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#096: How We Approach Clinical Expertise

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This Week’s Episode: How We Approach Clinical Expertise:

Monica and I are continuing to dive into all things evidence-based practice!

We kicked off the month’s series by talking about how the components of EBP have been super helpful for us, and, what we found to be the most challenging about putting it into action.

Last week we focused on the bottom part of the triangle and discussed how to approach internal and external evidence. We provided some tips and some of our favorite resources.

This week we will be talking about the second component of the triangle: Clinical Expertise. Tune in as we discuss the importance of making an honest assessment of the progress your students are making. Is this External Evidence right for my caseload? Can I tailor it to fit my students’ needs?

Remember, trust your clinical expertise. You are your best tool! 💛

Evidence-Based Practice Triangle (EBP):

In this episode of the SLP Now podcast, Marisha and Monica break down their process on how they approach clinical expertise.

Links

– ASHA Practice Portal
– SLP Now Membership
– ASHA: Evidence Maps
– ASHA: Tutorials – Interactive and video resources to help clinicians expand their understanding of evidence-based practice (EBP).

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Transcript

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Marisha: Hello there, and welcome to the SLP Now podcast where we share practical therapy tips and ideas for busy speech language pathologists.

Marisha: Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLP Now podcast. I'm your host, Marisha, and this month, we have Monica Lynn joining us to talk about all things evidence-based practice. So in Episode 95, we did a review of the EBP Triangle, just some of our initial thoughts. And then for the rest of the month, we are going to be diving into the different parts of the Triangle.

Marisha: So without further ado, let's dive in into this week's episode.

Marisha: So Monica, what does clinical expertise look like for you?

Monica Lynn: I think that because I take interns and I supervise CS, I get to see kind of how it looks like for them and some of the difficulties that they have transitioning into learning all of this and trying to balance all of this and kind of comparing brand new SLPs to people who are a little bit more experienced or super seasoned, I think, SLPs, so I think brand new SLPs that don't have a lot of clinical expertise to rely on, they have a lot of that external evidence and internal that they can rely on, but it's just analyzing your data and being able to do what we were talking about.

Monica Lynn: And then to then take that and look at where the kids aren't making as much progress and honing that part of your clinical expertise to know where to make those adjustments, I think, is really kind of what becomes difficult because when you have an entire new caseload, it's like you don't know what type of progress those kids should be making because they're really new to you. So I think that can be hard.

Monica Lynn: And then I think for experienced SLPs, you might use your clinical expertise as a way to look at how can you level up the progress that your students are making? You might have someone who's making awesome progress already, but you just kind of know, you have that clinical expertise and judgment to know that, "You know what? I know that they could be making faster progress" and then it's just pulling all of the different things together to try something. And a lot of times, it's overwhelming to add something new. So a lot of times, I'll just start with maybe a couple students. And then if that new type of thing goes well, and you're just using your clinical judgment to know if this is going well and using some of that internal data too, then I'll do it with my entire caseload rather than changing everything at once.

Monica Lynn: This is also kind of where it's hard too because you're just making a really honest assessment for if your students are making progress or not. And sometimes that's really hard to think, "You know what? I don't feel great about this student because so and so and so," so that can be really hard to kind of look inward and know that you need to do a little bit more legwork, especially during a really busy IEP season.

Monica Lynn: I think it's just made easier by some of the resources that we have nowadays though because even a couple years ago when we didn't have a lot of this stuff, when you really did have to go find one article and figure it out and then kind of have trial and error. I feel like now with some of the things that we talked about or even social media, there's new ideas popping up all the time. It's a lot easier now, but your clinical judgment and expertise is also filtering all of that out which can be really overwhelming as well.

Marisha: I love what you said. If you're a really experienced SLP and your students are consistently making progress, it's worth asking that question, "So they're making progress, but could they be making more rapid progress, or could they be progressing more quickly?" And I love what you said about how that our clinical expertise can be a filter.

Marisha: It gets really interesting to think about how we can turn that off and maybe... I don't know. I wonder what that would look like. Maybe not attending certain courses or not reading certain articles because it doesn't fit with our view?

Monica Lynn: That's so interesting.

Marisha: And it is.

Marisha: I bet we all do a little bit of that. It's like, "How do I do it," right?

Monica Lynn: I sound like clinical fellows. Try not to look at too much social media your first year because you're just trying to tread water, and there's so many new things coming in at you that sometimes it's just... you just need to get that progress going with your students and get to know them and build relationships that sometimes it is. It's really hard to know what to look at.

Marisha: And I bet having students and interns is a great way... if they're asking questions, that's probably a great way to check our filters.

Monica Lynn: For sure. And I know because I tend to talk way too much. If any of them are listening, they're like, "I know." But it's like if you have to explain something, if you can't explain it in a simple way, then you don't have a good grasp on it because you are then kind of not able to put it simply. So I think that's also a great measure of where I might need to look into things a little bit more.

Marisha: No, that's so good.

Marisha: Is there anything else that you wanted to point out when it comes to clinical expertise?

Monica Lynn: Maybe asking teachers and parents. So I tend to do goals that are really functional and will generalize, but I think that you kind of have to know what that generalizing will look like and where you should start that student. And so making goals really is a lot of clinical judgment because you're looking at the student where they are now and where you think that they'll be in a year. And then my district has benchmarks, where you think they'll be in a couple months.

Monica Lynn: And that's pretty daunting to be that portion telling, crystal ball type of situation. But I think that by asking teachers and asking parents what do they look like in different areas and putting that together and making that a part of your clinical judgment can also help, I think, so it's like if in the speech room looks different than the classroom because it's a different setting, making that a part of how you make your goals or what you do with your treatment.

Monica Lynn: I think that starting small, kind of we talked about, and then celebrating how much your students are improving along the way is great, just not being too critical. We're constantly learning. We have so many areas to cover. And I think a lot of us tend to be that Type A perfectionist thing where you want everything to go just right. But it's like our case loads are so varied. We have so much to do. You just need to give yourself a little bit of grace with that.

Monica Lynn: And coming back to you have your activity and your materials, but being critical of it. Just because it says it's EBP does not mean it's EBP because your caseload is different. So that person who made it has a certain thing in mind, but it's really using yourself as that tool to modify it for your students. So it's knowing that you can't just take a product that's out there and do it just the way that it's given. You're going to have to modify it with visuals or the way it's presented or the explicit teaching that you have to do before to really make it EBP, I think, sometimes can be the hardest part, especially when you're new and you're starting out. And if you go to a site and you're new, there are no materials.

Monica Lynn: To then have to get all the materials for your caseload can be really overwhelming which is why SLP Now is great because you just have access to everything, and you're not having to get individual things for everything. That really helps. I always suggest that for new SLPs. It just makes that a little bit less overwhelming, but then being able to look that up and use it in a way that's EBP can be a balance. It can be a struggle, for sure, I think.

Marisha: Absolutely.

Marisha: I just think that's a huge takeaway that a given resource isn't EDP. It's just how we use it, how we implement it, and how we as clinicians incorporate all three parts of the Triangle is what makes that evidence-based which it's a big task. It can be really exciting and fun to tackle.

Marisha: So we've got this. We have the skills that we need, and we'll just going to continue growing and building over time.

Monica Lynn: For sure.

Monica Lynn: Actually, ASHA has a practice portal, so if you get a new kid on your caseload or you have something and you're just like, "I don't even know where to start. Where do I start?" A lot of grad students don't necessarily get a lot of experience with students with apraxia. That's a big one that's very specialized. There is a practice portal that has everything from prevalence to roles and responsibilities, assessment, treatment resources, and you can start there for your external evidence and has a little bit of a guide too for where you might need to use your clinical judgment.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast.

Marisha: If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you.

Marisha: See you next time.

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Core Vocabulary Approach to Speech Therapy

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This is a guest blog post by Monica, a school-based SLP, all about core vocabulary and why it is so important to focus on!

Do you have pre-verbal and non-speaking students, and you’re not quite sure where to start? Core vocabulary is your research-backed answer. In this post, we’ll cover what core vocabulary is, why it’s essential, and how to use it in your therapy sessions. By the end, you’ll have a ton of ideas to support your students! 

If you’re an SLP Now member, there’s a preview of our core vocabulary lessons in this post. They plan everything out and have everything you need in 10 minutes or less of planning and prep time a week.

What is Core Vocabulary? 

Core vocabulary is a treatment approach where you teach words that are general and frequently used.

The philosophy is that if you had to pick a limited set of words to teach a student, you would want words that allow for different communicative intents and for the words to be used across many different situations and environments (Beukelman et al., 1984).

A study done by Fallon (2001) found that core words made up to 89% of a preschooler’s vocabulary. These words are most commonly “pronouns, verbs, prepositions, and demonstratives”. These core words come from studies that compared the most frequently used words in conversation (Banajee et al., 2009, Beukelman et al., 1984). Fringe words (nouns) are the counterpart to core words and not included core word lists, as they are specific to certain situations. 

It’s easiest to think of core words when you pretend you only have a couple of words to communicate. If you wanted someone to cut up your apple, saying “apple” (a fringe word) would not immediately communicate what you wanted. You could gesture cut, but it might not be universally understood. If you said “cut” and handed someone an apple, they would quickly know what you wanted to communicate. You would also use the word “cut” for other things and in different situations. You would not be able to use the word “apple” in other contexts the same way.

Core words are also what get used with an AAC system, both low and high-tech. You see them mostly on the main page. Project Core is a great resource for core boards if you need a place to start. (They also have a lot of free trainings!)

Why is core vocabulary important?

You get early buy-in because these are POWER words that help students to communicate.

You can move beyond requesting to help students voice their needs, make comments, ask questions, interact with others, talk about their feelings, and more. 

Access to core vocabulary is a great way to work on oral and written skills to give students access to academic curriculum that specific vocabulary would not (Witkowski & Baker, 2012).

It’s easy to make EBP. There’s a lot of research-based evidence behind core words.  You can customize word selection for your students and their families. As a clinician, you can make clinical decisions about which words to select and use best practices during your therapy sessions. (Hint: It’s a lot of modeling.) 

Who can benefit from a core vocabulary approach?

You will most commonly use core words with emergent/beginning communicators. 

Check out this resource from Project Core if you want to learn more about emergent/beginning communicators. http://www.project-core.com/beginning-communicators-module/

How do I pick which core vocabulary words to use?

Assume competence and that your student will be able to learn core words. Make sure you make a core board for yourself and staff members to model for your students! You don’t have to start with low-tech, but it’s a low-cost and easily accessible way to start using core vocabulary. 

Don’t choose words based on what would help them be compliant in the classroom. You won’t get student buy-in, and it won’t help to reduce “behavior”. It will take time and patience, but it’s so worth it! You want a variety of core words to express a variety of communicative intents (not just requesting!) and ease points of frustration for the student (Witkowski & Baker, 2012). 

Pick core words to target based on high-frequency use according to research, their setting (Rutherford et al., 2020), and what’s important to the student and their family. 

The Banajee et al., (2009) article is linked here for reference. 

Here’s a great post from Praactical AAC that links to questionnaires to send out to team members when thinking about vocabulary selection. Most words will be core words, but important fringe words should also be included. https://praacticalaac.org/praactical/praactical-resources-vocabulary-selection-questionnaire/

How do I use core vocabulary in my therapy sessions?

Use core boards to model and for your student to communicate with. Honor all communication (unaided and aided), and don’t expect language output (pointing to the word on the core board). Like natural development, it takes many exposures before a child uses new words (Crowe et al., 2021). 

It’s going to take time! Model and give opportunities for language. Point to the words you are saying on the core board as you are saying them. You might have to adjust your sentences to use the core words that are available. Use activities that will allow you to model the core word as many times as possible and allow for opportunities for your student to use that core word (Crowe et al., 2021).

As you model, you are not modeling what you want to hear from the student but the possibility of what language the student could have. It’s very age-appropriate to have silly answers and communicate refusal, so don’t forget to model that in your sessions! Even though you’re modeling a core word, the focus is on language input and increasing different types of communicative intents (model and plan for requesting, commenting, asking questions, etc.). 

Here’s some more information on what it is and free training also from Project Core on modeling! http://www.project-core.com/aided-language-input-module/

Research shows that you need at least 30 models in a session (Binger and Light, 2007).  Stay with me for a lesson plan included with the SLP Now membership that hits 30+ repetitions in one session in less than 10 minutes of prep and planning a week. 

What it look like to use core vocabulary in a session?

Here’s an example of a routine that’s worked well for me with students, mostly preschool to kindergarten, that required different levels of support. For the most part, I follow this routine, but we all know that there are days when we need to mix it up! I am not a huge stickler with the order of the activities, especially if I am going to get more participation by letting my students choose what goes first. Modeling language takes a higher priority for me in my sessions. 

I like to include something with music or a video so we can act out the core word. Adding movement to the mix is always a win! 

A book activity comes next. (Check out this podcast on the importance of AAC and literacy! https://slpnow.com/042-a-crash-course-in-aac-literacy/). 

Last is a play activity that is an opportunity for using the core word that’s less structured. I do a mix of therapist-led and child-led activities.

Here’s a preview of what’s included in the membership that follows this routine!

A video is included for each core word. Each video has everyday activities that use the target core word. The bar on the bottom of the view will let you know when each scene is done so that you can pause and act it out! 

This is a screenshot from the video for the word “go”.

Screen Shot 2021 09 20 at 1.18.26 PM

The book for “go” is We’re Going on a Leaf Hunt. There are activities to go with a book for each core word, with lots of opportunities to work on other goal areas!

