#004: How to Use Books in Therapy

Welcome to the fourth episode of the podcast. I've gotten a lot of questions about how to use books in therapy, so this episode is going to be addressing a couple of different types of questions. Because I know some of you are asking, "Why should I even used books in therapy? Isn't it a waste of time?", or "How do you use them to make the most of the therapy time?"

I've gotten a lot of questions about whether it's better than using drill therapy, and some of you are confused, like how in the world are students going to make progress if you're not doing drill based therapy? So, those are some of the questions that we're going to answer.

And I'm also going to dive into the how, and how it actually can come together, and I'll give you a process on how you can make this happen in your therapy room. So, before we dive into the how and the practical tips, I wanted to take a step back and address some of those first questions, like why even use books in therapy? Isn't it a waste of time, and how does that make sense? But there is so many studies, I won't list them all here, I will link to some different resources that go into a little bit more detail. But there are so many studies that have documented improved outcomes compared to other approaches like the drill based therapy. And they've resulted in improvements for a number of goals, whether it's receptive vocabulary, expressive vocabulary, narratives, all sorts of skills.

There's a lot of evidence to show why he would want to use this type of approach for a number of our students. And I'm just going to highlight one study done by Gillam, Gillam and Reece in 2012. They provided small group intervention three times a week over six weeks, which is, I mean a little bit more than we would normally do, but it's close to what we would see in the schools. The goal of the research was to evaluate narrative intervention that's contextualized or literacy based, versus decontextualized, or using the commercially available games and drill cards. And they were trying to increase students vocabulary, sentence complexity and social language too.

The contextualized intervention used a number of different tactics tied to literature, and then the decontextualized approach they used different games and drill cards. But they found that student's comprehension and their story retell and story generation skills improved more with contextualized intervention when compared to that decontextualized intervention.

Granted, we don't want to go change our entire therapy routine based on one study, but this is one study in the context of a number of studies. So, I think there's some really great evidence in using this approach, but definitely, definitely send your challenges my way. I would love figuring this out and working together to figure out what's best for our students. So definitely send any feedback along.

Just some of the benefits that I found to implementing this type of approach is that, a lot of times we are doing thematic units and especially around a book, and that's the approach that I'll share is using literature in the context of a thematic unit. But it makes for easier planning for us, which we love. It is more predictable for students, which can often make it easier for them to participate and to be able to access the activity, because they're not having to worry about everything else, like decoding and figuring out what's going on. They know the structure of what's going to happen, and then they can focus all of their cognitive resources on learning and implementing these new skills.

It's also an incredibly meaningful context for learning. Even if we just pick a book, students are encountering books all throughout the day, so that's a meaningful context in and of itself. But, if we can find books and thematic units around what they're seen in the classroom or at home, or in their daily lives, it can be so incredibly powerful. And by using these types of units, we're really able to work towards larger goals, so we can target past tense verbs in a more structured approach or at a simpler level towards the beginning of the unit. But then, as we're addressing that throughout the unit in the context of this literature, and in the context of the thematic unit, we can end with the final product where the student is potentially using past tense verbs when telling a story.

So, we're moving from this very simple level, into an incredibly meaningful and relevant context. And so, we're able to target these discrete skills and then integrate and move towards independence throughout this unit. And it's a really great way to, kind of move up that hierarchy in a really meaningful way.

The ultimate goal is really to be therapeutic in a functional context. Because, it doesn't matter if the student can follow 500 step directions in the therapy room if they're not able to use that skill in the classroom or in their daily lives, then there's really no point. We want to help our students achieve meaningful outcomes that will allow them to access their curriculum and participate in the classroom, and interact with peers and connect with everyone in their life. We really want to help students access all of those things so that they can fully participate in their own life, and not necessarily helping us check off boxes in the therapy room.

So our ultimate goal is really to help improve student's language and allow them to participate and profit from instruction in their general education classroom and interacting with peers and all of those meaningful contexts. The good news is that, we can totally do it, it's totally possible. and I know that a lot of you are worried about this. I've talked to so many SLPs. One SLP started using ... I was working through this with her, and she was saying that she read the book with the students, and she wasn't sure what else to do. And that totally makes sense. This isn't something that we really dive into in grad school, and if it's something that feels really new to you, it can be hard to know where to start or what to do, or knowing what will help. So, the goal for this is to really dive in and figure out what will make sense.

