#037: Tips for Success with Literacy-Based Therapy: Later Learners

Hi there, and welcome to the SLP now podcast. Today we are diving into all things literacy based therapy, with a focus on older students. So, in episode four, I talked about how to use books in therapy. I talked about the five step therapy framework that I use, and we did include some ideas for older students in that episode. But we've gotten several requests to really dive into how to use this with older students, so that's what we're doing. It's still the same model. I'll still be going over that, but I'll be focusing exclusively on ideas for older students. And when I think of older students, we move away from picture books, which was a large focus of the episode for presentation. But once students start to get a little bit older, we'll move to texts that are not picture books. They're typically articles.

ReadWorks is my favorite source for those articles. But we'll talk more about that in just a moment. But the literacy based therapy model works best with fiction texts, because then those are an actual story. So, I will use that until my students have a really strong grasp on story grammar. There are so many benefits. Check out my narrative presentation if you want to know more about that, I'll link that in the show notes. So, there are some amazing benefits to teaching story grammar, which is why I use the fiction articles as long as I do. We definitely want to target nonfiction, and I will make that clinical judgment in deciding what is most appropriate for my students, and you'll be able to do the same.

But I really like to use those fiction articles as long as students don't have a very strong grasp on their narrative skills, just because of the broad impact that that has. Once they're doing well with that, I do want to move on. I'm not just going to stick with story grammar, fiction texts, just because I like them. I feel like nonfiction texts are a step up. The syntax is more complex, and the students will really need to be able to read to learn, and a lot of the things that they're learning are nonfiction concepts in social studies and science and all those different subjects. So, that's what we want to jump to once they have the prerequisite skills. And this definitely is not set in stone. That's just what I've seen from my clinical experience. So, that's what we've got.

So, with older students, we're focusing on articles. I'll tell you how to select those articles in just a moment. And then I typically like to start with fiction articles and then move to nonfiction as they demonstrate those skills. So, that's what we've got. And then just taking a step back to, why even use literacy-based therapy. Studies document improved outcomes compared to other approaches. Though, there's receptive vocabulary, expressive vocabulary, narratives, so many different benefits. I'll share some of the citations, and you can definitely email me if you'd like more. And then there was a really cool study by Gillam, Gillam, and Reece in 2012. They provided small group interventions three times a week over six weeks, which is probably a little bit more intensive than we typically do with our students, but it's not so far off. But the purpose of the study was to evaluate narrative intervention that's contextualized or literacy based, versus decontextualized, like using games, drill cards, those kinds of things. And they looked at vocabulary, sentence complexity, social language.

So, these are a lot of the goals that we're working on with our older students. So, they found that students' comprehension and story retell generation skills improve more with that contextualized intervention. And so, contextualized intervention is what this whole approach is about. The framework includes some decontextualized practice. There are some things that are a little more drill based, but they're still based overall on a more meaningful context than just rehearsing those past tense verbs. We are going to do some of that, but we're using targets that are relevant and applicable and that will be used in different steps. So, we'll dive into more of the nitty gritty behind that. But I just wanted to put this out there, because I know we are short on time;we are overwhelmed; there's a lot going on. Why would you invest in trying a new approach if what you're doing feels like it's working?

And so, I just wanted to share that study because it shows the potential benefits that we can see by implementing that kind of approach. So, it could benefit our students, and I'm willing to try anything that will benefit my students. And there's also some other benefits to this as well. Over the years I've built my framework, and I have some really simple materials that I have set up, and I'm able to tackle pretty much any text that comes my way. And I can make it work really well. Having that framework and just that structure to a unit makes it really easy to plan for therapy. It makes it predictable for our students. It gives our students enough exposure to a target in a variety of meaningful ways, whether we're looking at vocabulary, or grammar, or comprehension. It just is set up in a very strategic way that allows our students to make some really nice progress in a meaningful context, which can help with that generalization.