 

Screen Shot 2021 09 20 at 1.19.55 PM

Screen Shot 2021 09 20 at 1.22.45 PM

 

The play activity for “go” is a virtual trip to the zoo! Students can “go” see different animals and talk about their trip along the way!

Screen Shot 2021 09 20 at 1.24.00 PM

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The companion packets also include parent newsletters, ideas for targeting different goals, tips for training staff members, and more! The materials are perfect for push-in classroom lessons and also as small group activities. They are super adaptable! 

Last-Minute Tips!

Be flexible. Being a school SLP is always a juggling act! Can you push into free play in the preschool setting and model while you play? 

Include focused interests, and be able to pivot. 

The companion packets give ideas for including focused interests. I always found that it was easier to incorporate favored items and increased participation. 

The membership also has additional core vocabulary activities, including more literacy activities and interactive books. 

I adapt these activities to use for other groups that are not using core vocabulary. That means less planning for me! The videos are great for describing and making sentences, and the book gets used for other literacy-based activities.

 

References

Banajee, M., Dicarlo, C., & STRICKLIN, S. (2009). Core Vocabulary Determination for Toddlers. AAC: Augmentative and Alternative Communication, 19, 67–73. https://doi.org/10.1080/0743461031000112034

Beukelman, D. R., Yorkston, K. M., Poblete, M., & Naranjo, C. (1984). Frequency of word occurrence in communication samples produced by adult communication aid users. The Journal of Speech and Hearing Disorders, 49(4), 360–367. https://doi.org/10.1044/jshd.4904.360

Binger, C., & Light, J. (2007). The effect of aided AAC modeling on the expression of multi-symbol messages by preschoolers who use AAC. Augmentative and Alternative Communication (Baltimore, Md. : 1985), 23, 30–43. https://doi.org/10.1080/07434610600807470

Crowe, B., Machalicek, W., Wei, Q., Drew, C., & Ganz, J. (2021). Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-021-09790-0

Fallon, K. A., Light, J. C., & Paige, T. K. (2001). Enhancing Vocabulary Selection for Preschoolers Who Require Augmentative and Alternative Communication (AAC). American Journal of Speech-Language Pathology, 10(1), 81–94. https://doi.org/10.1044/1058-0360(2001/010)

Marvin, C. A., Beukelman, D. R., & Bilyeu, D. (1994). Vocabulary-Use Patterns in Preschool Children: Effects of Context and Time Sampling. Augmentative and Alternative Communication, 10(4), 224–236. https://doi.org/10.1080/07434619412331276930

Rutherford, M., Baxter, J., Grayson, Z., Johnston, L., & O’Hare, A. (2020). Visual supports at home and in the community for individuals with autism spectrum disorders: A scoping review. Autism, 24(2), 447–469. https://doi.org/10.1177/1362361319871756

Witkowski, D., & Baker, B. (2012). Addressing the Content Vocabulary With Core: Theory and Practice for Nonliterate or Emerging Literate Students. Perspectives on Augmentative and Alternative Communication, 21(3), 74–81. https://doi.org/10.1044/aac21.3.74

 

How to Use ASHA Evidence Maps in your Speech Therapy Continuing Education

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This is a guest blog post by Holly, a school-based SLP, all about how to use ASHA Evidence Maps in your speech therapy continuing education!

ASHA Evidence Maps

Today, we’re talking all about ASHA Evidence Maps! Let’s explore what sets this tool apart from other continuing education resources, why these maps are valuable, and how to use them effectively.

In case you missed it, here is a podcast episode providing a Quick Review of Evidence-Based Practice (EBP) and a blog post discussing the use of PICO Questions in Assessment.

Story Time

Back in 2005, ASHA surveyed its members to find out what kind of resources were being used to make clinical decisions.

Of the respondents, 76% turned to colleagues, 56% relied on continuing education, and 20% reported scholarly journals.

When clinicians were asked about barriers that were impacting their ability to engage in evidence-based decision making, the most common responses were: insufficient time (79%), cost of continuing education (59%), and concerns with the evidence — that it’s lacking (53%), conflicting (48%), or not necessarily relevant to clinical practice (48%).

So if you can relate to at least one of these struggles, you’re not alone!

Enter: ASHA Evidence Maps

If you’re thinking, “That sounds familiar!” but “Honestly, I get all the ASHA EBP-related resources mixed up…” then this next part is for you:

ASHA Evidence-Based Systematic Reviews are released each year by ASHA’s N-CEP along with ASHA members or committees. They feature high-quality external scientific evidence related to different domains of communication.

ASHA Evidence-Based Practice Toolkit is a hub of PDFs, breaking down EBP into a step-by-step process, rather than this big, nebulous buzzword.

ASHA Practice Portal is a database of reference sheets related to communication disorders. This is comparable to how a graduate-level class would break down content related to a certain condition (e.g., Spoken Language Disorders).

ASHA Evidence Maps are searchable, online research summaries that help you navigate the latest information related to the clinical population you work with. These are especially nice for starting broadly and then narrowing down your clinical questions as you go, with lots of ways to customize your search!

The Evidence Maps help break down lots of the barriers mentioned above by centralizing research summaries all in one place for free. Yes please! ✋ Plus, it makes journal articles more accessible by evaluating the quality of the sources and outlining applications to clinical practice.

How to Use Evidence Maps Like a Pro

One of the biggest perks of using the maps is that you can browse through relevant resources, rather than endlessly search keywords. In my experience, it has helped solve the problem of “you don’t know what you don’t know!” since you can start broad and narrow down based on what evidence is currently available in a given map.

Here are some tips to use the evidence maps like a pro:

1. Start with the list of Evidence Maps.

Select a map based on the population you’re working with, such as an area of practice or specific communication disorder.

2. Refine your search.

Focus on a specific Practice Area (Assessment, Screening, Service Delivery, or Treatment). You may also be prompted to filter your findings by Client Characteristics, Age, Condition, Special Considerations, Domains of Communication, Setting, or Publication Date Range.

3. Explore different types of evidence.

You can view All Articles, or focus on External Scientific Evidence (systematic reviews or meta-analyses), Clinical Expertise (clinical practice guidelines), or Client Perspectives (input from clients and their families on services).

You may notice that each map has the most articles under the “external scientific evidence” tab, followed by “clinical expertise” — which is a sign that our field could really benefit from amplifying the voices of the students and families we serve.

4. Enter search terms.

If you need to narrow things down further, add keywords to your search, and voila! You’ll have evidence summaries available at your fingertips.

Now, let’s dive into an example!

The Evidence Map for Spoken Language Disorders includes summaries for 176 different articles, 155 of which are external scientific evidence, 29 are labeled as clinical expertise, and 4 pertaining to client perspectives.

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Let’s imagine I’m seeking continuing education related to language outcomes for secondary students with Down Syndrome on my caseload.

After sifting through the articles, I found a systematic review and meta-analysis by Smith et al. (2020) that looks relevant.

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The Article Summary

Here are some things I would look for in the article summary:

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The Article Snapshot

This includes details about the research question, population, intervention, and studies from the review. In this example, Smith et al. (2020) sought out the common characteristics of effective language intervention for children with Down Syndrome (birth to 18 years).

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Conclusions

This section discusses if and how the approaches from the article are supported by the evidence. This summary suggests interventions (including those with morpho-syntax and phonology targets) can have large gains in language outcomes.

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After reviewing the different pillars of evidence available (e.g., external scientific evidence, clinical expertise, client perspectives), don’t forget the importance of using clinical judgment to see how the evidence applies to a specific client, setting, and situation!

Note: As the literature in our field is in the process of growing, it’s up to us to maximize what evidence is available today!

Ready to give the maps a try? Fill us in on how it goes for you!

If you have any questions along the way, feel free to chime in below 👇

References

Miake-Lye, I. M., Hempel, S., Shanman, R., & Shekelle, P. G. (2016). What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Systematic reviews, 5(1), 1-21.

Mullen, Robert. “Evidence-Based Practice: Opportunities and Challenges for Continuing Education Providers,” American Speech-Language-Hearing Association. Accessed September 2021.

Smith, E., Hokstad, S., & Næss, K. A. B. (2020). Children with Down syndrome can benefit from language interventions; Results from a systematic review and meta-analysis. Journal of Communication Disorders, 85, 105992.

ASHA Evidence Maps Tutorials: YouTube Playlist

#095: How We Approach Evidence (Internal and External)

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This Week’s Episode: How to Approach Evidence (Internal and External)

Monica and I are continuing to dive into all things evidence-based this month for our next podcast series!

Last week we kicked off this month’s series by talking about how the components of EBP have been super helpful for us, and, what we found to be the most challenging about putting the work into action.

This week we will start breaking down the triangle and dive into how to approach internal and external evidence.

I will have to confess, that I just recently started thinking about the evidence as internal and external. It has been a really cool perspective shift for me. Let’s start talking a little bit about what that could look like!

P.S. You’ll want to stay tuned for episodes  96 and 97 where we will discuss Clinical Expertise and Client Perspectives.

Also, for any real nerds out there, we’ve linked a ton of great resources below!

Evidence-Based Practice Triangle (EBP)

In this episode of the SLP Now podcast, Marisha and Monica discuss how they approach internal evidence and external evidence. They break down their process and share tips on how to add evidence to your therapy.

Here’s what we discussed about external evidence:

– How we stay informed and up to date on the current research
– Places to go when you’re looking for external evidence
>> Google Scholars
>> The Informed SLP
>> The Table of Contents Alerts 
>> ASHA Evidence Maps
>> SLP Now Membership – Research Summaries & Academy is included in the membership
– How we use Caseload At A Glance Sheet freebie
– Tips to stay organized

Here’s what we discussed about internal evidence:

– Make sure the evidence is relevant to your population
– Rely on your clinical expertise
– Take informal data to make sure you’re on the right track
– Collect quick probe data and use that information to determine what the treatment will look like
– Make time to put the data away and focus on the therapy and what types of supports are needed
– Strategically use qualitative data (e.g., describing the types of support the student benefited from)
– Use progress monitoring tools
– Make adjustments based on the internal evidence/data

Links

– ASHA: Evidence-Based Practice
– ASHA: The EBP Process
– ASHA: EBP Catalog (blogs, articles, and documents that explain the “why” and “how” of EBP)
– ASHA: EBP Toolkit (a collection of PDFs to guide you as you implement the EPB process for your own clinical questions)
– ASHA: Evidence Maps
– ASHA: Tutorials (interactive and video resources to help clinicians expand their understanding of evidence-based practice)
– SLP Now Membership (a resource including research summaries and courses)

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Transcript

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Marisha: Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLP Now podcast, your host Marisha, and this month we have Monica Lynn joining us to talk about all things evidence-based practice. So in episode 95, we did a review of the EBP triangle, just some of our initial thoughts. And then for the rest of the month, we are going to be diving into the different parts of the triangle. So without further ado, let's dive in into this week's episode.

Marisha: Let's dive into all things, evidence. So I don't know if I missed this in grad school or just forgot about it, but it wasn't until recently, I will have to confess, that I started thinking about the evidence as internal and external. Which was just like, obviously, but it was a really cool perspective shift for me. And so let's just start talking a little bit about what that could look like.

Marisha: Monica, do you want to share a little bit about how you tackle the side of the triangle and what you think about?

Monica: Yeah, so I think it's probably different for me, because I really like reading research articles and if one of my SLP friends is like, do you know about this? I'm like, hold that thought. I know a little bit, but I will find the perfect research article for you, and it's a side hobby for sure. So that might not be the same for everyone. It's kind of like thinking about where do you get it? Where do you go first when you need external evidence? Do you go to Google and type that in? Google scholar is a great thing for that, if you're just looking for research articles, but I think one of the biggest hurdles is justifying something that's easily digestible. Especially you had a full day of work.

Monica: You're really tired and trying to read this research article and get out of it what you need to might be really difficult. So some of the things that I do to get easier external evidence are I have an informed SLP subscription. That's really easily digestible. They have an audio one that I do the most frequently, so monthly and you can just listen to it, and then they have little summaries of them that are the most relevant. So a lot of times I'll listen to it, their monthly one, and then the ones that are really relevant to me, I'll go back and then just read those articles instead of having to read a bunch. I also subscribed to the Table of Contents notification for journals.

Monica: So the one for ASHA, I believe you can go and you can get an email notification every time a new one comes out. And then that way you can scan through all of the new ones that come out and then just read those relevant ones. So for things that come up the most often, so like the areas that I work with the most with my population, I have a folder on my computer that have those so that I can go back and reference those the most. We talked about the ASHA evidence maps. Those are sorted by topics and then the different areas of the triangle. So you can also... They've got a search bar because if you just click on it, there's lots and lots and lots. There's lots to scroll, but you can always search through those.

Monica: SLP Now also has the academy and research summaries, which is where I really started to look because it is a perfect one-page summary for those research summaries. Especially when I need something really quick. A lot of times I feel like we know what we're doing is working and we've learned about it in grad school, we've heard it about it in the CEU, but I just want to double check, just to make sure. And so something that's one page like that has been perfect. And then the academy has also been really awesome to watch with my interns because sometimes I feel like when I am doing things, like we're doing sessions together, like we're talking about little bits and pieces here and there, but it's nice to have everything together where it's comprehensive and then it's also been really great as a talking point. Especially because I've got new, fresh knowledge in grad school.