And I know a lot of you are worried about it feeling boring. Like, students don't like to read, they love my games, they love playing Ned's Head and Connect Four, and they're not gonna want to read a book. So, we'll talk about some different ways to get through that too. Like I promised, it's going to be so fun. And a big step there, is believing in that too. So, I hope that you walk away feeling like you can make this fun and engaging for your students, and that really starts with you.

If you're having fun and enjoying the process, then your students inevitably will too. And then another concern that I've gotten a lot of is, it doesn't feel like therapy? How is it therapeutic if we are just reading a book and doing what they do in the classroom? Because, that's what they do in the classroom, right? They just read books and kind of talk about them, how is that therapeutic?

So, this is where one of my SLP heroes, Dr. Ukrainet comes in. So she came up with a framework called RISE. And RISE stands for Repeated Opportunities, so R is repeated opportunities. I is Intensity. S is systematic support. And E is explicit skill targets. So, when we're looking at repeated opportunities, if we're trying to help a student learn past tense verbs, they're not going to learn it if we just give them one opportunity to practice. And we definitely want to have multiple opportunities for them to practice those past tense verbs. That's so incredibly important. And I know that this is one concern that a lot of you have in targeting goals in the context of books. Because you know that you'll get a decent amount of repeated opportunities if you use the therapy deck. And it's a little bit harder to figure out how to get those repeated opportunities using a book, but it is totally possible, totally doable. Even if we end up with less opportunities, if they are meaningful opportunities, we're going to get so much more bang for our buck.

And this is especially true when it comes to vocabulary goals, but it applies to all of the different types of goals that we're targeting. We also want to look at intensity. So this is what we think about when we're writing the IEP. We will not make a lot of progress if we see a student once a year, so we want to make sure that the intensity is appropriate to help the students make progress on these goals. So this is why we schedule out students and see then usually on a weekly, hopefully multiple times a week. And I know we have some limitations here in the schools, but as long as you are being strategic with how often you're seeing the student, then we are at least on the right track. And if they're not making any progress, then that's something we may consider changing.

Then, the next component is systematic support. So, this is when we provide all of the scaffolds and queues, and help the student perform whichever skill we're trying to get them to achieve. So, if we're working on past tense verbs, we would do some teaching, and we would provide a visual, we would give them some scaffolded practice, give them some prompts and queues, and all of those different components would come into systematic support. And we'll talk through that a little bit more throughout the presentation.

And then the last component is explicit skill targets. So, the students have to know what we're working on. There has to be an explicit focus on these skills. So this is, if we are working on past tense verbs, we want the student to know that we are working on past tense verbs. They are not going to walk outside of the therapy room and when someone asks them, "What do you do in speech therapy?" They're going to be able to say, "I am working on past tense verbs.", or "I am working on describing.", or "I am working on creating complex sentences." They're going to be able to answer that question, because we have an explicit focus. We're going to make it really clear what we're working on with our students in our therapy session.

And it's also important, there's also the student factors here, so we want our students ... and this ties with explicit focus, but we want our students to be aware of their goals. And then we also want them to be able to reflect on their progress and move towards that. So, we can really use this framework to evaluate, particularly if a student isn't making the progress that we would expect. We can look back at this framework and figure out what we might change in order to address that. So, it's a fabulous problem-solving tool, and it's helped me a ton when it comes to troubleshooting.

So for example, if a student isn't making progress on, I don't know, on their narratives, I might look at how many opportunities am I giving them to create a narrative, or to listen to a narrative. Or, am I giving them enough support, do I have appropriate visuals, so I can really jump through this and kind of come up with some hypotheses in terms of why the student isn't making progress, and then work backwards from there and do some testing to figure out what I can do.

So now, we get to jump into the how. So, there are five steps in my process for using books in therapy. And we want to start with, so we'll do just a quick listing of the five strategies, or the five steps in the process, and then we'll dive into each of them.