We could potentially make this work if we grab a deck of verbs to work on irregular past tense verbs, I guess we could shape that into the larger context by creating a story using those cards. But it's not as meaningful as pulling the verbs from a story and practicing those targets and then using those verbs to retell the story and then creating a parallel story. And we'll dive into all of the specifics of that in just a moment too. I'm alluding to a lot here. But we can work on past tense verbs and sentence construction and specific vocabulary words and all of that, and then we can shape that into retelling a story, and using those targets in a very meaningful way. And I don't know about you, but my ultimate goal is to be therapeutic in a functional context. I want to be able to teach students the language that they need to participate in the classroom and be successful. And yes, that's the ultimate goal. There's a quote by Gillam and Ukrainetz, 2006, that's a really helpful, and I'm just going to read this off for a second.

So our primary goal with literature based language intervention is not to teach students to read. So, we're not doing literacy, we're doing literature based language intervention. Sorry, that was unquoted there, but quote, “Our goal is to improve the many aspects of language, vocabulary, knowledge, grammatical acceptability, grammatical complexity, pragmatic awareness, phonological awareness, conversation, narration.” That's a lot of skills. That quote influenced the ability to participate in and profit from instruction in the general education classrooms. So, I know that was a lot, but we are giving this really meaningful context to target all of those different skills. I really feel, and I'm not the only one, but we can target pretty much any goal. And if you have any questions, if you're like, “I don't think I can target this goal using literacy based therapy unit,” send me a message, and definitely let me know. Because I'd love to brainstorm with you, because it's just such a meaningful context.

I haven't come across a goal that I can't target in that way. And articulation, when we're at the beginning levels, I want to target that separately if at all possible. But we can still make it work if we need to. And there are different goal areas like that where we just want to get some really structured practice just based on the research. But for all the vocabulary, grammar, pragmatics, social language, phonological awareness, all of those different things, we can really target those very, very effectively using narratives. And this is totally possible. It doesn't have to be a huge headache. It doesn't have to be a huge overwhelm. We're going to break this down in a way that makes a lot of sense. And I've talked to so many SLPs who have started implementing this, and so I've gotten a lot of their questions and their feedback. And so, I've heard a lot, and hopefully I'll be able to share all the different tips and strategies that will help set you up for success.

And I talk about this all the time. So, if there are certain areas that you're not sure about, I'm sure I have blog posts and other podcasts episodes and additional courses that can help break this down even more. But my goal is for this to be a really good starting point. And then I know, if you're feeling like, “Okay, well I read the book, and I don't know what else there is to do,” or, “I spend one session on the unit, and we're good to go,” for me, and we'll talk more about timing as we go through, but these units can last a month. You can spend several therapy sessions really diving into all of these elements and still be fun, and engaging, and have your students experience success and progress and all of those great elements.

So, well we've got this. We can do this, and let's just dive on in. So, before we go into the specifics of the actual framework, I want to share one other framework. Because this is a question that comes up a lot in addition to the, “Okay, I read the book. Now what else do I do?” The other element is, “Okay, I feel like if I'm pulling a tax based on what they're doing in the classroom, or if I'm pulling an actual text from the classroom, I feel like a tutor. I feel like I'm not doing anything.” And that's a common comment or question that I get. And so, Dr. Ukrainetz, who also, if you're wanting to read more about this, her textbook called Contextualized Language Intervention is incredibly helpful. That's where this framework came from. I learned all of the things from her when I was struggling as a CF. So, that's definitely an amazing resource if you want to dive into any of these elements in more detail.

But she has this helpful framework called RISE. And so, they're the four elements that we want to include in our therapy to make sure that we're being therapeutic. And it's just when I'm feeling like a tutor in a session, I go through the RISE framework and I ask myself, am I doing R-I-S-E, and often times if I'm not feeling therapeutic, there's one of these elements that are missing. And it just breaks it down in a way where I can be like, “Oh, okay. So, I need to make sure that I'm doing this.” And then I implement that, and then I feel great. And sometimes it takes a little bit of troubleshooting, but then at least I know where to start. So, RISE stands for R, repeated opportunities; I, intensity; S, systematic support; and E, explicit skill focus.

So, R, repeated opportunities: if a student is going to master past tense verbs, or a vocabulary word, or whatever it may be, they need to have repeated opportunities. A tutor might just say something once or twice if they're going through a vocabulary activity, but as a speech language pathologist, we know that our students need a lot more exposure. That's why they're getting speech and language therapy and they're not seeing a tutor. Your tutor just gives a little bit extra support. We really break things down, and we're very strategic with the number of opportunities that we give.

