#046: A Crash Course in Scaffolding for SLPs

Marisha: Hi there. Welcome to the SLP Now Podcast. I am so excited to have a returning podcast guest today. Lauren LaCour Haines is going to be talking about all things prompt and cueing, all the scaffolding. I get quite a few questions about this topic. I saw that Lauren presented at her school and her district on this topic. I reached out to her and she said yes. We're going to be diving into all the things scaffolding.

Marisha: Before we do that, I just want to re-introduce Lauren. She is a graduate of Louisiana State University and has been as school-based speech language pathologist in the Baton Rouge area for over 12 years. She serves as an SLP and lead special education teacher at a local primary school. She is also the author of the website, busybeespeech.com. She sells speech therapy-related resources on Teachers Pay Teachers.

Marisha: Today, like I said, we're going to be focusing on prompts and cues. I'm just super excited to dive into this with you.

Lauren: Yeah. I'm so excited too. Thanks for having me.

Marisha: Yeah. The last episode was episode 14 if any of you are listening and are curious. We talked about fluency. That one was definitely a crowd favorite. Extra, extra excited about this one. Before we dive into prompts and cues, I was really curious about ... because I found out about this when you were sharing about your presentation. Correct me if I'm wrong, but I think this was related to, you were giving this presentation because of your role at your school, right?

Lauren: Yes. I am a lead teacher at my school, so I am over all of the special education teachers and the paraprofessionals. Then, twice a year, we have staff development day. On this particular staff development day, I was in-charge of presenting to the paraprofessionals just at my school level. We talked about prompting and we talked about behavior. It was fun.

Marisha: Yeah, that's awesome. I just love hearing what other SLPs do and the different roles that they end up taking on. Thank you for sharing a little bit about that. I know that it sounds like that role includes a lot more than presenting twice a year though, right?

Lauren: For sure. Okay. As lead teacher, I'm responsible for checking all of my special education teacher's paperwork. I have to make sure their IEPs are good to go before we hold the meetings. If they have any kind of procedural questions, I'm the one they go to. I help them write behavior plans for kids. I step in and model different techniques and different ways to handle those challenging behaviors. I'm extremely busy with that all day long. It's almost like two full time jobs in one.

Lauren: The good thing is I do have only half of a regular SLP caseload. I only have about 20 speech kids that I work with. Then, the rest of my time is helping the teachers and the paras and basically putting out a lot of fires.

Marisha: Wow. That's super interesting. I didn't realize that it was, because at first I was wondering like, how does she do all of that? I still wonder because you have a lot of different things on your plate. That's helpful that at least your time is split a little bit so it's not completely impossible.

Lauren: Right. It's a lot easier to write 20 progress reports than 50 so it does help.

Marisha: Yeah, for sure. That is amazing. Because you said that part of the role includes doing some presentations and teaching and really working on that collaboration. This definitely won't be the focus of our chat today, but I know that a lot of SLPs reach out to me about that too in terms of stepping outside of their comfort zones and giving a presentation to a group of teachers or paraeducators or anything like that. I'm curious if you have any quick tips or things that worked for you the first couple times you did that.

Marisha: I mean, it sounds like you've been at this for over 12 years now, so you're definitely further down the road. Any tips for those starting out?

Lauren: Sure. As a lead teacher, I've only been for three years. This is my third year, so I haven't done that role as long. As an SLP, at first, I mean by nature I'm more introverted, more quiet, which is different for SLP. I think a lot of SLPs are very bubbly and try to talk a lot but not me. It took a while for me to gain that confidence, I guess, in myself and in my skills.

Lauren: I had to get to a point to where I was ready to be able to present to a lot of people. You'd have to push yourself. That's one thing I would say. I didn't just want to do it all the time or anything like that, but whenever I stepped into this lead teacher role, I just had to become this other version of myself because I had to do all the things that I wasn't used to doing.

Lauren: For this position, I was basically voluntold, I guess, to be put into this position because our other lead teacher had moved on to a different role and they have asked me to do it. I also have a hard time saying no. I said yes. When I did that, I had to just I guess, put on my big girl pants and just be brave and tried new things. I think it really benefited me in the long run because it made me a lot more confident because other people were depending on me.

Lauren: I guess to a new person I would just say, just find that confidence in yourself and in your abilities and don't be afraid to ask questions and do your research because you do know more than you think you know.

Marisha: Yeah. That was one of my takeaways too when I was navigating talking to teachers in the beginning. Because I really wanted to do, like I always talk about curriculum based therapy and stuff like that. You really need the teacher buy in to optimize what you're doing with that. I was so scared the first time that I talked to the group.