So the first is, prestory knowledge activation. Two, we jump into a shared reading. Three, post-story comprehension. Four, focus skill activities. And five, we create a parallel story. And these are some helpful quotes from Gillam and Ukrainet in 2006. They say that story books, language skill targets and focused activities vary within this framework. So, it doesn't look the same every single time. We kind of modify this as we're going through the process. And then, almost any language objective can be taught within this type of literature based language intervention. So, we can target a number of goals.

And if you're struggling with a particular goal, let's do some brainstorming, reach out and we'll figure out how to make it happen. So, before we dive into a unit though, we need to be able to pick a book. And I like to pick books that can be read in 10 minutes or less, and that have multiple demonstrations of the targets that I need to work on. So, this is incredibly important, if we think back to the RISE framework, the R stands for repeated opportunities. So, if we're working on irregular plural nouns and the book doesn't have any irregular plural nouns, then that's not going to be very helpful.

We can sometimes get creative with this. We can kind of come up with our own pleural nouns to imbed in the book. And if there is, I don't know, none in the book, then we can talk about them then, even if they don't write about them in the book. But as you can see, we want to make sure that we're picking a book that's conducive to doing that kind of modification, because that could be a little confusing, depending on the context. So, those are two things that I really like to do. And if you're having trouble picking books, I will link to some different blog posts that give suggestions for some of these different areas, and it's really helpful. I have also analyzed a bunch of different books inside the SLPNow membership, and I bet there are some other resource out there too that break down the books, but I have really benefited from using that.

So, let's hop into the first step. So, step one is, pre-story knowledge activation. This looks a little bit different, depending on the age of the student. A lot of times our students are missing some of the background information. They might not have a schema or any kind of vocabulary around the topic that we're diving into during the unit. So, for example if I live in Arizona and I'm working with a preschooler, and we're reading about Snowmen At Night, that student might have no clue, like she might have never seen the snow. If she's never seen the snow, she probably hasn't built a snowman or she definitely hasn't built a snowman. She might have seen something about it on TV, but we don't know what she knows. So we want to take some time to dive in and talk about snowmen and snow, and what we know about that. First of all, to see what she knows, and if she doesn't know much, there's a couple different things that we can do.

So we can do like a virtual field trip. There's some amazing sites that we can use to really dive into that. And we can look on YouTube and watch a video about a kid building a snowman for example. There's so many different options in terms of videos on YouTube too, there's great stuff out there. For older students, we might fill out a graphic organizer and look at that. We might read something else before we dive into reading. So we might pull a nonfiction book from the library with some beautiful photographs and look through that. We might not do a ton of reading, but we might look through some pictures in a book, or we might look at pictures on Google images and so some discussion around that. We might fill in a graphic organizer to talk about what we know. There's so many different steps that we can take here to first of all, like I said, figure out what the student knows and then to fill in any other information that they might need to access the story.

And I did this with, like there's one example that was super helpful and that made this super salient for me as a clinician. So, I was working with some sixth graders, and we were doing a unit around forensic science, because that's what they were doing in the classroom, and it was super fun. But we just dove into reading, we skipped a step, because I didn't know better at the time. And they were really struggling with, they didn't understand the vocabulary which really impacted their comprehension, and it was very, very challenging. So, I realized this and I took a step back, and we just did some pre-story knowledge activation, talking about what we know about, like detectives and crime scenes, and criminals and all of those different pieces. We mapped that all out. We even did some different role play of different crime scenes to really make that vocabulary more salient, and help make that clearer.

And we spent maybe 10, 15 minutes going through this, but it was amazing to see the impact that this had. So our students are often missing a lot of that background knowledge, and if we can take the time to help them organize what they already know, and then gather some new information, it is so incredibly powerful. Like this was a group of students who previously did not participate in the classroom discussion of the articles. Presumably because they were missing a lot of that background knowledge and they were just struggling with reading in general. But after we did this, they were so much more confident and they participated in the discussion, and I got like raving super excited email from the teacher. And so it just shows how powerful taking the time for this pre-story knowledge activation can be.

And we can get really creative. Like with my preschoolers, when we do a snowman unit, because they don't know anything about snowmen, living in Arizona, like there's this fun little melting snowman Play-Doh thing that I got at target, and that's a fun thing that we can do, it's little more hands on. You can pull some ice, you can get really creative about what you do in this step. But the more engaged the students are, the better. And it might feel like a waste of time, but it is so incredibly powerful, and it can have such a great impact on our students.