Monica: And then I learned a lot from them because they've got something that they've been learning in class to connect altogether. So between all of those, I feel like it helps me to really stay up to date on the external evidence in a way that doesn't feel like I have to go search it out myself all the time. So it's been a little bit easier just because our responsibility as SLPs is to stay up to date on the research and to make sure we're doing that, it just feels so overwhelming to do on top of our jobs, that I think it's been an easier way to do it.

Marisha: Yeah. The Informed SLP has been tremendous because they do 99% of the work for us. They scour all of the journals. They pull out the clinically relevant ones and then they help us with the analysis and not all of the journal articles are accessible for free, but it's really nice because they can do that initial legwork for us.

Marisha: And then if we need more context or if we want to use our own clinical judgment and analysis, we can still go to the source. All we have to do is type in the title and we can find it more easily than trying to dig through and find the right search terms and all of that. So that is a huge help. I also subscribe to the Table of Contents for different journals. In the show notes, we'll link to where you can do that and tell you how to do that. But I think that's another cool way to keep up with new articles that are coming out. And it's nice because in the email they just list the name of the article and the authors, and then you can just click there to open them. And I just have a folder where I automatically save those articles and if I don't have time to read it right away, then I just flag the stuff that applies to my caseload.

Marisha: So then I can go revisit it if I need to. So I think that's super helpful to keep up with the current research. I feel like those two combined will give you everything that you need to know on all of the current research. But a lot of times as SLPs, our caseload changes, we move to different settings. So sometimes it is like starting from scratch. And so definitely as a CF too, like I had just gone through grad school. What we learned in grad school was very different than what we need to apply EVP for our caseload, I feel like. So one thing that has been super helpful for me, because it is overwhelming, whether you're a CF or you've been doing this for 20 years, it's a lot of information. I've definitely gotten down on myself, like Marsha, you should keep up with more of the stuff or do more of the things or you don't know what you're doing with this kid or whatever.

Marisha: And obviously I've got my strong foundation and I do my best to keep up with everything, but I think just to take a step back, I really like filling in a caseload at a glance, that just helps me manage my brain a little better. So basically what it is, is just, I just list it by grade. So I have a section for preschool, kindergarten, first, second. And you just put in whichever grades you're working on. And then I go through my students' goals. So let's say I go through the preschool IEPs and you can make it as general or specific as you want. Like if you put phonological awareness, apraxia of speech, or if you want to put specific goals like categories, whatever they're working on, I just start a list. And then if there's multiple students that have that goal, I just add a little tally. If I'm feeling overwhelmed and it's like, okay, this week, maybe I don't have time to read anything this week, but next week I have a little bit of time where I can read one or two articles.

Marisha: I can go back to that caseload at a glance sheet and be like, oh, well I have 10 kids working on this area that I don't feel as good about. So let me focus my energy there. Then you are a little bit more strategic in how you're spending your time versus just trying to fight fires. And I think that's super helpful. And then when I'm trying to build my skills in a specific area, like if I haven't had a kiddo with apraxia of speech in a couple of years, and I have someone on my caseload, that's one case where I would want to go back to the evidence maps and start looking into that. And so that caseload at a glance just helps prioritize it. So maybe there's only one or two kids who have apraxia of speech. If I don't have a lot of knowledge, I'm going to highlight that in red or something or flag that as higher importance.

Marisha: And so that just helps me decide where I spend my time when things are overwhelming. And then I think the evidence maps are super helpful because we want to think about the quality of the evidence. So the evidence maps include a lot of systematic reviews and meta analysis and randomized control trials. So when we're collecting all of this different type of evidence, it's important to keep that in mind as well, because it can get a little bit disorganized if we're pulling all the different sources. And you said you like to use a folder to organize your articles?

Monica: I do. I keep them... I have a folder on my desktop, but I am a paper journal article reader. I can't do it on the computer. I've tried it on an iPad. I just can't do it. So I have a big magazine holder type thing on my desk that I just have them readily available too that are all highlighted and marked up.

Marisha: Yeah. That's super helpful. I have a couple of different ways that I go through articles. Like The Informed SLP, I actually download the PDFs and drop them to my iPad, and then I annotate and highlight there. And then it syncs with my Google drive. If I'm searching for something I can do that. I don't know if most SLPs would want to do this or would benefit from it, but when I was in undergrad, I did a bunch of research and did my thesis and everything. And so I started using a tool called Mendeley. M-E-N-D-E-L-E-Y. I don't think I've ever paid for it, but it's really cool. And I use it now too, because I do presentations and stuff, so I want to keep track of all of my citations and have a nice database to be able to search.

Marisha: I still use it clinically if I'm like, okay, so I'm working with this type of student. Let me pull up the articles that I've read before and get a little bit of a refresher. But it's a really cool tool if you're into the digital organization, it helps us keep track of those pieces. But I think that's important in talking about how we keep it organized and all of that.

Monica: Yeah, for sure. I will definitely have to look into that.

Marisha: One other thing that I was thinking about. So when I attend seminars or watch an online course, at least the quality courses they'll include a list of references and so that can be a good way to like, if there was a presentation that was really helpful, we can go back to the research and look into that as well.

Monica: I do try to keep all of the PowerPoints from presentations if they have it just kind of accessible because sometimes those CEs are really long and it's hard to remember and digest that information.

Marisha: Especially at a conference because they're doing like 20, well, maybe not 20, but a lot of hours of learning and it's hard to process all that. Is there anything that we need to consider when it comes to the external evidence?

Monica: I definitely think so. I think we've talked about how to maybe be critical of the information that you digest, because it might not be super specific to your populations. You can't just take it from that and then apply it straight to your students, but just using all of your grad school knowledge, making sure that it's high quality research, making sure that you're not taking a single case study and applying it to your whole caseload. Also making sure that it's relevant.

Monica: I think that it's a balance between how relevant it is to your population, how high quality it is, and then sometimes the research may not be available for exactly what you want, especially if it is a rare disorder or really complicated case with a kid that has a lot of different support needs. You might not be able to find exactly what you need, so you might have to rely more on your clinical judgment and more on that internal data as well. So I think that's something that we could talk about right now is the internal data, how you do that and then how you use it.

Marisha: That was the perfect segue. So in terms of the internal data, and I don't know if I'm the only person who does this, but especially as a CF when I was like, I'm not sure if what I'm doing is working.

Marisha: If I wasn't feeling confident, I would pull a progress monitoring tool or assessment or something. Like always an informal thing if it was impromptu like that and just give me some data to make sure that this is actually working. So it is a huge for your assurance to me. I spent a lot of time watching courses and reading books and articles at the very, very beginning to help myself feel a little bit more confident. So in terms of how I approached my data, I attended an intensive with Dr. Strand and it was for apraxia of speech, but she talked about how she approaches data collection. And it's really similar to what I'll talk about here, but it just made so much sense when she was teaching that way. So the idea is we do a quick probe, and a probe is just progress monitoring, like a mini snippet of data where we don't give the student support just to see where they're at.

Marisha: And I tend to not write my goals with support because it's just easier to measure. And obviously it's not black and white and there's some in between there, but that's how I typically like to do my probes, if it makes sense. Given our clinical expertise and the other parts of the triangle too. So what I'll do is the students come in, we've got a routine around it, we collect that quick probe data. I know exactly where they stand with that skill. Like if they've retained anything or just like how they're coming in. And then I use that information to determine what the treatment is going to look like. And it's really nice because I just pull up my probes in the SLP Now app. And then I just take the data, super quick, enter that. And then I get to forget about that, put that away and really focus on being the best therapist that I can be.

Marisha: And so how I use that data, for example, if we're working on WH questions and a student achieves 0% accuracy when responding to who questions, I'm going to back up and do some teaching and do some more structured practice before we dive into some more contextualized practice, like answering who questions about a story. So we're going to back way up. But if they're at 50% accuracy, I might jump into the contextualized practice, but just make sure to give them a visual support or do a quick review before we do that. Or if they're at 80, 90, a hundred percent, that'll change the session significantly. I won't give them any support in context, unless they end up needing it. But that's how I use that, whether it's articulation, language, vocabulary, it only takes a couple of minutes if we're super organized, the students know that that's part of the routine.

Marisha: We get that out of the way and then put on our therapy hats. So that's how I approach it. What about you, Monica?

Monica: I think that I'm really similar and I'm glad you brought up Edythe Strand because I got to go to the same one and was just blown away by it. So if you ever had the chance to see her in person, she's just so dynamic, she is such an amazing speaker. So definitely go, but I definitely have the same thing. So I do something very similar. I do SLP Toolkit and I have to take data for every session because of my district and billing. So for those of us out there that do have to, I will take data qualitative and quantitative, and I only take the data that I'll use. So I'm not... Same thing. I'm not taking data the entire session.

Monica: I'll take a little bit of data, pretty much the same as you, take it in the beginning to kind of see where we're at and then focus on the session. And then that way, I can adjust the supports and visuals and everything like that. And then I can just make a note, I'll make a note after about what type of support they needed, just so I know for the next time where they're at. And then definitely the same. I'm a really big fan of progress monitoring. So just using your therapy materials, or if you use something that's similar, but maybe change the story, but you do it in a different way that you're using for different progress monitoring. Like you could use the cube as a progress monitoring tool, or you could use a lot of the SLP Now materials are set up in the same way.

Monica: So it's like, if you do a story with a comprehension task or whatever, then the next time you use a different story for the same type of task and then you're comparing apples to apples, I think is a good way to do it too. But I think that is the best way to check for progress. So it's like, you've made your goal and then now you need to see if you can adjust it because we're making goals for a year. A lot can happen in a year. So if you're looking at your students and halfway through the year, they've almost met it. If you have been doing that progress monitoring, then you know, you can set up the dreaded amendment and redo a little bit of that IEP. But the opposite I think is also true that if you're doing all this progress monitoring, and then you see that that student isn't making as much progress as you expected, then that way a couple of months in, or a couple of weeks in, you can make adjustments rather than waiting for a little bit longer.

Monica: And it's all going to be based on that internal evidence, that data that you're taking. So it's like if you're not getting a great outcome, you're monitoring that and then you can go back up and then change it based on maybe some external evidence that you kind of have in mind for that student and then make sure a little bit more progress is happening.

Marisha: Yeah. And I loved how you mentioned the qualitative data, because I think that's just as important or maybe even more important than the quantitative. Just because I put away my data binder or my data collection system, that doesn't mean that we're not taking data. We're being super analytical and noticing which types of support does the student benefit from? And I think being able to document, oh, the student really benefits from this verbal cue, and this specific verbal cue, this specific visual, and being able to document that and use that in future sessions and reference that is huge.

Marisha: And then if anyone were to transfer speech therapists or whatnot, then they would be set up for success with that. So I think that is huge. I love what you were saying about keeping an eye on the data to see if things are working. And that's one of the really cool things about digital data. In SLP Now, you set your baseline and then you set the goal accuracy. So if their starting at zero and the goal is to be at 80% in a year, it makes this trendline and then you can see if they're following along on that line. And then it makes it really easy. I mean, you see the data every time you go into a session, but it might be cool every month to look at that and be like, okay, this isn't working for this student.

Marisha: What can we do differently? I guess we do that every session really. We're always thinking about that. That's incredibly powerful. And just making sure that we have a way... It doesn't have to be digital, but having a way to see that progress or lack thereof and being able to respond quickly.

Monica: For sure. And I think that really goes along with talking about how you are the therapy tool, because you are constantly analyzing that as you're going through a session. Which is sometimes why it's hard to explain our job because it looks like a simple therapy activity, but really as we're doing it, we're making so many little micro adjustments as the session goes along that takes an incredible amount of skill.

Marisha: Yeah. I could not agree more.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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#094: A Quick Review of EBP

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This Week’s Episode: A Review of Evidence-Based Practice

I am incredibly excited that Monica and I are diving into all things evidence-based this month for our next podcast series!

We are kicking off this month’s series by talking about how the components of EBP have been super helpful for us, and, what we found to be the most challenging about putting the work into action. We will start by reviewing the beautiful triangle, you know which one I’m talking about.

If you’re excited about evidence as we are, then you’ll want to stay tuned for episodes 95, 96, and 97 where we will be breaking that beautiful evidence-based triangle down and discussing each part in full. 🤓

Also, for any real nerds out there, we’ve linked a ton of great resources below!

The Evidence-Based Practice Triangle (EBP)

In this episode of the SLP Now podcast, Marisha and Monica share a quick review of evidence based practice.
Here’s what we discussed:

– How we’ve gotten hung up on one component over others
– How we can use EBP to benefit our practice
– Where do we need to make adjustments? Trial and error is OK!
– When you laminate something and that activity doesn’t work out. Oof! We can find a new approach!
– An activity is not evidence-based. It is what the SLP brings to the table.
– We are our best therapy tools.

Links Mentioned

– ASHA: Evidence-Based Practice
– ASHA: The EBP Process
– ASHA: EBP Catalog (blogs, articles, and documents that explain the “why” and “how” of EBP)
– ASHA: EBP Toolkit (a collection of PDFs to guide you as you implement the EPB process for your own clinical questions)
– ASHA: Evidence Maps
– ASHA: Tutorials (interactive and video resources to help clinicians expand their understanding of evidence-based practice)

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Bonus points if you leave us a review over on iTunes → Those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review, select “Ratings and Reviews,” “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

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Marisha: Hello there and welcome to the SLPNow podcast, where we share practical therapy, tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLPNow podcast. This month, Monica and I are diving into all things evidence-based practice. So we'll start off just reviewing the evidence-based triangle that we've all seen probably 5 million times throughout our graduate school training and through our continuing education. But we're going to talk about that in a way that has been super helpful for us. And then we'll spend the next episodes really diving into each part of the triangle and what that looks like in practice.