Marisha: Yeah, you put on those big girl pants and make it happen. What came out of it was amazing in terms of the actual results of having that conversation with all of the teachers. It was also really good for me to continue growing as a professional because I definitely ... you prepare for what you're going to share, which solidifies your knowledge. Then just, yeah, putting yourself out there and showing up as the expert and knowledgeable person that you are is pretty amazing. Highly recommended to all the listeners.

Lauren: Yeah. If you step into that role in small ways first, it builds your credibility too. You can offer a lot of suggestions, just one on one with teachers and then maybe join your leadership team, which is what I did before I became lead teacher, they asked me to be on leadership team. So I did. I could give suggestions there which benefited multiple grade levels. Gradually, I built that credibility.

Lauren: People learned to respect my ideas and my opinions because the things that I would share would definitely benefit the kids because we have that expertise in that language.

Marisha: Yeah. Because we're going to be talking about scaffolding so we can scaffold ourselves and maybe first talk about, like teach something or share a strategy with one teacher. Then, as needed, like share it with the whole group and all that. I like it, step by step. Individual small groups, all the good stuff. All right. Perfect.

Marisha: Thank you for taking that little digression there. Let's get into the topic for today, which is prompting and cueing. Can we start out just by defining both of those?

Lauren: Yes. Prompts and cues are strategies that can help the student, but it still increases their learning. A lot of educators, a lot of teachers in SLPs, they'll do this naturally. We automatically will just ask questions and try to help students come up with the answer or learn a task in basically any way we know how.

Lauren: It does help to define what we're doing and to be more purposeful with our interaction. If we know those terms and the differences, I think it helps us as well as the kids in the long run. There's prompting and then there's cueing. They can be different from each other. Though, sometimes, it might depend on who you ask because those terms can be a little bit interchangeable.

Lauren: From my research, prompting is said to be the little more invasive of the two. Prompts are the ones that lead the student to the correct answer more directly. Then, if you're talking about cueing, that's more like a hint or a clue and that typically doesn't give them the answer directly. It's more indirect. Cueing is the one that's more indirect and prompting is the one that's more direct.

Lauren: If it's okay with you today, I might just use the term prompting as the broader term to refer to just any type of assistance because I don't want to keep saying prompt slash cue.

Marisha: That is okay.

Lauren: I know it might bother a lot of people, no, that's a cue, no, that's a prompt. It's just assistance right now. If we're purposeful in the way that we help students and we prompt when necessary and then we prompt as soon as we can. I mean it can really help. That's why I did want to teach the paras at my school about those different ways to prompt as well as the importance of backing off on the prompts.

Lauren: Because we want our students to be as independent as possible and we don't want to overly assist them. That's why you'd rather give them more indirect cues so they can come up with the answer on their own. In general, prompts themselves are not a bad thing. If you do them right, it will not only help them learn but it will aid them in that learning and it won't give them any kind of a crutch.

Marisha: Yeah. I love that distinction. They're definitely helpful. We want to be careful to not over prompt or over cue because that can also hurt in the long run.

Lauren: Yes.

Marisha: Yeah, super helpful. Then, anything else that you want to talk about in terms of why we want to prompt and cue? Or, are we good to start diving into the different types?

Lauren: Yeah, we can talk about why they're beneficial. Sometimes, it's really the only way that a student can learn a skill. You can't expect a student just to know what to do without some kind of assistance. Honestly, we use prompts ourselves whether we realize it or not. When we're in Target, we look up at the aisle signs to help point us to what we're looking for. Then, if we still can't find the item, we ask someone who works there. Then, we even need them to put the item out to us.

Lauren: Then after that, the next time we go into Target, we probably won't need any prompts to find the item because we already know exactly where it is. We'll just go straight there and find it independently. It helps our kids also when they're learning a new skill. If you do want the student to become fully independent, you have to be able to decrease those prompts. You don't want them to become prompt dependent.

Lauren: I wanted to say that on the front side so that you know that's our goal is for them to be independent. Because if they become dependent on those prompts, that could hinder their progress. Fading those prompts is almost as important as giving the prompts. Things that you can do to prevent prompt dependency might be things like rewarding or reinforcing with the prompts first. Then, as they progress, you only reward when they respond correctly without those prompts.

Lauren: This could help the student learn the skills more quickly as well as prevent them from depending on the prompts. That fading is really important. Then what's really essential though is just to make sure that the whole team is on the same page about the prompt fading schedule and the reinforcement schedule.

Lauren: That's one of the main reasons that I wanted to talk to my SPED staff about it because I wanted everyone to know the prompting hierarchy and the importance of trying to say the prompts quickly. Because I have some paras that love to help the students and they mean well but sometimes it can be a little too much. I want them to know how to back off the assistance appropriately. Then, how to reinforce them correctly, the correct way.