So, that wraps up step one, pre-story knowledge activation. Then have step two, which is shared reading. And this is when we read the story with the student, and we can't stop to ask questions. We definitely want to keep the students engaged, we want to monitor their engagement. If they are staring at the ceiling, or taking a nap, we'll want to switch things up a little bit. I like to incorporate some movement, especially with the little ones. So if where are reading about we're going on a bear hunt, we might make some gestures and pretend like we're walking, and we're going over and under, and just having some different movement in there to keep them engaged. But it's mostly focused on the reading.

We might incorporate some questions and some interactive elements, but keep it pretty simple here. If you are familiar with dialogical reading, you could incorporate some of those types of questions. But I usually keep it pretty simple when I'm doing my units. So, that's what we do for step two, shared reading, pretty simple there.

And then for step three, we dive into some post-story comprehension discussion. And this can look different, depending on a number of factors. So I oftentimes do just some general comprehension. Whether they're working on comprehension or not, most of the time if I have a mixed group, there's at least one person working on comprehension. But we're able to use this activity to target a lot of different skills. But we also just want to make sure that they understood what happened in the story before we dive into some of the other focused skill activities.

So I really love, for younger students, a lot of the students I work with at least, really struggle to answer questions, so I like having a field of visual traces, and I've made visuals for, oh I don't know, like over 100 different books at this point. But I have simple WH questions, and then I have a field of three visual choices for the question, and that is super helpful for students struggling with this skill, and it just makes it a little bit more accessible to even our earlier communicators. And it's just a really fun way to scaffold the skill.

Other times, I'll just pull my list of questions and ask just basic literal comprehension questions, inferential questions depending on the students and what they're working on. But that's a really helpful strategy. If I know we're going to be working on narratives, which is a very common goal in my speech room, I love working on narratives and I think it gives them ... because they're using narratives all day long in the classroom and on the playground, and at home, so it gives us a lot of bang for our buck. But I will often ask story grammar questions. So I'll ask questions around the story of grammar of the story. So I might ask who was the story about? Where did the story happen? When did the story happen? And then we will fill in a graphic organizer, and then we can use that in the next activities, which is super awesome. But it's a great double whammy there, because we're able to work on comprehension, but also use that comprehension towards a larger goal.

And then, if you're looking for narrative organizers, there's a lot of different ones out there. And there's a lot of really great evidence around using story grammar. There's been a lot of different studies on using icons to teach the different elements of a story. One example is story grammar marker. They take it a step and have more like tactile icons, and visuals that students can use. So that can be super helpful. I personally just use paper graphic organizer with flat images on it. That has worked well enough. But there's so many options out there, and they're all great tools to work on step three of post-story comprehension.

Then for step four, we dive into some focus skill activities. Now this is one meaty area. We could spend a lot of time here. There's a number of things that we do, depending on what your student's goals are. So you're only going to target things that your students have goals for, because we don't have time to target things just for fun.

And this looks really different, depending on the student, but my go-to items are, I need to make sure that I'm doing teaching before I expect the student to dive into this skill. So I need to make sure that I have activities that I can use to teach. And then, to help bridge that gap, I use those visuals in the context of the book or the text that we're using. So, for younger students, I oftentimes use picture books. For older students, we often use articles. And then, we'll dive into those different skills.

So, for example if the student is working on describing, I will pull out my describing visual or expanding expression tool kit, EET, it is amazing for describing. The students love the different beads and the tactile pieces of being able to move the beads around. And the symbols are super clear and helpful for students, that's one awesome tool. But, we'll do that teaching and then we'll use it in the context of the book. So, if we're working on describing, I might pull my visual and use that. Or if you have the expanding expression tool, EET, we might pull that and describe things in the book. After we've done that initial review, and that I know they've had ample teaching and are able to bridge that gap.

If we're working on compound sentences for example, we might look at the article that we just read, and grab some simple sentences and use different cards or interactive pieces to select the appropriate conjunction. Or I might give them a conjunction and have them build a compound sentence pulling sentences from the text. So I just gave some examples for describing, and for sentences we can also work on summarizing for example.