We also look at I, which is intensity. So, this is typically what we think about when we're writing the student's IEP. We are strategic with how often we see a student and what that looks like. And so, if we have a student who isn't making progress, we might want to look at the intensity. Do they need to be seen more times a week for shorter sessions, or do they need a longer session, one time a week, or do we just need to increase the frequency of sessions overall while keeping the same duration? What will help the student be successful? And where we definitely are careful about, and we're conscious of this decision, we make our best guess when we're writing the IEP, but that's something that we can check in on and do a pulse check if we're not seeing the progress that we want.

Then S stands for systematic support, and this has something that we're really good at. We are always providing scaffolds and cues and all that good stuff. And then E stands for explicit skill target. So, with my older students, I definitely want them to know what we're working on. And Ukrainetz adds, she calls it RISE plus. So, the plus is a student factor. So, with older students this is incredibly important, we want them to be aware of their goals, and we want them to be able to reflect on their progress. So, when I'm setting up an activity, I make sure that I have that explicit skill focus. I show the student the visual; I tell them what we're working on, and they know that's what we're doing. If we're working on complex sentences, I say, “Okay, the goal is to make these complex sentences. That's what our focus is,” and that visual makes that super clear.

Then in addition to that, I want the students to know the why behind their goal. And the way that I do that is anytime I write new goals for an IEP, I have the students fill out goal cards, and then they write their goal in their own words. And then on the back I like to have them write why that goal matters, and why it's important to them. And it's incredibly helpful if it can relate to any of like their personal or career goals. If they want to be a professional football player, or if they want to be a YouTuber. One of my students, one of my third graders, really wanted to be an amazing Dad, which is so sweet. But we can really connect with the students and find out what motivates them, what their goals are, how we can connect with that. And we're working on communication, so it's not hard to make that connection. And that just helps so much with the buy-in, especially if we can involve them in the goal setting process, and think about that ahead of time. It's such a game changer.

But even if you're just trying to implement this now, we can always find a way to connect our goals to what they want to do in the longterm, and if not, we might want to check on our goals. And sometimes it can be super far out, like their career goals, what they want to be in 10 years from now. Or it can also relate to, “I want to be able to pass this class,” or just whatever is meaningful to them. Or I want to be able to talk to my friends and have them understand me. Or I want to be able to ask a girl to the prom and not the plum. Whatever their goal is, whatever their motivation is, we want to have that be at the forefront ideally every session, so we can just keep reminding of that.

So, off that soapbox and onto the steps of the framework. So, we have five steps here. We start with pre-story knowledge activation. Then step two is shared reading. Step three is post-story comprehension. Step four is focus scale activities, and five is a parallel story. And so, before we dive into the framework though, we need to pick the vehicle for this session. What are we going to be talking about? And with older students, this is typically an article. So, I really liked to use readworks.org. It's a free site. It has tons, and tons, and tons of articles. I can always find something that is relevant to what they're working on in the classroom, and a lot of times teachers are using these articles in the classroom as well. You can pull anything from the classroom. If you're working on fiction articles, you obviously want to pick something that's fiction or nonfiction; pick something from a social studies book, or a science book, or whatever it may be.

I personally haven't had as much success pulling from books, because I could spend a whole month on just one little tiny section of a chapter. And I think it's frustrating to the students if the class is going ahead on this whole text, and they're making a ton of progress, and we just keep revisiting this tiny little section. It doesn't feel as redundant and frustrating if it's an article, because we're doing so many things within the article. But I think just the reminder that we're working on that very specific section of the book, it's a little frustrating. If it's a really meaningful section of a chapter in their social studies book, if we want to focus on learning about a specific battle or, I don't know, whatever it may be, I've had a lot of success with that, or any types of articles that they're reading. And so, that's my personal preference. I like to pick something that I can read in 10 minutes or less. So, if I pick something from a book, I pick a small snippet, and I want to make sure that the text has multiple demonstrations of their targets.