Marisha: So, hello, Monica.

Monica: Hey, I am so excited to be here and talking about EBP. It's definitely one of my favorite things.

Marisha: We probably need a nerd alert or something on this podcast.

Monica: I'm sure.

Marisha: Who's excited about talking about the triangle? If you are excited and you're listening in, come hang out with us on social media. On Instagram is probably the best place at SLPNow. Anyway, so we have this triangle and let's do a quick recap of what the three parts of the triangle are.

Marisha: Do you want to walk us through?

Monica: For sure. So the three parts are evidence, so internal and external, clinical expertise and then client perspectives.

Marisha: Awesome. Because I think this will be a really helpful discussion, because I feel like we tend to lean towards one of the pieces of the triangle and it turns into not an equilateral triangle where it's a little bit skewed to one side or the other. And so I know that in my past experience, I've gone really heavily towards the evidence side and then really heavily towards the external evidence, where that was the main thing that I was focusing on. And that's one thing that I think is super interesting to think about, because it's internal and external evidence. So we can even get a little bit skewed in a specific part of the triangle too. Do you feel like you've had something like that too, Monica?

Monica: For sure. I feel like it's the same way. I either go to a CEU or I read an article and I get really stuck on, it has to be this way. But there is so much other stuff, like you're talking about, like the internal evidence and then what I know maybe that particular student needs, based on my time with them. Oh yeah, that's right. I need to also consider their family and how they're doing with that and all the cultural stuff. So it does sometimes then feel overwhelming with how do I connect everything together, even as an experienced clinician?

Marisha: Yeah, absolutely. So we talked a little bit about what we did wrong when looking at the triangle or something that we learned from it. So let's chat a little bit about what it could look like or how we can use it to benefit our practice.

Monica: So I feel like maybe even using a real life example might be where to start. For me, it almost is like if I had a mixed group in school, SLPs were always having mixed groups. So if I had one and by some stroke of luck, I was able to just get my speech sound kids together, even between that speech sound group, I might have an articulation kid and a phonology kid, but doing EBP, I'm not going to do the same approach with those kids. So the articulation one and the phonology one, I know I'm going to need a lot of trials, but one might need more phonological awareness than the other one. The phonological student, I might have to use a certain treatment approach because of the way their errors are. But then the one with articulation, the research external has shown that I need to really have a certain type of prompting to really have that motor focused approach with them.

Monica: So, you might have the same activity, but it's not your activity that's research-based, it's the method that you are using for each student that you've used your external and internal data with the progress monitoring that you're doing with them to figure out the best approach for each student, even if you're using the same activity for them, you're using that whole approach together, that EBP triangle to figure out what you're doing with each student. And then with the things that you sent home, or even your target list, you might've asked the teacher or the family for some functional word targets, especially if you're using a core word approach. And then if somebody came into your room, you look like you're doing one activity with two students. You have this whole entire process where you've narrowed down different things.

Monica: They're just supposed to look really seamless, but it is a process and it does, I think take a lot of time to make that a smooth thing. And sometimes it's not. That's the other part of the EBP triangle as well, I think, is that sometimes you try something and they're not making as much progress. And then you have to try something else and maybe re-examine that triangle again. Where do I need to make some adjustments in that?

Marisha: Yeah. I love that. There are two things that really stood out to me. You can't see this, but I've been bopping my head all the time, just nodding a lot. Yes, Monica, you got this. I love that what you mentioned about activity is not evidence-based. So we can have the most beautifully researched protocol with 5 million randomized controlled trials and meta analysis supporting it. Just because we're using that doesn't mean that it's evidence-based. It could be completely not evidence-based. There's a lot of external evidence there, but there's not the internal evidence.

Marisha: We're not using our clinical expertise and considering the client perspective. There isn't an activity, it's what we bring to the table. And I always say that you are your best therapy tool and really our brains, because it is a lot of work managing all of those different pieces. And it's no wonder that we're tired at the end of the day, thinking about all these things, because there's a tremendous amount of things going on. And I also really loved what you said about it being trial and error. We're supposed to stumble a little bit, as we figure out the ideal combination. I've definitely put on my blinders at times where it's like, this is what we're doing. I get laser focused on one thing and not always pulling in the different parts that we could be thinking about. And it's supposed to be that back and forth.

Monica: And I mean, sometimes it's hard. You plan this perfect lesson, you want to do the lesson and then you find that it doesn't work with your students. And you're just like, but I took so long and I prepped this thing. You might've even laminated it and cut it. So, it's rough.

Marisha: Oh, that's the worst. When you laminate and it doesn't work out, oh man.

Monica: Right.

Marisha: And we'll talk about specific areas that we can look into, strategies for the internal and external evidence and clinical expertise and client perspectives. But what are some good general resources that SLPs can start looking into as they're trying to navigate this?

Monica: I think the ASHA website really, they have a lot of graphics and videos talking about it, just PDFs that are, I think, summarized really well. So, if you just need to watch a video on it and listen to it and just get the basics to just refresh that a little bit before you get going, I think that's probably a great place to go.

Marisha: Yeah. So the evidence maps, they focus obviously a lot on external evidence. And we'll talk about this more later this month, but the client perspectives, they have some articles embedded there as well. So that can be a good resource to look at if you're like, "Oh wait, maybe my triangle is a little bit out of whack." That can be a good resource to look towards as well.

Monica: For sure. And then for anyone who hasn't ever been on the ASHA evidence maps, they have it tabbed. So there's three different tabs for each part of the triangle.

Marisha: Yes. So it couldn't get any easier. It's been a really cool resource to look into. So I think that's a good overview of the triangle as a whole. Next time, we'll start talking about the evidence and then we'll follow up with two more segments about the other sides of the triangle.

Marisha: Thanks for listening to the SLPNow podcast. This podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you.

Marisha: See you next time.

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Service Delivery Models for Speech Therapy

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This is a guest blog post by Monica, a school-based SLP, all about how to pick a service delivery model!

How to Choose A Service Delivery Model

Deciding on a service delivery model and how many minutes you suggest at a meeting can be one of the most complex decisions you make during the IEP process. Hopefully, this post will help give you a sense of the options out there and expand your choices beyond 30 minutes, twice a week in the speech room!

First things first! Be ready to be flexible at the IEP meeting. Service minutes should never be predetermined before a meeting. Your recommendation may have to be adjusted based on what you learn at the meeting. There are a lot of different factors that drive the final decision! With that being said, let’s dive in.

Service Delivery 101

Service times and service delivery are built around goals and drive that recommendation. Here are some of the factors that you may consider:

1. How many goals are being targeted?
2. What intensity is required to achieve the goal(s)?
3. Will the goals will generalize outside of your speech room?
4. What does the research recommend?
5. What are the student’s feelings and personality/temperament?
6. What supports does a student need to be successful?
7. What is the school’s schedule?
8. What input do parents and teachers have?

Considering all of these factors helps maintain an evidence-based practice (EBP) lens when you’re making decisions about service delivery.

1. How many goals are being targeted?

Deciding how many goals to target can be a tough decision to make.

I always go back to Common Core Standards and target the goals that will make a significant impact.

If a goal area is not affecting the student’s ability to learn or participate, I will monitor it and target it with teacher education and collaboration.

This is an area where the least restrictive environment (LRE) comes into play. If we could, I’m sure we would target every challenge that comes up for our students! The reality is that we need to balance the time that students are in their classrooms with how much time they truly need to spend with us to be successful in the academic environment.

Adding more service minutes comes up frequently during IEP meetings.

When your clinical judgment tells you that more service time would not equal enough progress to warrant taking them out of the classroom, what can you do?

More service time does not always equal more progress.

I like to use an analogy of a baseball game and the SLP being a specialized batting coach. No matter how much batting practice we get, their game stats won’t improve unless they’re playing with their team. (This, of course, is different for motor speech disorders.)

Click here for more information about treatment intensity.

Goals drive service times. Do we have enough evidence and areas of concern that would outweigh the need for being in the classroom?

How ASHA Talks about Service Delivery Models

This ASHA page talks about different school-based service delivery and the benefits of classroom teacher collaboration. https://www.asha.org/slp/schools/school-based-service-delivery-in-speech-language-pathology

Talk about what support in the classroom looks like and how the classroom is Tier 1 of support.

2. What intensity is required to achieve the goal(s)?

Your service times and delivery will vary depending on the treatment areas that your goals are targeting.

For example, students with a severe speech sound disorder require a greater intensity of service delivery (Murray et al., 2014).

Students with apraxia need massed practice (Maas et al., 2014), which may require more service time or individual sessions.

My favorite service delivery model for students working on articulation and phonology is short, but frequent bursts of therapy where we have a high number of repetitions in a short amount of time. Byers et al., 2021, found that “children with mild or mild-moderate speech sound disorders may benefit more from a shorter, frequent, individual service delivery model (3 times a week for 5 minutes) than a BAU (business as usual) model.”

3. Will the goals will generalize outside of your speech room?

Language and social skills are naturally embedded in the classroom and school environment, so taking the student out of that environment for too much time to target these skills doesn’t make sense when pushing for generalization.

Speech therapy that targets strategies students can use outside of the speech room (or better yet, pushing into the classroom) is a great way to promote generalization.

Contextualized therapy, such as narrative intervention, leads to greater amounts of generalization than decontextualized therapy (Gilliam et al., 2012).

4. What does the research recommend?

Spoiler alert: Service delivery is very individualized. Because goals and treatment plans are so individualized, the research also has many different recommendations.

Check out this EBP Brief about service delivery in the schools.

5. What are the student’s feelings and personality/temperament?

Sometimes, no matter how much time we spent planning the perfect session or how fun we think we are, going to speech is just not what some students want to be doing.

From a preschool student that hasn’t been in school before to a high school student that doesn’t want to be in speech anymore, we have to take our student’s feelings about speech seriously. It wouldn’t be EBP without doing so.

Montgomery (2006) states that many factors affect a student’s progress, with student participation being one of them.  There are a lot of factors that go into adjusting for this. Here are some to consider…

Has the student been making adequate progress with the current service delivery model?

Can we reduce minutes or switch service delivery models to keep the student in the classroom environment more?

For older students, goals for self-monitoring can be a pathway to reducing or exiting from services.

For younger students, shorter times broken up into more frequent sessions could be an option (example: 5 minutes a day speech for speech sound disorder students).

Are push-in services an option? It may take some convincing, but after doing one push-in session, teachers are usually pretty on board!

6. What supports does a student need to be successful?

In addition to the student’s feelings and personality/temperament, other supports and aspects of the session could be modified to support emotional, sensory, or attention regulation.

Examples: flexible seating, visuals, breaks, additional goals for regulation

Could you break sessions up if the student has attention and/or sensory regulation needs (e.g., 3×10 instead of 30×1)? Is pushing into classroom centers an option?

7. What is the school’s schedule?

Often the bain of speech schedule tetris is the actual school schedule we have to plan around.

When I was at a junior high, the bell schedule and not pulling from any academic classes (or PE!) made me think a schedule was going to be impossible.

Adjusting service times to target goals in one 45 minute period instead of twice a week can make it easier on everyone.

Collaboration with the teacher and teaching strategies made it work, and the student was in the classroom for more time.

8. What input do parents and teachers have?

The last, but maybe the most essential, factor to consider is parent and teacher input.

Putting in the time to talk to parents and teachers before you draft service minutes can help you make an informed decision.

They can provide important information about how to plan for generalization and what goals to focus on that will make the most significant difference.

Planning this from the beginning helps to make the most amount of progress in the shortest amount of time. It also involves parents and teachers in the planning process for reducing therapy time in the future when we see a lot of growth and they are ready to scale back on specialized services.

I hope this blog post has been informative! More than anything, remember that making these decisions gets easier with time and that the IEP is a fluid document that can always change depending on your student’s needs.

References

Byers, B. A., Bellon, -Harn Monica L., Allen, M., Saar, K. W., Manchaiah, V., & Rodrigo, H. (2021). A Comparison of Intervention Intensity and Service Delivery Models With School-Age Children With Speech Sound Disorders in a School Setting. Language, Speech, and Hearing Services in Schools, 52(2), 529–541.

Gillam, S. L., Gillam, R. B., & Reece, K. (2012). Language outcomes of contextualized and decontextualized language intervention: Results of an early efficacy study. Language, Speech, and Hearing Services in Schools, 43(3), 276–291.

Maas, E., Gildersleeve, C., Jakielski, K., Kovacs, N., Stoeckel, R., Vradelis, H., & Welsh, M. (2019). Bang for Your Buck: A Single-Case Experimental Design Study of Practice Amount and Distribution in Treatment for Childhood Apraxia of Speech. Journal of Speech, Language, and Hearing Research, 62(9), 3160–3182.

Montgomery, J. (2006). Vision and Values in SLP Intervention: Let’s Get Intensive! Paper presented at the American Speech-Language-Hearing Association Annual Conference, November 2006.

Murray, E., McCabe, P., & Ballard, K. J. (2014). A Systematic Review of Treatment Outcomes for Children With Childhood Apraxia of Speech. American Journal of Speech-Language Pathology, 23(3), 486–504.

#093: Considerations for Linguistic Diversity When Assessing Narratives

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This Week’s Episode: Linguistic Diversity and Narrative Assessments

So far in this month’s podcast series, we’ve reviewed a few of our favorite formal assessments and the importance of narratives in everyday life. We dove in and took a closer look at the different language structures with informal assessments.