Lauren: The only other hand I have like some of my new paras, they still aren't really sure what to do in how to help. They need some general guidance on the different ways that are available to support the students in the classroom they might not know about. Whenever I met with them, we talked about those things a lot. Then, we also discussed IEP accommodations and different types of support we could give during tests and in the classroom and then learning new skills and all that because it's a lot to remember.

Lauren: Especially even to the most veteran teachers and paras, refreshers are important. We had a really good meeting and I'm really happy that we got a chance to talk about all of it.

Marisha: Yeah, that's super helpful. Then, I'm curious too, because I think for SLPs who ... because this is kind of like a dual presentation, I think it's a good overview for us just to take an inventory of the strategies that we're using in therapy. I think, a lot of us, or pretty much all of us do a lot of this automatically. I think it's really helpful to have the terminology when it comes to writing about what we do. I think, what you're sharing today will be incredibly helpful just to have more of a stronger set of vocabulary around describing all the different things that we do.

Marisha: Because there are some pretty nifty terms that you're going to be sharing. Then, I think it's also helpful because you presented this to your parent educators, so I think it'll be helpful because I'm sure you'll present it in a very similar way. SLPs can use this when they are presenting to their teachers or paraeducators to just to help with that conversation as well. I'm really excited about the dual purpose of this.

Lauren: Yeah. It's important for you to have that good framework in your mind so when you share it with others, you're clear. Your whole team can be on the same page and the kids are ultimately the ones that benefit from it the most.

Marisha: Yeah. I love that. I'm really curious too, because we know that you gave a presentation to the paraeducators, but what is the best way or do you have any tips when it comes to communicating the appropriate level of prompting? Once we have that shared vocabulary, what would you do? How would you communicate that? The level of support that Johnny needs with certain tasks, for example?

Lauren: A lot of things will depend on the student and with the skill that we're working on or whatever. I gave them a hierarchy of the different levels of prompting that we use. Then, we talk about like, okay, what have you tried so far? To try to see what level that they're at. Then, we'll go more in depth, in detail of this a little bit later. Since we've already talked about it, I can reference that visual, that hierarchy that I gave them and say, okay, let's talk about the prompts that you're already giving them. How are you helping?

Lauren: I guess that's one thing that I would do. I would use the terminology that we already went over. If they needed more help with that, like if they weren't sure, I would model for them or explain to them or scaffold for them how I would do it.

Marisha: Yeah. I think if we have the opportunity to go into the classroom that could be a good follow up step. Maybe I might model something and tell them, okay, so this is the level that I'm going for. See what you can identify in me. Then, maybe observing them in an activity and be like, where did you think you were at? It's hard to talk about if we're just hypothetical. I think getting super specific could be helpful too.

Lauren: Yes. Okay. Maybe I didn't understand your question. During my presentation, I had YouTube videos.

Marisha: I love it.

Lauren: Yeah. I showed them the different examples of the prompts. I had videos. There's tons on YouTube by the way. If you all ever do any kind of presentation, there's examples of all the different types of prompts. I showed them an example of each one and then after we went over all of them, I had them practice with each other and divide into groups and did groups of two. Then, they had to come up with a scenario and do their type of prompt that they were supposed to be practicing and then they show the group.

Marisha: So smart. I love those ideas. Yeah. There's definitely like, we can use scaffolding here. We can give them the definition first, like explain what we're doing. Then, we can show a video of it. We can have them practice it with a partner and then we could reinforce it in the classroom then.

Marisha: We're being very strategic with our own prompting and cueing with our colleagues. I love that. Because I think we can apply this to any type of skill that we're trying to share with teachers or paraeducators. I'm really happy with this discussion so far. Okay. Are we ready to start talking about the hierarchy and the different types of prompts and cues?

Lauren: Yes. Okay. The prompting hierarchy I use was from The Autism Helper. I think her name is Sasha and she's at autismhelper.com. She has a really nice visual of the hierarchy that they use. There are a lot of hierarchies out there, especially related to ADA and programs like that. I just thought that this lent itself best to a variety of disorders, not just autism that really, because I had paras teachers from that worked with all levels of students.

Lauren: She has that great visual for the most intrusive prompts, which are like the ones that the student would be the most dependent, all the way to the least intrusive, which would be for the student to be the most independent. Obviously, our goal is for the students to be completely independent, but depending on the student and the skills that we might need to teach, we may have to give a lot of support, especially at first. I wanted them to know the different levels and just depending on the kid where they might need to start.

Lauren: I'm going to go over the different types of prompts and I'm going to start with the least invasive or the most independent level, if that makes sense. That most independent level would be the visual prompt. That is a prompt that is a support in the form of pictures or text, photos or even videos. This one is a great way to give support in a way that's natural and it's really easy to say.

