be targeted to match what is being
covered in class, an OT will give suggestions in terms of correct seating for
the child, etc.)
Potential Intervention Agents
Consider the child and the family’s ability to access intervention services,
who else could you work with to deliver intervention?:
Parents
Caregiver
Class Teacher
Trained Facilitator
Occupational Therapist
Physiotherapist
Psychologist
Extensive Chapter Summary from Textbook
The purpose of intervention is to teach a generative repertoire of linguistic
features; and to stimulate overall language development. The functional
language intervention model involves the inclusion of family members and
teachers as language facilitators. In this way, language is taught in a
meaningful context and the intervention experience closely approximates
patterns of non-impaired language development. In this sense, intervention
is integrative and interactive. The SLP trains communication partners to
modify the contexts that language occurs, to elicit and modify language.
Collaboration between the SLP and caregivers is an important aspect of
intervention.
Principles of intervention:
1. The language facilitator as the reinforcer
 Language intervention should be non-intrusive, and language facilitators
should provide support and evaluative feedback to the child.
Communication partners should reduce the authority-figure persona;
demonstrate attentiveness and willingness to adopt a child’s topics; and
remain accepting while providing feedback. Intervention should be fun,
surprising, interesting, and inviting.
2. Close approximation of natural learning
Intervention strategies should approximate the natural process of
language acquisition, to achieve generalisation (an essential aspect of
the functional model). Communication partners (such as parents and
teachers) act as language models and language facilitators and should
be trained to use facilitative techniques.
3. Following developmental guidelines
Knowledge of typical language development guides the selection of
training targets. Language form typically precedes language function,
and easier, less complex structures are learned first. A SLP should
analyse and monitor progress of trained targets to ensure that a child
possesses the appropriate rules for new learning. Language impairment
is individualistic and often does not follow a typical developmental
hierarchy. Language development is influenced by perception and
cognition; opportunity; needs; and training.
4. Following the child’s lead
It is important that language facilitators attend to a child’s utterance and
respond appropriately. Facilitators can do this by either directing or
maintaining a child’s attention (adult-centred approach), or by attending
to what interests the child (child-centred approach). Child-centred
approaches guarantee joint attention, enhances semantic contingency,
and reduces noncompliance by a child.
5. Active involvement of the child
Active participation of the learner is an important aspect of the
functional model, and of language acquisition. Learning occurs more
rapidly when a child actively participates in an event. This also allows for
greater generalisation.
6. Influence of context on language
Language intervention should occur within the contexts of everyday
events and routines. Language facilitators should create a rich context
whereby the child with language impairment can experience a variety of
linguistic and non-linguistic stimuli and should be supported in their
communicative attempts. Facilitators should be trained to manipulate
linguistic and non-linguistic contexts to attain desired targets.
7. Familiar events providing scripts.
Scripts contain shared knowledge based on common experiences, that
aid and enhance memory and comprehension. Scripts for routine
events/familiar activities provide specific situations whereby children can
learn appropriate language. Scripts can be used to improve functional
communication, and group play.
Designing a generalisation plan:
Generalisation variables include context (the method of training,
language facilitators, cues, contingencies, location of training) and
content (the training targets and training items) variables.
Training targets
It is important to identify the settings, situations, and persons across
which training can occur. Language targets are selected to increase
the effectiveness of a child as a communication partner. The first
goal of intervention should be to successful communication by a
child at their present level of functioning. Language forms should be
taught in a natural setting. Target selection should depend on what
is necessary in the contexts in which a certain child frequently
communicates. To determine this, environmental observation is
required. The environment may need to be restructured to facilitate
the use of newly acquired communication skills. The SLP must
identify the targets as well as the daily environments in which the
targets will likely occur.
Training items
 Enough target items should be trained during intervention to enable
a child to generalise other untrained items. SLP’s should structure
the environment to ensure that linguistic regularities are obvious to a
child. Using target items in different settings ensures that a child
does not identify the SLP and therapy setting as the only contexts in
which those targets should be used, enabling generalisation of such
targets. Functional training should make use of several examples,
several facilitators, and several settings throughout intervention, to
ensure generalisation.
Method of training
Intervention should aim to teach a child the abstract rules of
language by providing the child with organised language data to
illustrate the use of such rules. Structured approaches enhance the
likelihood of generalisation. Interactions between adults and children
can be used systematically in unstructured situations to enable the
child to practice communication. Children learn to communicate
better within a particular context. SLP’s can model behaviours for
caregivers to facilitate the occurrence of situations in which the child
is successful. If desired interactions do not occur, SLP’s can
manipulate the environment. The child’s learning and cognitive style
must be considered for intervention. Routine event knowledge
coupled with a communication-facilitating adult provides the
scaffolding for communication.
Language facilitators
A child’s communication partners provide a strong social base for
intervention and should be involved in intervention. Partners involved
in intervention will depend on the age and circumstance of the child.
Language facilitators must be attentive and responsive to a child;
consistently recognise a child’s attempt to communicate; and
furthermore, provide appropriate responses. Communication
partners must be trained and monitored consistently and thoroughly.
Communication partners must be taught the best teaching
techniques, as well as the goals and materials for intervention. Direct
training and modelling, in service training, and written/illustrated
instructions are all ways in which facilitators can be trained.
 A caregiver’s conversational style is likely to affect the language
development of a child. Caregivers should receive training to adopt a
more facilitative style of conversation. Facilitators should receive
frequent, regular, structured training. Additionally, training should
involve role-playing and critiques to maximise effectiveness.
Family-centred intervention is an approach to intervention whereby
all family members participate in intervention. Families are treated as
valued, equal partners, and engage in all stages of decision making.
Collaboration between the SLP and the family is key to this
approach. Culture is an important consideration, as culture
influences the structure, interaction, function, and life cycle of each
family. The SLP must try to understand each family’s perceptions,
feelings, and concerns.
Families and children from culturally diverse backgrounds
Recognition of cultural contributions by an SLP increases the
likelihood of appropriate and effective intervention. SLP’s need to
consider differing expectations and perceptions of various ethnic
and racial minorities. Mutual respect, trust, and open communication
govern a successful SLP-family collaboration. SLP’s must determine
the cultural belief systems of a particular culture and modify
intervention accordingly.
Training cues
SLP’s must be concerned with the context in which training occurs.
The use of the functional conversational approach ensures the SLP
assesses the effects of certain cues and explores the possibilities of
eliciting language with a variety of linguistic and non-linguistic cues.
Contingencies
The facilitator’s responses to a child’s utterance help form the
context for the child’s utterance. Conversational responses are likely
to maintain communication behaviours. Attending to a child is often
sufficient to maintain a child’s participation. Conversational
responses should be semantically (related in meaning to a child’s
utterance/topic) and pragmatically should make sense within the
conversational framework) appropriate.
Location
The physical location as well as the conversational context of
language should be considered in intervention. Everyday
environments provide natural and familiar stimuli for intervention and
generalisation.