Last week Monica and I shared tips on how to collect language samples to help minimize your stress levels and collect a valuable language sample!

This week we are moving along to a very important topic: Linguistic Diversity and Narrative Assessments. I have to tell you that part of the reason I’m so grateful to be sharing the mic with Monica is that we have double the experience to draw from. 😍

Especially this week because Monica has a ton of experience with linguistic diversity in the schools — and she generously shared what she’s learned about navigating this with her caseload.

Let’s get to it!

Here’s what we discussed:

– If you don’t speak the student’s language, make sure you have a native speaker to translate for you during the assessments.
– Build rapport with the student.
– Interview the parent/guardian.
– What is the student’s dominant language at home?
– What language do they prefer to use?
– Take a language sample in their native language and their second language and compare the two.
– Is that language sample the language that they are most comfortable with?
– Don’t assume things based on a student’s ethnicity.

Quick Links

– Cornell University: The Multilingual Language Use Questionnaire
– Tips and Tricks for Working with Bilingual Students with Liliana Vasquez (The Bilingual Speechie)
– The Portland State University website
– BiLingustics: What Story-Telling Elements do All Cultures Share?

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Thanks so much!

Transcript

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Marisha: Hello there and welcome to the SLP Now Podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.
Hello there and welcome the SLP Now Podcast. I am your host Marisha and this month we are diving into all things narratives. So if you head back to episode 90, you can hear a little bit about how Monica and I tackle narrative assessment and just kind of our framework for it. Then the rest of the episodes throughout the month for 91, 92, 93, we'll dive into specific aspects of assessment and just things that we want to consider when we're getting ready to target narratives in therapy.
Without further ado, let's dive right in.
Now, let's dive into linguistic diversity. Monica, you've gotten some really great experience with this at your schools, and so I'm going to let you take it away and just kind of tell us a little bit about how you navigate this with your caseload and just some experience shares if you're willing to dive into all that.

Monica: For sure. So I am not bilingual in English or Spanish, so when I'm doing these assessments I make sure that I have a native speaker translator with me. She's a professionally trained translator who is able to help with all of the testing. So beforehand I'll make sure that I kind of give her a heads up, like I want to make sure I do a language sample today. She's got a little reference to look at for maybe, "Oh, I'm looking for past tense, because that's something that I heard in English that they didn't have."
So, we're just doing little things like that. So we do a little kind of catch up before I go get the student, and then I make sure that I've talked to parents about language usage at home. So, what is their dominant language at home that they prefer using? If the student is old enough, I ask them, what language do you like using? Because that's going to be the best indication of what they're comfortable with.
I ask about their siblings in the home, like parents, do you feel like they are at the same level that your other children were at if there are other kids in the home or cousins or their friends that they play with, do you feel like in whichever language, native language or English, how do you feel like they're doing? Just because if the students are only speaking English at school, you're not going to get a measure of that. Especially if that student is shy, they're not going to want to talk to two new adults in the same room. An assessment like that can feel really overwhelming for kids, so is the sample that I got the same as how they talk at home in that language for the translator that I have?
Then Marisha, you sent this cool language use questionnaire from Cornell that I've never seen before that I liked too. So it's information about it, how fluent do the parents feel? What is their education level, language use questions, information about your parents, information about grandparents and then attitudes towards the language. Because that does come up frequently in meetings where parents will say, "Someone told me that they should only be exposed to English." You're like, "Full stop. No."
It's unfortunate that that might be the first time that someone has told them absolutely expose your child, children to your native language. So, that's also something that you can find when you're doing that parent interview or parent questionnaire that you sent home.

Marisha: I have that quick little plug here. So I learned about that resource from Liliana Vazquez from the Bilingual Speechie, and we did a podcast interview, I think it was in July, so almost a year ago. If you guys want to check it out, it's at slpnow.com/54, but she shares a bunch of tips and tricks for working with bilingual students as well. She's the one who shared this language use questionnaire with me. We're just doing a quick little conversation, but that can be a good place to dive in if you want to find more information too.

Monica: Yeah, for sure. It sounds like an awesome resource. So, the other things to take into account are just cultural differences. So I'm Asian American, as a child I was really shy, but even though that's kind of like a stereotype, not all Asian kids are going to be like that, so that's a good place to kind of check where you are. Am I assuming that this child is a certain way because of their ethnicity? Maybe you might have to build more rapport before you dive into an assessment.
You can talk to parents, are they usually comfortable around adults? So if you're thinking about stuff like eye contact or body language, are you taking those different cultural things into consideration and not counting it as something that needs to be worked on? Because it might not be, it's just something that they do with their family. Especially for students who come over here from a different country, and they are dealing with a lot more than just trying to come into a whole new culture.
But yeah, we kind of talked about how to ask parents and teachers if that language sample is representative of how much they speak at home when they're comfortable, but dynamic assessments really are the big thing. So we kind of talked about it a little bit, but it's just like you're not necessarily going to get that type of input with formalized standardized assessments. So, you were looking at the norming population and it's not great for the student that you want to, maybe they have a language that that student wasn't even a part of that norming population. So, that's really where you want to pull in that dynamic assessment to be able to measure their skill for learning things when the language isn't there.
We talked about making sure you use a translator to make sure that you're measuring their skill in their native language, and then being able to compare that. So, if you're comparing two different language samples and you're comparing the language sample in their native language and they're comparing the sample in the English language, you're going to want to account for language differences in your language sample for English. Even if they have a dialect, it's AAE, you're going to want to look up things for that specific language.
So, I don't necessarily have one resource that I go to. I'm in California, so there are lots and lots of languages that could pop up here. We're really diverse in Southern California, so typically whatever language comes up is when I'll go and try and find it. So Marisha, I don't know if you had anything that you usually typically go to for that, or if you just kind of look it up on a case by case basis as well.

Marisha: Yeah, I think there's definitely some case by case research, but Liliana shared about, I believe it was from Portland State University, apparently they have a resource that I personally haven't used, but she talks about it in her podcast episode, slpnow.com/54. So, that would be a great place to go for some additional inspiration and tools that we can use as well.

Monica: Awesome. So yeah, then when I am looking at the two different language samples, I'm accounting for those differences and then I am looking for the same thing that you would look for in each language sample kind of traditionally. The complexity of their language, do they use a lot of vocabulary, the length of their sentences, where their grammar is. Truly when I asked the kids, what do you like using more? Do you like using this one or this one? I would say the majority of time, because they're in school all day and a lot of times their parents will say they end up using English at home, it's something you can keep in the back of your mind that I just need to make sure that I'm not missing something with the native English and just making sure that you're testing it. But that is a good opener for the parents though to be like, "Even though they speak English at home, keep talking to them in your native language."
Then we talked about the LEADERSproject, but Bilinguistics is also a great research kind of based resource. They've got a lot of blog posts on there, a lot of free resources as well. I was trying to look for research articles for the differences between narratives for different cultures. There was one blog post from Bilinguistics about, I think Scott Prath wrote it, and what story grammar parts are consistent across cultures and what's different, I didn't find too much honestly.

Marisha: But even that, when we were talking as we were going through the research together, I thought that was absolutely fascinating. Maybe I should be ashamed, but that wasn't something that I thought of that different cultures would have differences in the story grammar elements, so that's something we should consider when we're writing those goals as well. So we'll definitely link to that article, because I think that's fascinating and really important to consider. It's not just the language structure and vocabulary and grammar, overall structure can be different as well.

Monica: Yeah, and I'm even thinking about when I watch K-dramas or if I watch American TV shows, that the storytelling even in those is really different a lot of times, so it really does become an embedded cultural thing. Then I am Chinese American, but I watch K-dramas all the time and I lived in Japan for a short time, so I watch a lot of Asian films and movies and everything, and it is, it's very different. A lot of times when you're watching the two, to go back and forth between American entertainment and Asian entertainment I feel like.
But back to that Bilinguistics one, they were referencing an article and they said that the things that would be the same across different cultures would be the initiating event, the attempt, the consequence, the resolution, and the setting, and then added onto that there were differences between that. So, I feel like that's at least kind of a good starting point.

Marisha: That is so fascinating. Yeah, I got really excited when you found that, that was really cool. So, just a couple of other thoughts. So, we talked about taking cultural differences into consideration and we talked about building rapport with the student, and then the teacher parent report will really come into play there, especially if we use the language use questionnaire, that can give us some good information.
I referenced Liliana's podcast episode where she talks about a resource to learn more about cultures. Google can be a good resource too, although we want to be critical of what we're reading, so making sure that we're getting good sources. But then I thought it would be interesting to talk about ... So, I loved your idea of showing the language sample and asking parents if that's typical of what they see at home. I think that's a good way to kind of approach that. I'm curious if there's anything else that we can do to be very mindful and sensitive to those differences?
One thing that I was thinking about was observing the interaction between ... I was also required to do classroom observations, so I think it could be interesting to observe the student interacting with peers, with the teacher. If they're all in the IEP meeting, we can see how they interact as well, or hopefully if we have the opportunity to see them before the meeting as well.
But Monica, do you have any other tips? If you feel like you're struggling to find the information online or in a journal article, do you have any other strategies to navigate that? Or how do you approach asking those questions?

Monica: Offhand before I forget, sometimes if I can't get a language sample in their native language, because it's overwhelming, there's two new adults in the room, I'll have the parents record a sample from home and then send it in. But I think that because you're asking parents, it's kind of a way in, like, "I want you to record this sample, because it's been kind of hard to get it while we're here." Then you can ask them, "Do you have these concerns?" In English, they forget this past tense, and then you can ask the parents are they also doing that in the native language? Do you have concerns with that?
So, then that can kind of be an opener to be like, "I want to hear your concerns. Are there other concerns when they are playing with neighborhood kids or their cousins or things like that? What concerns do you have?" Because then it's going to be through their lens and what their concerns are through their different culture or whatever they're doing.
So that can be a natural way, I think, to ask about concerns and ones that you might not consider. Because it might be something that is a big concern for you, but it might not be a big concern for parents. So as long as it's not impeding their ability to participate in school or be successful academically, than it might not be really high on my priority list. So, I think that is kind of an answer to your question.

Marisha: No, that was perfect. I haven't done that where I ask the parents to record a sample. That's such a great strategy and that can give us a whole different insight. Even if it's in the other language, we can work with the translator to analyze that as well. So, so many amazing resources, so helpful. Thank you for diving into this with me, Monica. We hope that this was super helpful for anyone listening in well, and we'll see you next time.
Thanks for listening to the SLP Now Podcast. This podcast is part of a course offered for continuing education through Speech Therapy PD, so yes, you can earn inaudible for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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Teaching How To Follow 2- and 3-Step Sequential Directions

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This is a guest blog post by Holly, a school-based SLP, all about teaching how to follow 2 and 3-step sequential directions!

Teaching Sequential Directions

Do you have students on your caseload that can follow one-step directions pretty well, but–as soon as the complexity increases–that accuracy goes out the window?

If that’s the case for you and your students, you’re not alone! There are plenty of factors that influence the ability to follow complex directions: hearing/vision, executive function skills, language comprehension, grammar, student level of interest, task complexity, and sequencing, just to name a few. These areas were reviewed in further depth in a previous post on following simple directions — a lot of that info applies here, too!

Complex instructions are relevant for students across the grade-span. Like many domains of communication, the milestones related to following directions are geared towards younger children:

– Between 1-2 years of age, kids generally follow familiar one-step directions with support (Linguisystem, 2014)
– Between 2-3 years, children can follow two-step commands (Linguisystem, 2014)
– Around 4-5 years old, kids typically understand sequential terms (e.g., first, next, last) and respond to three-step directions at home or school (ASHA)

We know, of course, that the importance and complexity of instructions don’t end at age 5. Whether you work at an elementary, middle, or high school, following instructions serves as a major foundation for learning. These skills are also incredibly valuable for students working on vocational skills and transition plans. (Imagine your first day at a new job! There are countless tutorials to follow and procedures that you’re expected to get the hang of!) So how can we support our students no matter what level they’re working at?

In a previous post on following simple directions, we outlined the process of assessing this skill, selecting meaningful targets, using visuals and strategies, plus designing structured and contextualized intervention.

Now we’re taking it a step further by teaching how to follow multi-step, sequential directions! We’ll review different types of complex directions, plus how to teach and strengthen this skill in therapy.

Types of Complex /  Multi-Step Directions

Not all directions are equally complex — that’s why it’s important to figure out what strengths and challenges are impacting a student’s ability to follow along with instructions. Here are a couple examples:

Conditional Directions: If you ride the bus after school, line up here. 

Spatial Concepts: Take a seat at the nearest table and face your chair towards the front of the room. 

Temporal Concepts: Before you sit down, hang up your bag on the wall.

One Action, Multiple Objects: Grab a packet, glue stick, and a pair of scissors from the table.

Multiple Actions, One Object: With your pen, circle the word you don’t know, then underline any clues that will help you figure out what the word means.

Multiple Actions, Multiple Objects: Pick out a book, bring it to the checkout counter, and present your student ID card to the librarian.

The more concepts embedded into a set of instructions, the higher the demands placed on language and working memory will be.

For a deeper dive into assessing these skills, check out the prequel to this blog post and browse through the assessment materials available through the SLP Now membership! There’s a Smart Deck to quickly probe students’ accuracy in following 1, 2, and 3-step directions.

Quick Probe Smart Deck

Teaching Multi-Step Directions in Therapy

How do you feel about using anchor charts, visuals, and compensatory strategies in therapy? From kindergarten through high school, I’ve found that these kinds of support make a huge difference for students.