So we can pull a graphic organizer and work on identifying the main idea of the text. So we'll identify that, and then we'll find the most important details. This is where we can work on identifying relevant details, and irrelevant details, because that's a common thing that my students struggle with when we're working on summarizing. And we just dive in to the different skills based on what they need, and so we'll do that initial teaching, and then we'll dive into context. And we just kind of jump around that.

Because I know this is tricky when you're working on multiple skills at a time. So, if you are working on ... like one student is working on describing, another student is working pronouns, and another student is working on subject-verb agreement for example. You're like, "How in the world do I do this all together?" So, I would take some time to give the students the appropriate visuals and make sure they're good to go. And then we can use the context of the book, the book is the glue for the session. So we can work on all of these skills at the same time using that book.

So, each student has their appropriate visual, we make sure that they're good to go, and then if we're working on describing pronouns and subject-verb agreement, then we can go around and we can look at pictures in the book and create sentences. And we'll work on describing what is happening, using pronouns and subject-verb agreement. So, we can say: He is, so pronoun he, is jumping, subject-verb, far. He is jumping high. He is jumping under. Or whatever we're working on. Or, He is eating a red apple. He is eating a blueberry. He is wearing a red shirt. We can get really creative in the types of things that we're asking our students to do, in targeting multiple goals at the same time.

And I really love trying to come up with different ways to target multiple goals in mixed groups. So I came up with this cheat sheet, that includes a bunch of different types of goals and how to mix and match them. I had a lot of fun making this, on so you can access this at SLPNOW.com/four, and in addition to all of the other resources for this episode.

And I know it's a little bit tricky at first, but I promise it gets easier, and you'll find yourself kind of becoming a ninja at mixed groups and putting together all of these different activities. And it's really amazing, because all of these students are working on skills that they need to be working on, and then at the same time they're getting models from their peers. It's so incredibly powerful. And it empowers the students to help each other, and it's just really cool to see them queuing each other, because there is some level of magic that comes when another student provides feedback, versus when I provide feedback. And this is especially great if they are in the same classroom, because we can teach them how to help each other in a very empowering and friendly, and helpful way. And it's just really neat to see the students gain confidence over the things that they do well.

So I've really learned to love mixed groups for this reason. I think it's so incredibly powerful that we're able to target these skills in a meaningful context, and getting the peers in on it together, it's just amazing and it's so much fun. So definitely check out that resource that helps you kind of start the brainstorm. And if you have questions along the way, just reach out and let me know, I'd love to chat more about this.

So then, on to step five. We're on to the parallel story. And this part is also so much fun, because in step four, we go through the different skills. And we'll circle through the student's different goals, and I'll try and group them in a way that makes sense. Because a student might have like three different goals, and so each of the students have that many goals. And we just cycle through and find the best way possible to mix them up and make that work.

And then when we get to the parallel story, we review the original graphic organizer, if we did the story grammar piece. And that's one that I often do. And if the student doesn't need it, then we don't necessarily have to use that graphic organizer, if they're mainly working on grammar, or if they're mainly working on vocabulary, and they're pretty good at stories overall, then we don't have to do this. But a lot of my students do need that graphic organizer. So we fill it out, in some step throughout the process. And we may revisit it multiple times.

And I just have to mention this too, so if you're working on filling out the story grammar organizer, you're working on answering questions, when the students are answering those question, they are giving grammatically correct responses, so you can target any grammar skills, you can also select books strategically to target specific vocabulary words, so you can work on vocabulary there. It's like really an amazing activity. And this is why I love the parallel story, because it takes it to a whole other level. So, when you're creating a parallel story, you look at your graphic organizer or you just review the story, and then you have the students create a new story. So, something that is parallel to what happened in the story.

So, the example that I give all the time is about Snowmen At Night, this is one that I love to use in my therapy room. But when we read Snowmen At Night in Arizona, we a lot of times we'll end up talking about cacti do at night, pleural for cactus. And then we can make super cute stories about that. Those are some of my favorites. I've done stories for like every book I've read, pretty much. So Giraffe's Can't Dance, we can come up with a parallel story, maybe even about them, about something that they couldn't do. Because Giraffe's can't dance is a story about a giraffe who got made fun of because he was a really bad dancer. And then he ended up learning to dance. And then all of the animals loved him and were jealous. So, we can make a story about how the student overcame a problem, and something that they were made fun of, and that they got really good at, or something that they worked hard at. And we can make a parallel story there. So, it's a really cool way to make connections with the stories and what's happening in their real lives, and it's a really great way to carry over the grammar structures that we worked on, because a lot of those will be very similar. We'll also be able to pull over the vocabulary.