Lauren: Examples can be anything from like a sign on the door to a visual schedule. I've also made visuals for the steps of going to the bathroom or completing morning routines for my students. Then, that's for the classroom. Then in speech, of course I use this one like nobody's interest, like visuals are for everything. I have sentence strips for expanding utterances and using correct grammar. I have pictures for WH questions. I made a product on TPC that's like an influencing product that's leveled. It's scaffolded and leveled based on the visual supports.

Lauren: Pretty much, I use visuals for a lot of language skills. It's my go-to way that I level that support. Then, it's super easy to fade because you can just take away that visual. That is visual prompting.

Lauren: Then, the next level would be verbal prompts. That is spoken instructions or questions that provide the student with direction on completing the task. This one can look a lot of different ways and it's probably the most commonly used. I feel like there's a mini hierarchy within verbal prompting because there's a direct verbal prompt, which is when you plainly give them the answer.

Lauren: Then, there's more indirect, which is just giving them more like a subtle hint, not the exact answer. If you want me to, I can dive a little bit deeper into the verbal cues and talk a little bit about that hierarchy with in them.

Marisha: Let's do it. I love it.

Lauren: Okay, good. I did a little bit of research and I saw a study that showed that kids improve their literacy skills when you follow the hierarchy to where you would comment would be like the least invasive, like using a comment. That would be like when you verbally provide that information about the topic or like you model your thinking. You might just say like, "I think frogs like to swim in ponds."

Lauren: You're just kind of giving them a comment when you're reading a book or whatever. Then, the comment would be that first one and then the question. Then, questions would be like, you could ask a open ended question that might give a variety of possible responses. Then, there'd be a closed question, which is like you want them to say a specific response and then like a yes, no question.

Lauren: Then, there'd be like a direction. Like, tell me this, tell me the frog lives in the pond. That was a little hierarchy in itself. It goes from comment to question to direction. Then, there are lots more other indirect prompts that I use, which is like close procedures. That's when you fill in the blank. The SLP might say the first part of an utterance and the child would finish it.

Lauren: You might say, like if we're, I don't know if we're looking at a picture and I want them to label, I could say, "She's putting on her," and they would say shoes or whatever. That would be close. Then, expansions is whenever the student gives a response and then the SLP would expand upon that response using an appropriate grammar and vocabulary. If the student would say something that might be grammatically incorrect, you would just say it in the correct way.

Lauren: If he said, "Him dirty," you might say, "Yeah, he was very dirty." You would just say it correctly expand it to where it was a little bit of a longer utterance. Then, giving choices is also considered a verbal prompt, binary choice. You would give a child a choice between two responses. Where's the dog? Was he in the yard or in the house? Then, there's also modeling and imitation, which as SLPs, we do all the time. We use that strategy for expanding language utterances as well.

Lauren: You would say, "The dog was in the yard, where's the dog?" Then, they would say, okay, yeah, in the yard because you just modeled the correct response. If you recommended sequencing, you could say, what did the boy do next? That might kind of be a little bit more indirect. Then, you could just make your way and get more direction or direct which where you're just saying, okay, what is this? This is a book. What is this? They would have to say book because you told them exactly.

Lauren: A lot of times, I'll use those more direct prompts when teaching WH question to a student who might be really echolalic because they need a lot more direction. I would say, what is this book? Because I want them to say book and not just repeat my question, which is what happens a lot of times when you're working with kids with echolalia. Honestly, verbal prompts can be done a lot of different ways and the possibilities for that one are as endless as languages. That's probably one that's most commonly used I would say.

Marisha: Yeah. I love that breakdown of the different types of verbal prompts and cues that we can give students. I think it can be just having that menu of options I think can be really helpful if a student isn't quite giving it. We can use this information just to help us problem solve a little bit of like, okay, here's what I did. Here's an inventory of the things I did. Then, here's what else I can try. I appreciate that overview.

Lauren: Yeah, you're welcome. We did visual prompt and then right below that one is verbal prompt. Then, the next one is gesture prompt. Honestly, and this is just Lauren talking, but I think that gesture prompting and verbal prompting can sometimes be interchangeable with the level of support, depending on the type of gesture and the type of verbal prompt.

Lauren: They're equally invasive in my opinion, but with her hierarchy that she has, she has the gesture prompt as underneath the verbal prompt. A gesture is when you just give a gesture like you point or you nod or you move to indicate the correct response as you're giving the instruction. This can even be looking at the student expectedly or looking in the direction of the correct answer as a gesture. I do feel like this one's pretty easy to say it as well since you just kind of gradually back off the gesturing.