Visuals

When teaching a new skill, it can be helpful to use visual aids to represent a concept. This is because many of our students are already challenged by auditory or written comprehension (Law et al., 2017), so we can use this teaching phase as an opportunity to play to any strengths! This might involve using pictures, symbols, photos, or other visual supports when teaching a skill. Here are some of my favorite visuals to use with complex instructions:

Following Directions

Strategies

When helping students strengthen skills in an area, it takes time and practice. Strategies can be taught, practiced, and used the very same day — that kind of success can be really motivating for our students when they’re starting out! Over time, using rehearsal/visualization techniques has also been found to improve students’ abilities to follow directions (Gill et al., 2003).

Teaching Strategies

These handouts (included in the SLP Now membership) are great for partnering with teachers and working on self-advocacy skills for students.

Targeting 2 & 3-Step Sequential Directions (In Therapy & Beyond!)

Once you’ve selected your targets and reviewed the skills and strategies you’ll be working on with your students, now comes the fun part… Practice!

Games

Introduce a new game or tweak a familiar one, emphasizing the importance of listening to the instructions

Recipes

Can you think of a multi-step activity that is more functional than following a recipe? Our speech-language rooms don’t often come equipped with extra space, so your recipe could be as simple as making trail mix. However, if your school has an area dedicated to cooking skills or a kitchen space that you can borrow, try incorporating it into your therapy activities!

Calendars

Try filling out a planner, agenda, or calendar with students. The working memory demands are high here (e.g., note that your spring break is from April 4th-8th, and your book report is due the following Monday), so it emphasizes the importance of using external strategies, such as writing down details!

Vocational Activities

When working with older students and developing transition plans, identify what kind of job skills involve complex directions (e.g., bagging groceries involves sorting items based on weight/shape/temperature, organizing them into a bag, and placing the bags into the cart). This is a great opportunity to incorporate your students’ interests!

Other Curriculum-Based Activities

To support carryover throughout a student’s school day, collaborate with other teachers to see what activities involve complex directions. In a framework developed by Wallach (2014) and Kamhi (2014), we see that a contextualized approach to targeting these skills can be the most effective!

I hope this post has been helpful for you! Do you have any other questions or ideas for targeting multi-step directions? Feel free to comment below — thanks for stopping by!

 

References

American Speech-Language-Hearing Association. (n.d.) What should my child be able to do? Four to Five Years Old. Retrieved from https://www.asha.org/public/speech/development/45/.

Gill, C. B., Klecan-Aker, J., Roberts, T., & Fredenburg, K. A. (2003). Following directions: Rehearsal and visualization strategies for children with specific language impairment. Child Language Teaching and Therapy, 19(1), 85-103.

Kamhi, A. G. (2014). Improving clinical practices for children with language and learning disorders. Language, Speech, and Hearing Services in Schools, 45(2), 92-103.

Law, J., Dennis, J. A., Charlton, J. J. V. (2017). Speech and language therapy interventions for children with primary speech and/or language disorders. Cochrane Database Systematic Review.

Wallach, G. P. (2014). Improving clinical practice: A school-age and school-based perspective. Language, Speech & Hearing Services in Schools, 45, 127–136.

#92: Quick Tips for Language Sample Overwhelm

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This Week’s Episode: How to Get a Language Sample

So far in this month’s podcast series, we’ve reviewed a few of our favorite formal assessments and the importance of narratives in everyday life.

Last week we got a standard score with a normative sample that is appropriate for our students. We dove in and took a closer look at the different language structures with informal assessments.

One of the common things we talked about was collecting a language sample. And that feels super overwhelming when you’ve got a backlog of 5 million evaluations and referrals. I’m exaggerating a bit, but the stress can add up, quick!

So Monica and I thought it would be nice to share some tips on how to collect language samples and hopefully, these quick tips will help minimize your stress levels and how valuable language samples are!

Shall we get to it?

Quick Tips for Language Samples

– Ask yourself, “what do you want from this language sample?”
– Build rapport with the student by asking about their specific interest.
– Are their responses very literal?
– Use a narrative rubric.
– Use a Language Sample Spreadsheet.

Context Samples
– Conversation Sample
– Story Generation
– Story Retell
– Persuasive Sample
– Expository Sample

How to Use the Language Sample Spreadsheet

Click here for your free SLP Now Language Sample Google Spreadsheet

Links Mentioned 

– SLP Toolkit Narrative Rubric
– Check out this blog for my 6-step process to quickly and easily collect a language sample.

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

Bonus points if you leave us a review over on iTunes → Those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review, select “Ratings and Reviews,” “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

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Monica: Hello there and welcome to the SLP Now podcast, where we share practical therapy, tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there and welcome to the SLP Now podcast. I am your host Marisha and this month we are diving into all things narratives. So if you head back to episode 90, you can hear a little bit about how Monica and I tackle narrative assessment and just kind of our framework for it. And then the rest of the episodes throughout the month for 91, 92, 93, we'll dive into specific aspects of assessment and just things that we want to consider when we're getting ready to target narratives in therapy.
And without further ado, let's dive right in. So we talked about all of these different informal language activities or assessments that we can use. But one of the common things, because we talked about this throughout when we were talking about the formal assessment, as well as the informal assessment and we talked about collecting a language sample. And that feels super overwhelming when you've got a backlog of 5 million evaluations and referrals and all of the things. And so in my district, we were required to do a language sample so it was frustrating at first. But I'm really grateful that this is how things were set up because I got to learn how incredibly valuable language samples are and I also figured out ways to make them a lot easier. So I thought it'd be interesting though first because we talked about these different tools that we can use in assessment, but Monica, do you collect a language sample?

Monica: Yeah, usually they're pretty basic. I'll just do the minimum that's required by EDCO. To be completely honest, I'm not capturing a 10 minute language sample from these kids. But I think what helps you, right, is to think about in your mind what I want from this language sample before you start it. What do I want to get from this? Is there something that I'm looking for based on what formal and informal assessments that I've given so far that I really kind of want to narrow down, maybe? So that's kind of how I set it up. But do you want to talk about the different contexts that we can sample from language samples?

Marisha: Yeah, of course. And so it's super interesting because I did a lot of conversation samples when I started out and I maybe did some story generation. There's a lot of different types of samples that we can get. So of course, conversation samples. So just having a conversation with the student and then transcribing what they say. Which I guess is optional, there are some nice checklists out there that we can use without having to record the language sample, but we'll get to that later.
So we've got conversation sample, we can have them retell a story, we can have them generate a story. It's super interesting. If you ever have the opportunity to collect multiple samples from the same student, it's really interesting to see how they vary and it can make a huge difference if they're given visuals or not. It's dramatic the difference in language that we can see if they're talking about something that's immediate, something that they can see versus something that they're just asked to retain. Fascinating, fascinating stuff. And I think that could give us a lot of insight if we're comparing, having an immediate reference versus not, that can give us a lot of information.
And if they're really struggling in the classroom with narratives, that can give us a lot of information. So we talked about conversation, story generation, story retell. For older students, I think it's helpful to switch things up too. We can collect a persuasive language sample where they're trying to convince us of something or pretending like they're convincing their parents to let them watch a certain movie or convincing the principal to shorten the school day or to shorten the school week. And that requires some very different language structure than just retelling a story or engaging in conversation. And then expository language samples, they elicit very different types of language as well. So like, how to do something or summarizing a text or whatever it may be.
So those are some things to think about and I've collected lots and lots of different types of language samples just based on the feedback, like the parent and teacher report give us a lot of information, also the assessment results if there's something that I want to look into a little bit more closely, that can be helpful. And then, yeah, just trying to collect the data like Monica said to help kind of answer our questions. So yeah, that's a recap of the context that we'd like to sample. And then Monica, do you want to talk a little bit about how you tackle your language samples and how you make it doable given all of the workload and all of that?

Monica: For sure. I think that kind of talking about that like double duty thing again. I work a lot with the autistic population, so a lot of times if it's their initial or maybe like shy, I can use it as a rapport builder too. So you can ask parents or teachers, what is their special interest? And then you can get them talking about that and they're going to generate a far better language sample than me asking conversational questions.
So then I can kind of see with kind of like memorized things, especially if they're a Gestalt language processor, where is it with that? Again, that's a strength of theirs. That's where we can start off with, I can see where that's at. Because a lot of times for those kids, if they have to do something, they have no picture, no information about it, no prior knowledge, you're not going to get anything. You might get one to two word sentences because they're just trying to give you an answer. But if they talk about their special interests, whoa, that language sample is always amazing. But also I can make note of different things. So, if we're doing a conversational one, are they talking about other people? Are they talking about emotions?
Do they have that language in their vocabulary? So you can connect that back to what teachers or parents might be saying, where they have a really hard time with moments of frustration. And it might be because they don't have that language to express their emotions. So that's something that you can do with the sample. Are they able to work through that? If you ask them about something that they did over the weekend and they talk about a brother or sister and they talked about something that happened that they didn't like, you can get those sort of emotion words, which I think is always super functional. Are they showing perspective taking skills with characters, if you're doing like a wordless picture booking, you're doing a word retell? Are they just doing exactly what's on the page and nothing beyond? Is it very literal?
So those are definitely some of the things that I look for kind of off the top of my head that can be really useful then for thinking about what goals you're going to do and making it something very functional across contexts so then that's generalizing. You're always talking about decontextualized versus contextualized and this is definitely a way to make sure that everything is going to be embedded and to really make sure that you're making a good use of your time.

Marisha: Absolutely. And then in terms of how I tackle a language sample, I like my numbers and my data. And so I get a little bit nerdy with this, but it's totally doable. And it's so impressive to an administrator or even a parent because it's something like when we're describing the things that we're seeing in a narrative, it can feel a little bit fluffy and if we can assign a number to it and then we can see progress over time, I think that's incredibly powerful.
So there's some really great rubrics out there. And I typically use those when I write goals, SLP Toolkit has some amazing narrative rubrics and they also have a language sample checklist too in their tool, I believe. But in terms of getting the numbers, I made a little Google spreadsheet, I'll link to it in the show notes. It has boxes to transcribe the language sample. So as we're having the conversation, as I'm listening to their story, whatever it may be, I try and type it in real time if I can. If I can't, then I'll just record it on my school iPad or whatever, and then just listen back to it later. But then I just type in what the student is saying. And then I use one line per utterance. It has all these smart pieces in it where it automatically counts the words or morphemes if you add spaces between the morpheme.
So just make sure you're being consistent with how you're reporting that. It calculates the total words or morphemes in the language sample. It tells me how many utterances there were. So that gives me the MLU. And then it also has a space to look at the number of clauses that are in there and then whether they're grammatically correct and then there's room to leave notes. So if I'm seeing pronoun errors or if I'm noticing a lack of story grammar structure. Or if I do notice something that they're doing well, I can just jot that down in the notes. And then I just print out that spreadsheet and I can just attach it to the evaluation. We can go over it. Then the parent gets a concrete look at the language sample. Like I said, sometimes I do this with the language sample from the TNL, or I do like the conversation sample or a combination of the above.
It makes it really easy to compare the different samples and it gives us some really good information and it can be helpful for goal setting too. So we probably don't want to do the language sample every week. I've never done that. But it can be helpful to do on a quarterly or semester or maybe even a yearly basis just to see how they're progressing and just having a concrete way to see that progress. And it's really interesting to compare the samples year over year, especially if we use the same type. Like if we use the slam cards in year one and year two, and just being able to see that is really cool. That's how I tackle that. And I'll link to that spreadsheet with a quick little tutorial video if you're interested in trying to use that as well. Monica, anything you'd like to add or any other tips?

Monica: No, I would say same, definitely. I do the same thing and compare the MLU and kind of where their general grammar is at. But I totally agree about having that little record of their language samples. Because for a couple years I would actually have students from preschool up to maybe second grade and so I would end up doing their try and I would remember back, and it was such a great moment in the meeting to be like, this was their language sample from preschool. And this is where they're at now and just have a really concrete record of their progress. And for us to just all celebrate that growth in the meeting was always really fun.

Marisha: Yeah. It's awesome for all the progress monitoring and celebrating and also it gives us really great information. Like with the language sample that I use, if the student is only using simple sentences, maybe we need a goal to write compound or complex sentences. If they are always making verb errors or pronoun errors, we can write a goal to target that. Yeah, it's great all around, especially if we get to attach it to the evaluation for future reference.
Okay. So I think that's a wrap with our language sample tips and tricks. Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through speech therapy PD. So yes, you can earn ASHA CEs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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How to Target Sequencing Goals

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This is a guest blog post by Monica, a school-based SLP, she reviews the importance of targeting sequencing and shares tips and therapy ideas. 

Why do we target sequencing?

It is important to target sequencing because it is involved with so many daily tasks and is a foundation to academic success.

We want our students to be able to listen to a sequence of directions and be able to follow them, to retell stories, and answer WH questions. The question really is, how do we target sequencing in a way that will generalize into these skills? 

Kamhi (2014) states that sequencing is not a process that should be targeted in isolation. The article goes on to review how working memory, attention, and conceptual knowledge are at the core of this challenge, and that targeting sequencing with contextualized narrative intervention is the path to generalization.

What do students need to be able to sequence?

Students need to hold that information as a visual representation in their head to use later (Barkley, 2012; Ward & Jacobsen, 2014).

Students then need to use self speech which uses verbal working memory (Ward & Jacobsen).

With this in mind, would your sessions targeting sequencing stay the same or would they change? 

