1. Challenging current models of intensity of intervention Kara Anderson, M.A. Ellen Kester, Ph.D.Scott Prath, M.A. Region 13 ESC Bilingual SLP Leadership Meeting February 14, 2011

2. The Origins of Our PilotStudy We have large, diverse caseloads that growthroughout the school year.Questions: Is there a more efficient way to serve ourstudents and not sacrifice quality? What are other academic areas doing toimprove services? Can academic models work within theframework of speech pathology? 3. Our Discussion Today Identify successful intervention techniquesand service delivery models. Discuss research on improving clinical services Review results of a clinic camp that tests theseideas for speech-language intervention Apply these successes to the school setting Provide therapy plans for implementingchanges to how you provide intensity ofservices 4. Professional Constraints Location of Service Format of Service (group vs. Individual) Dosage (Frequency, Intensity of Services) Insurance Federal Mandates IDEA Least Restrictive Environment 5. What aspects of our profession influence intervention practices? 6. Improved Language Outcomes Gillam and Loeb, (2010) reported that four components of language intervention were associated with successful language outcomes Intensity Active Attention Feedback Rewards 7. Increased Vocabulary Repetition of Vocabulary words requiresexposure of at least 15 times (Pui Fong, 2010 ) Longer interventions Teaching words through definitions and incontext (Stahl & Fairbanks, 1986) More word encounters Active processing (Baumann et.al, 2003 and A. Graves, 1986) 8. Evidence-based Intervention Techniques Literacy-based intervention Imitation Modeling Cloze procedures Binary choice Expansion Recast Scaffolding 9. Why do we provide services for the amount of time that we currently do? 10. Mixed Results Studies on the following topics found mixedresults Dosage (frequency) Parent implemented vs. clinician administered Classroom-based vs. Pull-out School vs. Clinic (Schooling et. al., 2010) 11. 30/60 minutes twice a week direct service on average 2-4 kids per group Who ever decided on 30 minutes/week ?? 12. Alternative Delivery Models Limited research on group intervention Adults with aphasia Hearing impairments Stuttering Very little address speech & language 13. Alternative Delivery Models Recent Studies found intensity as a consistent factor that contributed to increased language outcomes Gillam et.al (2008) , Loeb et. al. (2009), Tomblin, (2007), Gillam and Loeb (2010) 14. Define Intensity The number of hours of intervention over aspecific time period. (Lovaas) The ratio of adult to children (Graff et. al.) The quality and quantity of services in a givenperiod of time.(Barnett & Escobar) The number of specific teaching episodes perunit of time. (Guralnick)From Ukrainetz et. al. 2008 15. How Much is Necessary? How often should we use therapeutictechniques in a session? Which techniques work best for working onspecific goals? (Ukrainitz, et.al. 2008) 16. Research on intensity-over-time is contradictory Intervention of more than 8 weeks was more effective than less than 8 weeks (From Ukrainitz et.al, 2008; Law et. al, 2004)Contradicted by: Intensive 6 week service delivery model showed 5x the gains as a traditional 2-year service delivery model ( Gillam & Loeb, 2010) Number of delivery hours being equal 17. Study on Intensity Could we do a study of intensity that appliesto a public school population? How does the Bilinguistics pilot study lookdifferent from the Gillam et.al. (2010) than thestudy? How would we create a larger scale study inthe public school setting? 18. Could we alter the frequency and intensity ofspeech therapy and get equal or greater results? 19. Applying a Pilot Study of Intensity to our Field. Gillam StudyBilinguistics Study Individual Group Monolingual English Bilingual population 1:40/day for 6 weeks 2:00/day for 2 weeks Literacy-based, Literacy-based programcomputer program and Children with speech,academic programlanguage, hearing, Only enrolled childrensocial and cognitivewith language disorders enrolled inimpairments program 20. Study Overview The current study will examine the efficacy of a short-term intensive group intervention program for both English and Spanish- speaking children ages 3-8 with all classes of disorders. 