Lauren: Of course, as SLPs, we will look at students expectantly a lot, especially with our minimally verbal students to give them that hint that we're waiting for them to respond. Another way that I gesture a lot in therapy is by pointing when I'm teaching WH questions. If there's a picture of a mouse driving a car, I might say, who's driving the car? I'm rippling that question. Who's driving the car while I'm pointing to the mouse over and over again. That's one way that I scaffold that.

Lauren: Gesturing can even be as simple as if it's a student's turn to participate, you might make eye contact and nod in their direction for them to take their turn. I feel like I do this one, I use more of that point prompt in therapy when I'm trying to get that direct response from them. Then, just eye contact and nods are more indirect with the gestures.

Marisha: Yeah, that makes a lot of sense. Are we ready for the next one?

Lauren: Yeah. We have visual and then verbal and then gesture. Then, the fourth one is modeling. That is when you show the student what they are supposed to do before they do it. This is the one that we use a ton as SLPs, right? It's when we just show them what to do. If you tell a student to touch their nose, you would touch your nose. Or, if you are teaching a student a new skill, like sweeping the floor and they watch you do it first and then they would try it.

Lauren: I think a lot of classroom teachers I work with use this in writing. They provide the students with a strong model or an example of what strong writing is supposed to look like so that it gives the kids something to go off of. It better prepares them to what's expected of them. That's what they do in the classroom. In speech, we do this all the time with articulation, right? We model the correct productions of sounds mirror. We even pull out a mirror so they can copy our mouth, copy what our mouths are doing.

Lauren: Then, we use that modeling and imitation when we're doing artic therapy a lot. That's when we use. Then, we also encourage paras to use that modeling as well when kids are learning those new articulation skills. That one is modeling. Then, the next invasive one would be a partial physical prompt. This is when you're going in and you're physically guiding the student through the response with a partial physical gesture like a tap or a nudge.

Lauren: In this one, you're still touching the child, but you are giving them minimal physical guidance. If you want the student to touch a certain object, you might move their elbow in the direction of that object. You aren't completely hand over hand helping them at this point. It's a little more subtle. I use this one when I'm teaching simple signs. If I'm prompting the child to sign more and I've already modeled or I know the child knows it, I might tap under their hands to help them initiate the sign to try to get them to sign more.

Lauren: That was that partial physical. Then our last one, the last one on the hierarchy, the most dependent prompt would be the full physical prompt. That is when you go in and you're physically guiding the student through the response of that full physical gesture. You're completely hand over hand basically doing it for them.

Lauren: It might be doing the hand motions to a song within or getting the student to make a sign or maybe even helping the student do a new action. You're trying to teach them. For example, like if you tell the student to clap his hands, you would then take his hands and make them clap. Yeah, this one's the most invasive. You want to fade this one as soon as you can because you don't want them to be dependent on that because they are not mastering the skill at all if you're completing the task for them.

Lauren: Those are all the different types of prompts. We went over from the least invasive to the most. I'm going to go over them again, it's visual then verbal then gesture then modeling then partial physical prompt and then full physical prompt.

Marisha: Perfect. I love that just short and sweet. Lots of examples and just reminding of that hierarchy. I think just having that model to think about is super helpful. Now, let's talk about application a little bit. How do we know when to use which type? Especially, how do we communicate those to paraeducators who don't have ... I feel like it's like a sixth sense of how we do the prompting and cueing. It just automatically happens. How do we communicate that?

Lauren: Yeah. Okay. There are a couple of different ways that you can approach this when you're teaching a student with a skill. A lot of it will depend on the student as well as the skill you're trying to teach. You and your team might have to make some judgment calls and use your knowledge of the student. I'm going to give you a few rules of thumb that you can use to know when to use which type of prompt.

Lauren: Speaking of you and your team, I think, that's part of the way we can communicate this to our staff. It needs to be like they are part of our team. If we go about it as a team approach, like okay, let's talk to the SLP, the special ed teacher and the paraprofessional who are going to be working with this student day in and day out.

Lauren: If you're all on the same patient, you go into it saying, okay, let's talk about how we're going to address this. You come up with a plan together. They feel like they're more involved and then you can also lend your expertise in that area. It does both. It keeps you on the same page as well as the teachers. Then, the strategies they may have forgotten or might not be familiar with.

Lauren: The first approach is when you would go from the least invasive prompt to the most invasive prompt. You use the least intrusive prompt first, which according to our hierarchy would be the visuals. Then, you would go down the hierarchy, adding more prompts only if you need to. If you go back to our target example, that I gave earlier, like I couldn't find my item by using the store signs, so I asked the store clerk to help me and he gave me the directions to find it, which is a verbal prompt.