It's such a powerful process. The students love making these stories. We'll just fold some pieces of white paper together, and then I grab some construction paper, and then when they're all done we'll staple it, and we'll pretend like we're publishing it. And they are so incredibly proud of their final product. And just some logistics, a lot of times I will help them write, because that takes a long time. So I'll write, sometimes be pull pictures, sometimes we'll type it up and I'll pull pictures from Google images, and we'll have be kind of a whole group activity and it'll be interactive. That is super fun.

Sometimes we'll make the story on the iPad. Sometimes we'll just make the parallel story in the story grammar organizer. So, there's lots of different options to make this doable. It doesn't have to take five million years to have the students write out their entire story and draw all the pictures. You can get creative in how you structure that. You can have students make a book as a group, or you can have them make books individually. So, whatever makes sense for your students and the group, there's lots of ways to individualize this.

For older students, they are often reading more nonfiction text, so I've modified this to work for nonfiction. I really love having students make their own videos, they love tech. Pretty much every teenager that I've talked to lately wants to become a YouTuber, so they're incredibly engaged in this process. I've made mini movies, I just record it on a tablet or a phone. We've done newscasts. So we'll like record the summary of the story or of the article, they'll pretend to do a newscast, so it's in a slightly different format. We can use to Tunetastic, that's a really funny app, where they can make animations describing what happened in the nonfiction text.

And again, it's such a great opportunity to combine all of the skills that they targeted, and it's something really functional. Maybe they will become a YouTuber. Even if they don't, even if they don't use the tech component of it, they're going to need to be able to use information that they've read and make use of it. Writing they're writing a report in English, whether they are studying for a test and train integrate all of the information, it's such a helpful skill to be able to combine all of those pieces, and then use all the skills that they're working on in a functional context.

Whether it is vocabulary, or syntax or whatever, it's just such a meaningful activity and the students are super engaged, they love it, they love walking away with the final product. Whether they're The littles making their books, or the older kids making videos, or anything in between, they're often super proud of their final product and they want to share it. They're thinking about it, they're talking about it, it's just a really empowering and rewarding process.

So that's the overview of the five step process. Just a quick recap. This is based off of Gillam and Ukrainet's work. It was published in, the version that I'm working off of, was published in 2006. So the five steps are: 1. Pre-story knowledge activation. 2. Shared reading. 3. Post-story comprehension discussion. 4. Focused skill activities. 5. Last but not least, The Parallel story.

So in terms of implementing this in the real world, I'm also going to be sharing a quick graphic organizer or template that you can use to map out your own unit. I strongly encourage you to review this piece. And I'll also include a template that has some different ideas, so it's a little easier and you don't have to keep scrolling through the podcast. You'll have notes and summaries of the different section.

But I strongly encourage you to pick one group. Think of one group of your students, think of a theme that would be relevant for them. List out the goals that you need to target, and then work through the different steps of the process. So, what are you going to do for the pre-story knowledge activation? What do you want to remember for shared reading? What you want to do for post-story comprehension? And just work through the model and plug in those different steps, and make note of any strategies or any activities you want to use. And then, once you've done that, I often get asked how long does this unit last? If you really get into it, and you're really diving into the skills, this can last several therapy sessions. It depends on the frequency that I see the group, but it can't last as long as a month. You can get a good handful of sessions, really diving in to all of these pieces. And it's such a meaningful way to work through these skills.

Students are empowered. They might be struggling to use a certain past tense verb in isolation when they start, but by the end of the unit, they're using it when they're telling a story. And they've gotten so much scaffolded practice along the way, they're really able to perform and show up and use these skills with confidence.

So, it's been amazing to see this in action for my students, and yeah, I hope you try it too. So definitely head to SLPNOW.com/four to access the resources that I mentioned. And I hope to see you next time.