21. Methods Participants-6 children per group 2 groups of 3-5 year old bilinguals 2 groups of 3-5 year old English speakers 1 groups of 6-8 year old bilinguals 1 group 6-8 year old English speakers Time Two weeks sessions, 4 days a week Intensity 2 hours a day Disorders All disorders (Autism, speech and language impairment, Down Syndrome) 22. Younger Group-Spanish 23. Older Group-English 24. Results Complete data sets on 13 students (4 Spn, 9 Eng) Standardized testing Narrative language sample Phonological errors Word/utterance errors Type-token ratio MLU Story grammar components 25. MLU in Words English Mean Length of Utterance Spanish Mean Length of Utterance7665544Pre-MLUW3 3 Pre-MLUWPost-MLUW2 2 Post-MLUW1 100ISCL RG BE IG JF NC AC IRAGAA JR KV 26. Total Number of Words English Total Number of Words Spanish Total Number of Words 450400 400350 350300 300250250200Pre TNWPre TNW200150150 Post TNWPost TNW100100 50 50 00 AG AAJR KVISCL RG BE IG JF NC AC IR 27. Number of Different WordsEnglish Number of Different Words Spanish Number of Different Words14010012090 80100 7080 60 Pre NDW 5060 Pre NDW Post NDW 4040 Post NDW 3020 20 10 00IS CL RG BE IG JF NC AC IRAG AAJR KV 28. Number of Word Errors5045English Word ErrorsSpanish Word Errors 304035 2530 202520 15PreWord ErrorsPreWord Errors1510 PostWord ErrorsPostWord Errors105 5 0 0 IS CL RG BE IG JF NC AC IR AG AA JR KV 29. Implications Short-term intensive intervention is beneficialfor speech and language development Children can benefit from intensive groupintervention This could have implication for servicedelivery in the schools 30. How can I adapt therapy to take advantage ofchanges in intensity? 31. 30/60 minutes / week 240 minutes in 9 weeks 6 sessions across four weeks 32. Therapy Planning-Caseload 50 across 2 schools Intensity Students will receive 8 hours of therapy every six weeks Forming groups Groups classified by disorder or age? Alternating schedule 3 groups of 16 students (1,2,3) Each group will have an rotating schedule (a, b, c, d,e) Group are rotated through two week cycles along with alternating daily schedule 33. Therapy Planning-Caseload 50 across 2 schools 1 Rotation of a two week sessionMondayTuesdayWednesday Thursday ARD day8:00-9:00 Group a Group eGroup dGroup c9:05-10:05Group b Group aGroup eGroup d10:10-11:10 Group c Group bGroup qGroup e11:10-11:40 lunch lunchlunchlunch11:40-1240Group d Group cGroup bGroup a12:40-1:40Group e Group dGroup cGroup b1:45-2:45 Flexiblehour 34. Schematic of a Therapy Session Introduction greeting Pre-Reading Reading Post reading Direct Therapy Closing 35. Sample Sessions 1 hour therapy session 2 hour therapy sessionwww.speechpathologyceus.net 36. Future Studies What is next? What would happen across a semester Is the next step in the study. What are the results between disorder classes We saw gains in all but bigger gains in some 37. Dickson, K., Marshall, M., Boyle, J., McCartney, E., OHare, A., Forbes, J. (2009). Cost analysis of direct versus indirect andindividual versus group modes of manual-based speech and language therapy for primary school-age children with primarylanguage impairment. International Journal of Language & Communication Disorders, 44, 3, 369-381. Edgar, D. L., Rosa-Lugo, L. I. (2007). The critical shortage of speech-language pathologists in the public school setting:Features of the work environment that affect recruitment and retention. Language, Speech, and Hearing Services in Schools,38, 31-46. Gillam, R. B., Love, D. F., Hoffman, L. M., Bohman, T., Champlin, C. A., Thibodeau, L., Widen, J., Brandel, J., Friel-Patti, S. F.(2008). The efficacy of Fast ForWord Language Intervention in school-age children with language impairment, Arandomized controlled trial. Journal of Speech, Language, and Hearing Research, 51, 97-119. Schooling, T., Venediktov, R., Leech, H., EB Evidence-Based Systematic Review: Effects of Service Delivery on the Speechand Language Skills of Children From Birth to 5 Years of Age ASHA October 2010 Loeb, D. F., Gillam, R. B., Hoffman, L., Brandel, J., Maruis, J. (2009). The effects of fast forword language on the phonemicawareness and reading skills of school-age children with language impairments and poor reading skills. American Journal ofSpeech-Language Pathology, 18, 376-387. Peters-Johnson, C. (1996). Action: School Services. Language, Speech, and Hearing Services in Schools, 27, 185-187. Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, S., & OBrien, M. (1997). Prevalence of specific languageimpairment in kindergarten children. Journal of Speech, Language, and Hearing Research, 40, 1245-1260. Schooling, T., Venediktov, R., Leech, H.,(2910) EB Evidence-Based Systematic Review: Effects of Service Delivery on theSpeech and Language Skills of Children From Birth to 5 Years of Age ASHA October 2010 Stahl, S.A. & Fairbanks, M.M. (1986). The effects of vocabulary instruction: A model-based meta-analysis. Review ofEducational Research, 56(1), 72-110.Ukrainetz et. al. 2009 Ukrainetz, T., Proctor-Williams, K., Baumann, J., Allen, M., Hoffman, L., Justice, L (2008). How Much is Enough? TheIntensity Evidence in Language Intervention. Presentation at the American Speech Language Association AnnualConvention, Chicago Pui Fong, Kan(2010). Vocabulary Development and Function in Bilinguals: Comparison Across the Life span. Presentation atthe American Speech Language Association Annual Convention, Philadelphia 38. Thank you!Gracias!Thank you UT graduate students Stefanie SorianoJulianna Litts 39. Visit us atbilinguistics.com 40. For more great resources visit our resource library at SpeechPathologyCEUs.net 41. Thank you!