What if we thought about some of our students that we know may already struggle with executive functioning skills, like our students with ADHD or our autistic students? Same or different?

Universal supports in our sessions to support executive functioning makes a lot of sense!

The Challange

Research has shown that contextualized language intervention is where the magic happens. Contextualized language intervention effect sizes were three times larger on average than effect sizes for decontextualized language intervention (Gilliam, Gilliam & Reese 2012). 

Move away from sequencing tasks like brushing your teeth and how to make a peanut butter sandwich. Start to incorporate narrative retells as a more functional target that will help build communication and academic skills (Kamhi, 2014).

Use transitional words like first, next, then, and last to help students become familiar with the vocabulary for when they are self-generating retells. 

The next step is story grammar, which has been shown to help with comprehension (Stetter & Tejero Hughes, 2010).  We should always be keeping the next steps in mind when planning for a student’s success. 

Now that we see the flow and how it builds to working on comprehension, we can see the importance of targeting sequencing in the framework of narratives instead of by themselves. 

The challenge then becomes…

What do these supports look like?

How do we fade those supports? 

And how do we incorporate them into our goals and therapy sessions?

Session Solutions

An article by Dempsey (2021), showed that strong story comprehension skills were best predicted by a child being able to use a verbal account of a story (without pictures), followed by enactment (acting it out with prompts), then sequencing (retelling a story with pictures). This sets up a natural progression for fading support.

Preschool

Supports: I do a book walk and use parts of the story for a simplified retell. Videos that tell a story are another fun way to work on sequencing. You can use a graphic organizer with sticky notes or props if needed. Remember to use transitional words like first, next, then, and last when talking about the story to model the language.

Early Elementary

Supports: Use a first, next, then, last template (link below) and sticky notes while you are reading a story to mark what happens. You can adapt it to a three-part story if needed. This is the build-up to using story grammar and later generating stories of their own. Fade visuals as needed.

Tip: I use lots of narrative-based language during the session so that it’s familiar by the time we get to it.

> Point out that the bear is a character. When we answer WHO questions, we’re talking about the characters.
> Talk about the problem. If a question asks WHAT HAPPENED, we can think back to the problem.

That way by the time we have a WH question goal, we’ve been working on these language strategies and the student has had many many exposures to the language. We all know it takes repetition!

Additional Blog Posts for Narrative Therapy

Targeting Narratives with Literacy-Based Therapy: Preschool

Targeting Narratives with Literacy-Based Therapy: Early Elementary

Targeting Narratives with Literacy-Based Therapy: Later Elementary

Using Books to Target Sequencing (Scroll to the bottom of this post for a freebie!)

Additional Supports

Check for understanding by having students repeat the directions in their own words.

Have additional visuals available as needed. 

Check for emotional and sensory regulation before you start your session. 

Fahy (2014) states that there are six components to executive functioning: attention, working memory, inhibitory control, flexibility of thought and effort, initiation and persistence, and self-monitoring and regulation. Ensuring that your students are able to have “sustained attention over time” and are regulated prior to the sessions will be critical for student success.

A Sample Sequencing Goal

Goal: By XX/XX/XX, (in setting), after being read a story, Student will independently use self-generated language to retell a story on first trial data using at least 3 utterances, as measured by SLP observation and data.

Objective 1: By XX/XX/XX, (in setting), after being read a story, Student will sequence pictures in the correct order and repeat a 3-part story on first trial data, given picture prompts, as measured by SLP observation and data.

Objective 2: By XX/XX/XX,(in setting), after being read a story, Student will act out and verbalize a 3-part story on first trial data, given props, as measured by SLP observation and data.

Examples of Collaborating with Teachers

Push-in lessons (Brandal, 2014) are also a great way to make sure that the teacher is using the same language to talk about sequencing. Talk to the teacher ahead of time to see where they’re at with talking about stories. Taking a look at Common Core Standards is a great place to start to know what to ask the teacher. I usually talk about story grammar because it’s easily adaptable to different grade levels. This is also a great way to fade support so that the support is being provided inside the classroom.

Meetings

In meetings, it’s important to talk about targeting sequencing skills as a foundation for later narrative and retell skills by building on the student’s strengths. It’s also a great way to talk about something that can be practiced at home without adding too much to a family’s already busy schedule. Talking about supporting the student’s executive functioning skills can also lead to a great discussion with the team about other areas of need besides sequencing. 

Sometimes I’ll recommend that families print out daily activities onto a sticker magnet page and cut it out to put on the fridge. It can help children sequence the dreaded “How was your day at school” question. Children can see what they might have done that day that they want to talk about and then be able to sequence and verbally describe it.

 

References

Barkley, R. A. (2012). Executive functions: What they are, how they work, and why they evolved (pp. xi, 244). The Guilford Press.

Brandel, J. (2014). Making Evidence-Based Decisions Regarding Service Delivery for School-Age Students Participating in Narrative Intervention. 13.

Dempsey, L. (2021). Examining the validity of three methods of measuring pre-readers’ knowledge of storybook events. Child Language Teaching and Therapy, 37(2), 137–148.

Fahy, J. K. (2014). Assessment of Executive Functions in School-Aged Children: Challenges and Solutions for the SLP. Perspectives on School-Based Issues, 15(4), 151–163.

Gillam, S. L., Gillam, R. B., & Reece, K. (2012). Language outcomes of contextualized and decontextualized language intervention: Results of an early efficacy study. Language, Speech, and Hearing Services in Schools, 43(3), 276–291.

Kamhi, A. G. (2014). Improving Clinical Practices for Children With Language and Learning Disorders. Language, Speech, and Hearing Services in Schools, 45(2), 92–103.

Stetter, M., & Tejero Hughes, M. (2010). Using Story Grammar to Assist Students with Learning Disabilities and Reading Difficulties Improve their Comprehension. Education and Treatment of Children, 33, 115–151.

Ward, S., & Jacobsen, K. (2014). A Clinical Model for Developing Executive Function Skills. Perspectives on Language Learning and Education, 21(2), 72–84.

#91: A Quick Review of Informal Assessments for Narratives

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This Week’s Episode: Informal Assessments for Narratives

So far in this month’s podcast series, we’ve reviewed a few of our favorite formal assessments and the importance of narratives in everyday life.

So, we’ve got a standard score potentially with a normative sample that is appropriate for our students and all the other factors we want to consider. This week we get to dive in and take a closer look at the different language structures with informal assessments.

Let’s get to it!

Informal Assessment Options for Narratives

– The Index of Narrative Microstructure (INMIS, Justice et al 2006): This study investigated measures and developed a tool for analyzing narrative microstructure.
– SLAM Cards: These language elicitation cards and questions are designed as a tool to be used in assessing language for mid-elementary and high school-aged students.
– DYMOND (Peterson & Spencer, 2021): This is a dynamic assessment for narratives, grades one through six. It’s currently in a pilot version to get normed. This is really great for all age groups.
–Dynamic Assessment: This is used when we are trying to determine a language difference or language disorder. By having a measure from the pretest and the post-test, you’re measuring the skill that they have to learn new information as well as learning what types of supports they benefit from.
– Parent and Teacher Report

Links Mentioned 

– Leaders Project Website
– Matt and Molly
– Check out our other blog posts on Parent/Teacher Communication!

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Transcript

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Marisha: Hello there and welcome to the SLP Now podcast, where we share practical therapy, tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome come to the SLP Now podcast. I am your host Marisha and this month we are diving into all things narratives. So if you head back to episode 90, you can hear a little bit about how Monica and I tackle narrative assessment and just our framework for it. And then the rest of the episodes throughout the month for 91, 92, 93, we'll dive into specific aspects of assessment and just things that we want to consider when we're getting ready to target narratives in therapy. And without further ado, let's dive right in.

Marisha: So now let's dive into some informal assessments. We've got a standard score potentially with a normative sample that is appropriate for our students and all the other factors we want to consider. And now we get to dive in and take a closer look at the different language structures. So one of the tools that we can use is the Index of Narrative Microstructure. So the INMIS, I-N-M-I-S, developed by Justice et al in 2006. And this is a tool that helps us break down language samples, and I'll include a link to one of the articles that breaks it down even more. And it just helps us look at, they look at all of the T-units and all of that. They have some really great resources on their site as well that helps break it down as well. But that's just one to look into. One that I have more experience with myself is the School-age Language Assessment Measures.

Marisha: They're also called SLAM cards and they were developed by Crowley in 2014. But I found this on her Leaders Project website. And again, we'll link to this in the show notes as well. It's right at the top of the site though. So it's easy to find. I really like these cards. They even have some Japanese ones, which is really cool and they have guidelines for analysis. They give you lots of resources and they've got them in different languages and all of that. They have a couple of series. So one of them is a set of cards about a bunny going to school. And then there's another one about a dog coming home, a dog that got lost. And it ranges because there's one about losing a cell phone and there's a variety of sets of cards that we can use for a variety of students.

Marisha: And they're very colorful and just really nicely done. When I started working in the schools, I just printed these out and had them laminated and I would just pull them whenever I needed a good language sample. And I could use that across my caseload. Yeah, they're just really easy to use. And like I said, the site has different resources to help us break that down. So that is one of my favorites when it comes to collecting language samples.

Marisha: Monica.

Monica: Yeah. And those are free, right?

Marisha: Yeah, they're totally free. The Leaders Project website, if you haven't heard of it, or if you haven't been on there, they have test reviews. They probably have a test review of inaudible I haven't looked at that in a while, but they have disability modules for preschool and school-aged children. It's a wealth of knowledge. They do a really great job and it's all free.

Monica: Yeah. And inaudible too. I was like, "I totally forgot to mention that." So the ones that I like, again, from Peterson and Spencer is called The DYMOND, which I was like, "I don't know if there's a longer name for these. I should look that up." This one came out in 2017. So this is kind of similar. This actually looks pretty similar to the cards that they have. So it's the same illustration, but it's a dynamic assessment for narratives. So it's for grades one through six. It's currently in a pilot to get inaudible. So if you want to be part of that, I can get on that and you can send in your data for that and be part of that. So that's kind of cool. So since it's a dynamic assessment, if you're not familiar with what that means is you give a pretest. So you have a retell and you do that and then there is a portion in between where you teach them about story grammar. It's all laid out on the test and then you give a post-test and you compare those scores.

Monica: And it's fantastic for all populations, especially for bilingual populations or those diverse populations where you need something that's a little more dynamic. So that's super awesome for that. And this one, you can do that just for the retell~ and language complexity compared to the cubed, which has the comprehension and personal generation inaudible. So if you're trying to decide between the cubed and the diamond, those are the differences besides the age groups.

Marisha: And can you tell us a little bit more about dynamic assessment and why we might want to use that or how that could be helpful?

Monica: For sure. So I think dynamic assessment, when we think about it the most it's when we are trying to determine a language difference or language disorder.

Monica: So by having a measure of how they're doing from the pre-test, and then after teaching and the post test, you're really measuring that skill that they have. So you're not necessarily measuring their understanding of all of the vocabulary in that, especially if they're a second language learner. You're measuring that skill that they have to learn new information when it's taught and then to be able to use that new information. So you're measuring that skill of learning, So it's like relating back to the classroom. If their teacher is going to give them instructions and then they have an assignment, you're kind of that transference measuring that skill. So it's really a fantastic thing to do for that.

Marisha: Yeah. So it's helping us get at that difference versus disorder. It also gives us information about what types of support do they benefit from what helps them, which can be really helpful when we get into treatment.

Marisha: And also, just thinking if we even need treatment, if just after a little bit of teaching they're good to go, then maybe they don't need it. So it's really helpful. And it would be a shame to put them in that least restrictive environment, like go through the whole IEP process to find out that they don't really have a disability.

Monica: That's such a great way for you to be able to tell their teacher, "I just added this, this and this port and then they did so much better." Where a teacher in a classroom of 30 might not have the time to sit there and go through different supports and see what that student needs. So you're absolutely right. You could be that bridge right there.

Marisha: Awesome. Anything else on the diamond?

Monica: Nothing else on the DYMOND, but that does kind of make me think about other ways that I do informal assessments.

Monica: So if some of these tests, the language is going to be a barrier for me to assess those skills. Like maybe the vocabulary isn't in that child's vocabulary skills, then I'll use something that I have. So I have like Matt and Molly stories that I always have around that have simple pictures and then I can put the sentences that I want to test with and bring it down to their level to really, really look at what level they need support with. And kind of like we talked about like what supports I can add, because it's informal testing. You can add as many visuals as you want. You can add as many verbal prompts as you want. A lot of times I'll put that in my report, like, the student benefited from this, this and this, and then you have your baseline for goals and you're making your goals while you're doing assessments and rolling it all into one.

Monica: So I think that also makes it a lot easier. For my district, we have to do benchmarks under our goals. So if I can test a student and the first benchmark has this many visuals and this many prompts, and then the next one maybe I add another part of a story and I take away the support, I can test it while I'm doing the assessment and it saves me a little bit of time later because it's all kind of a bundled together thing. That's usually how I do it.

Marisha: No, that makes a lot of sense. That's perfect. Then it looks like you got one other resource for us.

Monica: My favorite. Yes. So the other one, which might be one of the most important things, which I know it's hard to squeeze in there, but it's parent and teacher reports. So when you're asking the teacher, you're really looking at common core standards and how they're functioning in the classroom. So some things that I asked teachers are like, "Can they put together a couple of sentences when they have a picture prompt?" Kind of like thinking about how much they support they need there. And also thinking about initiation, do they need a graphic organizer to get started? Do they need directions repeated a lot? Do they need a full example? That gets into executive functioning which is a whole nother conversation, but it's a good measure because when you're working on narratives, you're working on a lot of that executive functioning and students have that structure of what the story is in their mind.