Lauren: Then, if I still can't find it, he could walk me over and point to the item on the shelf, which would be the gesture. Hopefully, I don't need him to model taking the item from the shelf. I might need him to physically help me if it's out of reach or something. When it comes to our students, it's really the same way. We try visuals and then we give clues with our words and then we might point or gesture.

Lauren: Then, if they still don't get it, we'll model and then partially prompt them physically and then hand over hand if we need to. This is a good approach if you're trying to assess how much of the skill the child can do independently. You might start off using that if you want to see what the kid can do. Then, another benefit to this one is that if the student gets repeated time to respond to the request and more practice time with that skill since you're asking him to do the same thing over and over again.

Lauren: That's going from the least restrictive to the most restrictive. Then, the second approach would be to do the opposite. In this case, you start with the most invasive and work your way up to the least invasive. Depending on the skill, you might start with the full physical prompt and then continually fade the prompts as they learn that skill. If it's a skill that doesn't require physical prompting, like if you're working on answering questions, for example, you can't physically prompt that.

Lauren: You might start with modeling and then work your way back from there. I'll model the example or the answer and then I'll use the gesture and then I'll use verbal cues and I'll use visuals, so you would go back. If you're teaching a student to sign, like if they're trying to teach them to sign more, you might hand over hand the sign when you're first teaching it. Then, you may tap their hands to remind them to sign.

Lauren: Then, soon you might just model the sign when you expect them to use it. Then, they'll imitate you. Then after that, maybe you don't need to do that anymore. You just need to point to their hands or look at them expectantly. Then, you might just even be able to say, "Hey, what do you want?" Or, "Do you need more?" Then, they'll be able to make that sign on their own.

Lauren: This approach is good to use whenever a student is first learning something new. You just want to make sure that you're fading those prompts when you can. Then, I was reading some research and I think it said that this approach resulted in fewer errors and quicker skill acquisition than the other way. I'm guessing it's probably because as long as you're fading those posts quickly, then that one would work better for those fewer errors.

Lauren: Because you're starting off helping them and then you're backing off, backing off, backing off. They know what to do after you show them.

Marisha: Yeah. How did you explain that fading to your paraeducators too? Because I feel like it's just something that I was just trying to think about, like how would I explain that? Because I feel like it's something that we just naturally do to figure out. Did you come up with kind of more of a systematic way to explain that to them or what did that look like?

Lauren: I use with that visual hierarchy sheet from The Autism Helper and then I show them the different levels. If we're fading then we have to back up. If you're physically prompting them, you have be more hands off like on the next try. Then, we have to constantly assess and see where we're at. If they're hand over hand getting a student to try to cut with scissors, you have to eventually try to see what they can do without that.

Lauren: I gave them that hierarchy but then at the same time, I encourage them to back off a little bit. Then, there are some other tips for using these prompts more effectively that I went over with him as well. That was like the first one would be delay your prompting by decreasing that amount of time before you offer assistance.

Lauren: Basically, you would wait a bit before going to that next level of prompting. If you're going the first way, like you might give them a verbal prompt and then wait three seconds before you give them the gesture prompt. They have that hierarchy sheet, but they know you want to give them a chance between those before you go to the next one. You don't want to just automatically assume that they can't do it. You want to give them some good wait time.

Lauren: Then, if they're getting frustrated or whatever then you would step in. If you can constantly decrease and back off and lengthen the amount of time you wait before giving the next prompt just to give them that more independence or try to get them to respond appropriately, then you would do that.

Lauren: You would decrease the amount of time before you offer assistance. Then, you also want to gradually decrease the intensity of the type of prompt you're getting. Within each of those areas, within each of those types of prompts, there's many degrees of intensity that those prompts can be. It's hard to explain or our show unless you're in the moment and you need to see what a kid needs.

Lauren: For example, like if you're doing the partial physical prompt, you want to fade from the wrist and then maybe to the elbow and then to the shoulder, then maybe stand behind them. Then, you can back away entirely. Just that constant trying to back off as much as possible. Or, in the case of verbal prompts, you could start by giving them direct prompt and then on the next target try close or try an indirect prompt. They are constantly learning how to do those things in. It's going to take time, it's going to be trial and error, especially for the newer ones, the newer paraprofessionals.

Lauren: I feel like the ones that have been doing it for a while, they get to see the special education teacher and the classroom teacher and the SLPs modeling these types of prompts all the time. A lot of it might come with experience, but the more you can show them in, the more you can teach them, the easier it will get.