And with older students, we're going to be looking at things like compound complex sentences, adverbial clauses, relative clauses, prefixes, suffixes, all of those components. So, I want to be able to see at a glance that the article has the targets that I want. If I really want to work on passive voice, I'm going to pick an article that has some passive voice in it so that it has some demonstrations there. And of course we can create our own targets by manipulating the text. But it's really nice if it is already there. It's just a little bit more authentic and relevant, I suppose.

And so, I personally make cheat sheets for the articles that I use in therapy. So, it just really helps me structure my sessions. I can at a glance see, “Okay. These are all the grammar targets. Here are all the vocabulary.” I can decide within seconds if that's an article that I want to use with that group. And I just end up keeping these cheat sheets and they're easy to access. And then it just makes it super simple when it comes to planning and putting all the elements together. You can totally make your own too, and that's how that works.

So, let's dive into the framework. So, the first step is pre-story knowledge activation. And I think just to illustrate this a little bit more clearly, I'm going to pick an article that I have used in my therapy sessions. So, this is from the March SLP Now bundle, and this is the hiking trip. You can access the article for free on readworks.org. And then I just create companion materials, but you can totally just access the article and use it based on what we talk about today.

So, for pre-story knowledge act fashion, just backing up a second, the hiking trip is an article about. So Devin, the main character, had been waiting all winter to be able to go hiking, because it was snowing and she wasn't able to go. It's finally spring, sorry, he, Devin he, he begged his dad to take him on a hike. And then his dad didn't want to go hiking, because he usually goes with his mom. And so, they encountered some interesting things along the way. So, it's just a story about that experience. So, with pre-story knowledge activation, the unit includes a sheet with some different discussion questions that we can dive into. So, we can talk about, if they've ever been hiking, have they ever gotten lost? Where do they go hiking; what happens in the winter and the spring; why couldn't they go in the winter; all these different types of questions. And I cater this, because I get to know my students, and so I have an idea of what their experiences are, and so I will cater the questions that way.

But it's always surprising what they do and don't know. So, it's a good experience. And I like diving into these types of questions. And this just helps set us up for success. It gives me an idea of what they know and don't know yet. It gives me a pulse on how much exposure they'll need to the vocabulary concepts, because if they don't understand, if they've never been in a forest, and they've never been lost, I don't know. There's just so many different elements that will come into really understanding the story, and building that vocabulary, and all of those different elements. So, that's what we've got there. Some other fun ideas are to watch a video, so about hiking in the forest, or whatever it may be. And I like to call it a virtual field trip, because then it just helps us imagine what that would actually look like. So, we could look at a snowy forest, and we could look out of forest in the spring, and just to build that background knowledge to help understand what happens in the story and why.

And then another thing that I like to do in this pre-story knowledge activation section is take an article tour. So, a lot of the ReadWorks articles have a photo; they have a nice big title. Some of them have a headings. And so, we'll just look at the overall structure of the article and take a guess what it'll be about. And this is a strategy that some of my teachers taught me in high school too. It's a great comprehension strategy to just scope out the article and see what we can find, and just teaching those strategies, to set them up for success when they're tackling different texts, and just helping them to be able to do that on their own.

So, that is step one, pre-story knowledge activation. With older students, I don't do this as much with younger students, but with an older student, it might make sense to pre-teach some of the vocabulary, because I've had a couple of just super salient examples of how important this is. I always tell the story of when I was working with sixth graders and we read a forensic science article. And the first time we read through it, I thought it was super interesting, and they were excited about the concept. But after we just did a rough read through, this was before I used literacy based therapy units and this framework; but I asked them comprehension questions and they had no clue. I just did a little bit of teaching of the vocabulary in the story, like victim, suspect, all of that, and just teaching them a handful of words, their comprehension just skyrocketed. It was amazing.

So, I think using that as a strategy is incredibly helpful, and pre-story knowledge activation, before we dive into the story, is a helpful time to look into those words. And when you're doing the article tour, you can even have the students, you can have them spot-check the article and see if they can identify words that they don't know. Or if we're working on prefixes and suffixes, the cheat sheet that I use has the list of the prefixes and suffixes in the article, so it can just help me, we can start to look at that and notice those as well. So, alluding to what we're going to be doing and step four of the framework. So, that is step one.