Monica: So you're able to get out where they're at. They may not even have a schema. Do they have a little bit of it? And that kind of helps you with the levels of support because especially if it's an initial and you will only have that kid in your room for testing the one time, it's important to talk to the teacher to see what their real functioning levels are at. The other one is parents. I feel like one of the most frequent questions I get is, "When they come back from recess or lunch at school, can they tell you what happened? Because when they get home from school, they can't tell me what's happened." And so that's a great indication because that's retell too. So sometimes what I'll do is I'll send home a little visual schedule thing, just like pictures that they can cut out.

Monica: And I have them put it on adhesive magnet things that they can put on the fridge. So then when they get home, they can take the pictures from what they didn't at school and then be able to retell their day. So if that helps, then that also gives me a clue of where that student is at and what level of support they need. So it only takes 5 or 10 minutes and I feel like when parents have that little bit of input, it just makes everything go a lot smoother too.

Marisha: It helps with that generalization, if they understand what they're working on, if they're buying in, then the student will make that much more progress just by the fact that they're getting a little bit of extra practice. And parents are so busy, everyone's busy, but maybe they only do it once a week, but if they know their strategies, if they're in the car on the way to soccer practice, then they'll find themselves just using those types of strategies and supporting narratives, which I think is super powerful.

Marisha: What about Matt and Molly? Should we talk about that?

Monica: Sure, sure. So Matt and Molly, if you are listening and you don't know what that is, it's not a curriculum, but it's like a material bundle and they are stick figures just to be really simple. And it comes in four parts stories, like really simple four part stories and you get a little booklet. And each four part story has a story already written. But I don't always use it, I'll modify it. And then it has a set of questions that you can ask with it, but it's just to have something quick and easy, and that's always really similar each time. So the students then know what to expect. So what I'll do too, is sometimes I'll put the four and I'll mix them up and see if they can unmix them. Are they able to do that?

Monica: That might be where I start. And then I might tell them a simple three part story. I might take one out to make it more simple and then see if they can retell that. And if they can't, then I might try it where they repeat after the first one. So I'll do a sentence for the first one and then they'll repeat it. And then I'll repeat for the second and the third one, and then see if that extra modeling helps. That way I am able to listen to their sentences after I model, because I can tell you a lot about where they are with grammar and syntax as well, because they're not going to repeat something that they don't have super solid.

Monica: So it's like you're getting all of these super natural things from their language while you're doing narratives. And it's so quick, it's so quick. You just put out three pictures and you do it and you've got an informal assessment that you can do in eight minutes. If you're worried that this sounds super overwhelming to do informal assessment on top of your formal assessment, it doesn't have to take a lot of time and you get so much information out of it I feel like.

Marisha: Yeah, I couldn't agree more. And I love the ideas that you shared because sometimes we might try and administer the TNL. It's a high level language assessment and a lot of these require a lot of language. And I've had students maybe say one word. In retrospect, maybe I shouldn't have even administered the TNL in those cases, but you live and learn and we figure things out.

Marisha: But I especially love these because the pictures are super simple. Monica shared amazing ideas to adjust the task so that it works well. We can modify it. And just the nature of how it's set up. It has four simple pictures. We can decrease inaudible simplify the story if we need to. It has the sentence strips that can support some students if they are readers. I typically don't use these when I'm using it for assessment. I laminated my picture cards and then we can write on them and give visual supports and just try all sorts of different things and just really see what helps the student and what level of support helps us to get a narrative.

Marisha: And I left her idea for the sequencing activity too. That can be really helpful as well. So good step. So I think that's a wrap for our informal assessment, like blitz of different assessment tools that we can use. You can access the SLAM cards for free, and then the diamond is free as well. So there's something that you can use. If you don't have a printer, you can pull this up on your computer, or if you're lucky enough to have an iPad. So it's totally accessible. There's something in here that you can use. And even if you're not able to do any of that, you could just draw up some pictures and make a story about it. And this fancy set of Matt and Molly materials uses stick figures. So we can draw stick figures too. Just go for it. Yeah. We got this.

Marisha: Thanks for listening to the SLP Now podcast, this podcast is part of a course offered for continuing education through SpeechTherapyPD. So yes, you can earn ASHA CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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#090: A Quick Review of Formal Assessments for Narratives

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This Week’s Episode: Formal Assessment Options

I am so excited to introduce Monica Lind! She is the newest addition to the SLP Now team! She is a lead SLP in Southern California, and she is just as nerdy about evidence as I am. She has a broad range of experience as an elementary school SLP and loves literacy-based therapy.

For this month’s podcast series we’re focusing on all things narratives!

Narratives are so functional and so important when it comes to success in the classroom. Not only are they closely connected with academic achievement but they and allow students to connect socially.

We discuss how narratives are a great way to naturally measure where a student’s skills are at while also encompassing multiple different goals. We will break down 3 of our favorite formal assessment options and how to choose which assessment to use.

Grab your favorite beverage and let’s dive into discussing formal narrative assessments! 🤓

Formal Assessment Options:

– Test of Narrative Language (TNL, Gillam & Pearson, 2004)
– Edmonton Narrative Norms Instrument (ENNI, Scheider et al., 2005)
– CUBED: Narrative Language Measures (Peterson & Spencer, 2016)

Cheat Sheet

Formal Narrative Assessment Cheat Sheet
Click here to access our free cheat sheet!

Links Mentioned

– CUBED Free Webinars
– CUBED Free Tests and Norms
– ENNI Free Tests and Norms

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Transcript

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Speaker 1: Hello there. Welcome to the SLP Now podcast, where we share practical therapy, tips, and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode. Hello.

Marisha: Hello there. Welcome to the SLP Now podcast. I am super excited today because we have Monica Lynn joining us. She's the newest addition to the SLP Now team. We'll hopefully be recording many more podcasts together, but just a little bit of background on Monica since you may or may not have met her yet. She is a lead SLP for a school district in Southern California, and she is just as nerdy and all about the research as I am. She has a broad range of experience as an elementary school SLP. She's focused a lot on literacy based therapy, which we talk a lot about here, speech sound disorders, and then also functional social and language therapy, and so she's been a blast to work with.

Marisha: I hope that you enjoy getting to meet her too. Our goal for today is to dive into all things narratives. We'll start out just with quick introduction of why we're even talking about narratives this month. Monica, do you want to jump in first and share a little bit of your experience?

Monica: Yeah. Sure. I think that I really just love narratives because they're so closely connected with academic achievement. It's so functional. It's just like... When you're at a meeting and you're talking about goals and the teacher's like, "No. That's perfect. That's exactly what we work on." I feel like that's always what I'm going for, so definitely for that. I also just love the complexity of it because it's just such a good functional, natural measure of where their language skills are at. I feel like it also is a great way to add strengths in a report when you want to do that. Sometimes when you have all those formal standardized scores, it's hard. It can be tough for some of those parents to read that. But then if you do narratives, you can really highlight where their skills are at.

Marisha: Yeah. You can always find something that they're doing well with when it comes to narratives and communication and all of that. Yeah, I totally agree. I think it's cool to... Just piggybacking off of what you said, it is incredibly educationally relevant just across the curriculum, whether that's in the classroom, retelling a story that they read or on the playground, telling their friends what they did over the weekend. If they can't structure a narrative to tell that funny story or talk about what they did with their friends over the weekend, then they're really going to struggle with those social connections. Or if there's an incident on the playground and they can't tell their side of the story, that can be really frustrating for the student as well. Empowering to build those skills that they can use educationally as well as socially is incredibly rewarding. I love targeting narratives because I think we've established that it's a very meaningful context, but it also integrates a lot of different skills because we're producing sentences, which requires grammatically correct constructions and the use of vocabulary. There's also social language aspects.

Marisha: It's a really nice way to encompass a lot of different goals and we can do some really discreet practice on the different sub skills that the students need support with and then build that into similarly cool final products. Hopefully, you're on board with us too.

Monica: Yeah. You can't see because it's a podcast. I'm just sitting here nodding my head. It is. As school SLPs, we're always thinking about where can we get that big bang for your buck in narratives and putting that in part of your assessment. inaudible.

Marisha: Absolutely. Today, we are focusing a lot on assessment because we talked about why we want to target narratives in the first place, but how do we get started with them? What data do we want to collect? The first thing that we'll be diving into are some formal assessment options. I have used the Test of Narrative Language quite a bit, the TNL. The TNL is a test developed by Gillam and Pearson. It's in the second edition now. When I first started using it, it was in the first. This is a formal assessment. It's a norm-referenced test and it measures children's narrative language abilities. In other words, their ability to understand and tell stories. There's a series of stories with a series of different tasks. There are some retell involved, there's an opportunity for story generation, there's also some comprehension activities. I really liked this too. I will piggyback the assessment.

Marisha: I'll administer it as indicated by the manual and then get the standard score, but then I'll also record one or all of the retells and generations and all of that and I'll do some additional analysis on that, which we'll talk about when we get to the informal assessment option. A lot of what we'll talk about is informal assessment. This is a nice way to get some of those numbers, although we don't want to base all of our decisions off of a number. But that's a discussion for another day. Then another tool that I've learned about is the Edmonton Narrative Norms Instrument. This is the ENNI, E-N-N-I. It's another assessment tool and it's normed on children four to nine years old. It also uses a similar structure where they have illustrated pictures and then there's protocol to follow in terms of how we administer that. It's similar to the TNL, but it only has local norms.

Marisha: It was collected from 377 children in Edmonton, Canada. If you don't have access to the TNL, that can be a good option. Then if the normative sample doesn't match your students, it can also be a great additional tool to collect additional data. It's all free to access. They have some really cool demos and all of that on their site.

Monica: Then the next one is the Cubed. That's by Peterson and Spencer. They, I think relatively recently, have the norms for that. The cube has two parts. One is the narrative language measures and the other one is the dynamic decoding measures, and so I do the narrative language measures one. That one is preschool to third grade. You can use it as a progress monitoring one, so it has fall and winter. It has listening retell, comprehension, and personal generation. I really like it because it has norms. You can do it either for the entire normative sample or you can do it just for bilingual English-Spanish only. The school that I work at has a really large English-Spanish bilingual population, so I can make sure that I'm comparing the norms to that. It can also be used to do a dynamic assessment if you want to do that.

Monica: You can do the first benchmark one and then you can do a teaching part, and then you can do the second one because... We'll talk about one in a little bit that's called The Diamond. That one's grades one through six. If you have preschool through third grade, that works really well for that. They also have free recorded webinars on their website, not for CES, but it's just cool to be able to have those webinars so you can see it and you can see how the assessment is done. Sometimes it's overwhelming to think about learning a new test to give, but it's got the videos there so you can see how that's done.

Marisha: That's awesome. We'll link to more details for all of these assessments in the show notes, so you can take a closer look. We'll make sure to make it super easy for you to find those free recorded webinars. I think it'd be interesting to chat a little bit about how do we decide which formula assessment we want to use. We're going to dive into the informal assessments in the next segment here, but do you have any tips on how you decide Monica?

Monica: I think about the language that's used in the testing since I usually have younger kids. If the language used in the testing, they're not even going to be able to understand that, they won't understand what the story means, they won't understand what the directions are necessarily, I'm thinking about, is that actually going to test what I want, first of all. Then if it's appropriate for them... The Cubed has a lot more they're skateboarding or they're going to the park. It's a lot more relevant, so I like it. I Usually have younger students, so that's first how I'll do it. Then second, I'll look at the normed population. Is that relevant to my population? Do I feel like it's representative of them, so it'll be a really accurate score for me to compare to them? I think that's where I start off.

Marisha: Yeah, absolutely. Especially with your population because it sounds like you use the Cubed most often because that normative sample, the other assessments, you wouldn't be able to use the scores because they don't match up. That's one thing that we mentioned about the ENNE. If we want to use the norms, we do have to consider that population. It still can give us really great information. I think all of these assessments, there's definitely quite a bit of overlap in how they're gathering samples and having us take a look at it. Just the different samples and slightly different setup as tasks. I think if you're wondering which one to use with your caseload, do consider the normative samples and then take a look at the assessment and see which one you think would give you the most helpful information.

Monica: Then of course, if you really wanted to nerd out all of the sensitivities, inaudible in there in the technical manuals, they're there for us.

Marisha: I was looking through some journal articles and one of those came up talking about how a lot of us, we don't look at those metrics as well. It'd be cool if we made the little cheat sheet, just so it's easy to compare these three assessments. We should totally do that.

Monica: We should. We definitely should.

Marisha: We're going to do that. That'll be in the show notes as well, just to give you one additional resource to make it a little easier. Maybe we can just have a little breakdown table that makes it even easier to compare. Anything else that we need to think about for the formal assessments?

Monica: Probably just a general note, especially for all those new clinicians out there, that your assessment should not stop at formal assessments. Especially in school, if your district requires that you have a score, some districts do have a little more give, but just think that more and more people are realizing that there's a wealth of information in informal assessments and it is well worth your time. Formal assessment's definitely important. It's important to get that number and have that score, but just know that it shouldn't stop there.

Marisha: I could not agree more, which is why we are going to talk about informal assessments and give you lots and lots of options to gather additional information to make that decision in the next segment.

Speaker 1: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through speech therapy PD, so yes, you can earn extra CEUs for listening to this podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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