Lauren: Another tip I tell them is to know how to reinforce appropriately to prevent that prompt dependence. Like I mentioned before, you want to praise a child or give rewards that will help the student become more independent. If they are first learning, reward them for completing that task prompted. Then, after you have backed away from that type of prompt, only reward the student, if you're using a star chart or whatever, you would only give them a star for the level of prompting that they're on currently

Lauren: Then, that will motivate them to become more independent and try harder because you don't want them to depend on that assistance. I tell them that. Then lastly, we talked about it's always important to evaluate the effectiveness of the prompt that you're using. You want to use your observations and any data to make sure that the prompts being used are effective for that student. It will also help you determine when you can fade the prompts. It'll help you in a lot of different ways.

Lauren: You want to remember that each child is, and each new skill even, is different. You want to make sure that you're taking really good data and you want to use that specific data to help you make those decisions. You don't want to only rely on your previous experiences with that child or with that prompt with other children beforehand. You want to maybe even do trial runs with levels of prompting and create a plan of action with your team. It's important to take note in your data or tally sheets on what prompts you use and how invasive they were. I feel like if you're teaching your paras to take that data and then to mark that, then they're identifying the level of the promptings that are used.

Lauren: Even if like you are modeling, they could take the data for you and then they could write the prompts that you were using to get more familiar with those types of prompts. Just talking as a team to make sure that you're all on the same page when it just comes to all this prompting techniques is super important. Our teams aren't perfect but we try. I felt like the little presentation that I gave helped them and they had some good things to say about it afterwards too. I felt like empowered them a little bit more to help the kids in new ways.

Marisha: Yeah. I love those tips. I think those are really helpful. I'm curious too, because I feel like every SLP has a slightly different strategy. In terms of how I approached this, like in my therapy sessions and I think it could be helpful depending on what we're working on with the paraeducators. I like to collect just like a quick, like if I'm working on WH questions, the student walks into the session, I like to collect just like a quick little probe with maybe like five, usually five maybe 10 questions just to see where they're at. Then, their level of accuracy independently helps me determine how much support I'm going to give.

Marisha: Because I feel like I was constantly documenting the level of support. I felt like it wasn't totally consistent. This can maybe be like another thing that we talk about. I use that data to decide what types of support I want to give the student and how many of the supports I want to give. Because I think we would respond a lot differently if they're at 20% accuracy versus 70% accuracy.

Marisha: I think that's a strategy that worked really well for me. I love that you mentioned the data part too.

Lauren: Yes. I do the same thing, especially for non artic kids. I kind of like beginning of the session do 10 trials and see where they're at before we start drilling, drilling to see how much modeling or do I need to get up my tongue depressor or whatever had they might need. I do, I love that. Yes, take that initial data. Then, figure out what supports will work for them and where might they be at.

Lauren: If you work from inferences, when you ask them some inferencing questions, what could they do? Then, if you gave them that visual, could they do it? Then, so on and so on. If you took them away or add anything they need to add. Did you need to add more prompting to that?

Marisha: Yeah, no, that's super helpful. Then, yeah, I'm sure that could generalize to the paraeducators too. Or, maybe we could even, if they're helping us, generalize skills that we're targeting, we can let them know how the student did on the probe with us and have that indicate the level of support that they use.

Lauren: Yeah. I do a lot of my therapy pushed in in the classrooms. A lot of times, the paraprofessional is in the room when I'm doing therapy. It's easy to grab, as long as they're not working specifically with another kid or whatever. I can easily grab them and model something for them or show them a new way to support the student. Or, hey, he's been responding really well when I'm giving him these visuals. Next time, can you give him these visuals and see if he can respond a little bit better?

Lauren: That's one thing that's good about pushing.

Marisha: Yeah, that's amazing. Such a good strategy. Then, I'm curious too, because I started to touch on this, but in terms of the documentation, especially if you're working with the team, do you use any kind of template or anything to help document the level of support? Or, have you found any helpful tips there and just making it, I think, teaching and making sure everyone has the same vocabulary to start is super helpful. Do you have any kind of, I don't know, template or anything that you use?

Lauren: I have tally sheets that I use. I use SLP toolkit. On there, there's a little data section. There's a dropdown of the type of prompts that you can use or you can type in notes. That's how I do my speech tallies. Then for the team, like for the SPED staff, everyone, they're allowed to take data how they see fit. I don't want to step on the special education teacher's toes too much with the way that she takes data. I do encourage them to make a note of that support.

Lauren: In the data sheets that I had, I would always put the type of prompt and then the level of prompts. Was it low, medium or high intensity or like a direct verbal prompt or indirect, that kind of thing. I try to be a little bit more specific and so I would encourage them, the paras and the teacher to jot down the type of support that they were using so that whenever another person is working with them, then they would be able to know where to start.

Marisha: Yeah. Perfect. That's awesome. I'm always looking for different ways to document that consistently because I feel like if I say minimal cueing, that's probably something different than ... everyone would interpret that a little differently. I think that's super helpful. I think the shared vocabulary is a huge start. If we can describe what we did using that vocabulary, then I think that's much easier to understand. Just being able to be a little more specific. You would definitely give us the tools to make that more doable.