Then we have step two, which is shared reading. And with older students, I might have the students read it themselves, read it out loud. I might read it, and we might round-robin read, whatever makes sense. ReadWorks also has recordings for some of the articles. So, sometimes we play that. There's tons of options there. But it's pretty simple. We just read through it. I just make sure that the students are staying engaged. I'll pull out whatever tricks I can to keep them engaged, and it really depends on the group. So, that's why I mentioned maybe there'll be excited about listening to her recording, or maybe they need to round-robin to stay engaged, or maybe I need to read it and continue asking them questions. So, that really depends on the group and the factors there. But it's just a pretty quick read through, not a whole lot going on there.

And then I also want to say, throughout all of these steps, I planned this around my students' goals and I'm very strategic about how I show what I'm doing throughout the unit. I highly recommend checking out the vocabulary and the grammar podcast episodes, because those give a lot of specific strategies that we can use throughout the unit. But for example, just with grammar, I'm being really strategic. I'm recasting the structures that I want the students to use. So, if they give me a simple sentence and I want them to start using more compound sentences, I recast that into a complex sentence, or I'll throw in a relative class, or an embedded clause, or whatever we want to work on. I'll start making those things happen, so that when we get to step four where we're doing some super focused skill activities, then there'll be ready for that.

And, like I said, we might want to pre-teach the vocabulary in step one. We might want to teach just a grammar concept in step one before we dive in. It depends on the group and where the students are. It's not just a, do this then this, then this and this. This is a general framework, and then we get to apply it to our students. So, step one pre-story knowledge activation, potentially adding in a pre-teaching vocabulary, some grammar reviews, whatever it may be. Then two is shared reading.

Three is post-story comprehension discussions. So, with this, the cheat sheets include literal and inferential questions that we can ask. There's also different activity pages with more comprehension activities. And then again, I'm thinking about the student's goals, always recasting, always embedding that vocabulary, asking questions to try and elicit vocabulary, whatever it may be, or asking questions to elicit specific grammar structures. I'll do it all. I'm being very strategic throughout this whole thing. This isn't fluff. This is very intentional use of time, working through skills in a meaningful, embedded way.

So, that's what we do for post-story comprehension discussion. If we're reading a fiction text, I always make a little interactive, story-grammar activity. So, if we are working on a story retell, then I'll ask questions like who has a story about; where did this story happened; when did the story happen. And then, there's different levels of complexity across the story grammar framework. But that's a really great starting place to see how well the students understood the story, versus just asking questions about different details. You think it's a nice way, and then it sets us up for success for the subsequent steps of the framework, which is super helpful.

So, that's what we've got here. And I think having those visuals is incredibly helpful. I put my story-grammar organizers inside the SLP Now membership, but you can easily create your own, make a graphic organizer with the different story-grammar elements. There's tons of research studies that give you ideas for different icons to use. It's a really nice framework that has a lot of evidence behind it. I used to use sticky notes. I would just pull from Google images, all sorts of things, so many options there. And then I think incorporating technology too helps keep our students more engaged. So, that's always a fun thing.

Now the meat of the literacy based therapy unit is step four, which is the focus skill activities. And this is where we dive into all of the different skills. And we can spend quite a bit of time here. So, we work on comprehension in step three. We started working on vocabulary and grammar in step one. If you're looking for ideas for step four, definitely look back at the grammar and the vocabulary episodes. I'll link those in the show notes, which you can find at slpnow.com/37. But there are tons of different ideas and activities in there. So, we start with structure drill practice if that's needed, and then we'll work towards more embedded practice within the step four.

So, for example, if we are working on prefixes, we might do some activities first, and this might have started in step one, but I might have introduced the prefix a little bit. We might've worked looked at identifying the prefix in the text, because that's a really important strategy. If we want them to be able to use prefixes as a strategy to break down unknown vocabulary words, then we definitely want them to be able to identify. Because if we're working on the prefix re, like R-E, read starts with R-E, but d is not a word, or ad. So, we have to work on being able to identify that and actually identify the prefix.

So, we might go through and find some of the examples, then we might pull out some of the words and define them using the skill pack on prefixes and adding them to our vocabulary journal. And then we would start using them in sentences, and just embedding the words that we pulled in a number of different ways, using different activities. And then when we get to step five, then we would continue to use those words as well. Another exam.