Marisha: Then, I'm curious too, could we walk through just one more example, because you mentioned your inference as resource, so maybe we could just run through an example there. Maybe like a sample session. Like a student walks in and we're going to work on and for instance today, and so we do a quick probe. Let's say, they're at 20% accuracy. What would we do? What could we do after?

Lauren: Okay, so it depends on the type of inferencing skill. With my students, a lot of times, they have to, in class, they have to answer inferencing questions and then they have to find text evidence. A lot of those inferences, making inferences tasks are text-based. If I'm using a text and I go through my level three or my least invasive, so like just a text and I want you to answer the inferencing question and they're at 20%. Then, I would pull a task that has visuals and the text.

Lauren: For example, the resource that I have, it's three levels. Then, the third level is just text and the second level is text and a picture. I would use that one. Then, we would see where they were at. With that one, if they got a higher percentage or if they were still pretty low, I might back up to just the picture prompt. Because my first level is like just a picture, no text. Can they answer inferencing questions? Because that would tell me, if they still can't answer interesting questions based on just a picture, then it doesn't matter.

Lauren: It's not the texts that's hindering them. It's not the language and the grammar and the syntax and all that that's getting in their way. It's the skill of inferencing in general. You understand? I would have to back up to that level and start there. If they performed a little bit better on the text with the visual, that might just tell, okay, well, they just need some more experience with interacting with the text. They had this visual that support it, so they could use those picture clues. They just need a little bit more experience using text to find, to make that inference or whatever.

Lauren: Then, that would tell me I could stop that that level too and work on that at a little bit higher percentage and then go on to the one without the visuals where they're just using the text. That's how I use that resource and how I would target that, just backing up. Because like inferences, there's no physical prompting but if they could not do it at that level, they would back up to this level and then they would use that visual prompting. Then, I would be using my verbal prompts.

Lauren: If that's not the case, then I will be using my gestures. Then, I would even go down to modeling. This is how we'd make inferences. You would constantly back up and back up until you exhausted all your efforts basically. That's how I would do that.

Marisha: Yeah, that's perfect. I think it's super cool and interesting just to hear how different SLPs approach it. I think it's cool too because we can use our clinical judgment. Starting with the probe, I guess, we can decide if we want to use the least to most or most to least type of approach. If it's the first time we're introducing the skill, maybe we want to start with the most and do a lot of that modeling and all of those pieces.

Marisha: These hypothetical examples are so hard because we're missing like all of the contexts that we use. Yeah, I think, that was a super cool way to put these things together. I think that resource is genius because it makes it so much easier to scaffold a skill that could be tricky to break down like if we just had a text to look at. I love using that in therapy and I super appreciate it.

Marisha: Okay, awesome. Is there anything else that you think is super important to address or any last remarks or things you want to share?

Lauren: I guess we definitely, as SLPs, we don't want to keep these tragedies ourselves. If you have this type of this knowledge and you've gotten some good practice with it, definitely, I would encourage you to share those with your teachers and other educators so that you can provide that, a good support system for your students. I guess that would be my final thoughts.

Lauren: I would just encourage you just to keep at it and talk to your team.

Marisha: Yeah. We just spent almost an entire hour talking about prompts and cues. Because I have been getting some questions about it, but I think if you had asked me a couple of years ago, it's like, yeah, that's just something we do. There's not a talk about it.

Marisha: It's definitely something that we have. I mean we went through a lot at school and we spent a lot of time building that knowledge and building those skills. They're incredibly powerful for our students. Yeah, I completely agree that this is something. Yeah, I think we just take for granted the knowledge and skills that we have. This is definitely a skillset that can really benefit our students.

Lauren: For sure. For sure.

Marisha: Yeah. Thank you for breaking it down in such an easy to understand way. I'll be linking to, you have a blog post about it and then I'll link you to The Autism Helper so that other SLPs or other listeners can find that visual. I'll also link to the inference resource that you mentioned because I think that's a really great example of some of the different strategies that we can use.

Marisha: One last thing, where can SLPs find you if they want to learn more about what you do or just read more about your resources?

Lauren: Yeah, you can find it at busybeespeech.com. That's my blog and my website. I am on Instagram and Facebook at Busy Bee Speech. On Teachers Pay Teachers, I am a Lauren LaCour Haines. If you need to reach out, you can always email me at busybeespeech@gmail.com.

Marisha: Perfect. Thank you so much, Lauren. I so appreciate your time. You are an incredible SLP and blogger and just resource and friend. Thank you so much. Thank you to everyone who listened in today.

Lauren: Thank you so much too.