Interprofessional collaborative practice is rare in schools

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Interprofessional collaborative practice (IPP) means different professionals working together to provide the best services possible and spark big, systemic changes to help their clients thrive. Its precursor—interprofessional education— involves professionals coming together to learn about each other’s roles and how to collaborate. IPP is a buzzy topic in healthcare and education right now, and while grad programs are starting to add interprofessional education opportunities, it’s one thing to learn about it and another thing to make it happen in your setting. In a large survey, Pfeiffer et al. looked at school SLPs’ use of IPP. Their main findings were:

  • SLPs most often engaged in IPP during IEP meetings (43% of SLPs), while using IPP in evaluation and treatment was less common (8% and 14% of SLPs, respectively).

  • SLPs were more likely to use IPP if they received interprofessional education training, had more years of experience, or worked in elementary (vs. secondary) schools.

  • SLPs reported that a lack of time, buy-in from other professionals, and administrative support stopped them from using IPP.  

If you’re finding it difficult to use IPP in your school, know that most of your peers are, too. The authors recommend that grad programs add more interprofessional education training and that schools create opportunities for collaborative learning between professionals. While systemic change is needed, even baby steps toward IPP might make a difference for your clients. See these articles to learn more about IPP, and get inspired by this fun example of an SLP collaborating with an adapted PE teacher.

 

Pfeiffer, D. L., Pavelko, S. L., Hahs-Vaughn, D. L., & Dudding, C. C. (2019). A national survey of speech–language pathologists’ engagement in interprofessional collaborative practice in schools: Identifying predictive factors and barriers to implementation. Language, Speech, and Hearing Services in Schools. doi:10.1044/2019_LSHSS-18-0100

Individual vs. group language sessions: Does it matter?

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The only way that most school SLPs can even hope to schedule their caseloads is to see children in groups. Unfortunately, we don’t have much evidence on how grouping affects children’s progress. Groups might be distracting—or, children may actually benefit from hearing the teaching directed toward their peers.

Eidsvåg and colleagues treated a group of preschoolers with developmental language disorder (DLD) and morphological errors either individually or in pairs. The researchers selected a target and a control morpheme for each child. For children in the group condition, they also tracked a third “ambient” morpheme—the one that their peer was learning. The children received enhanced conversational recast treatment, where clinicians get children’s attention before recasting their errors using a variety of verbs. Each child heard 24 recasts of their target morpheme per session, which means that children in the group condition also heard 24 recasts of their partner’s target morpheme.  

Confirming earlier studies, the researchers found that the treatment was effective. Children in both conditions were better at using their targeted morpheme (but not their control morpheme) after 5 weeks of sessions. Gains in the individual vs. group conditions were similar, but children in the group condition did not improve on their peers’ target morphemes (meaning kids aren’t necessarily learning from instruction directed to their fellow group members).

So, it looks like group treatment for morphology is as effective as individual treatment, at least when the groups are small and when the dosage* of teaching episodes is the same. We can’t stress this point enough, though—kids got the exact same amount of teaching in each condition. In a mixed group of 4 kids, that probably won’t happen, and these results might not hold.

Psst! Check out Elena Plante’s advice for SLPs on keeping track of variability and dose during enhanced conversational recast sessions in a note on this review.

*Want to think more on dosage? Scan down to Schmitt et al., here, and also read here.

 

Eidsvåg, S. S., Plante, E., Oglivie, T., Privette, C., & Mailend, M.-L. (2019). Individual versus small group treatment of morphological errors for children with developmental language disorder. Language, Speech, and Hearing Services in Schools. doi:10.1044/2018_LSHSS-18-0033

Spanish and English in the classroom: Does it matter?

In this study of nearly 2000 dual-language learners (almost all Latinx) ages 18 months to age 5, in Educare/Headstart programs across the U.S., the researchers asked—does classroom language matter?

The language of children in three classroom types were compared:

  • English w/ No Spanish

  • English w/ Some Spanish

  • English & Spanish

The researchers found that all three classrooms supported English growth, but the English + Spanish classroom best supported Spanish growth.

The authors state, “… DLL children learn English at equal (and advanced) rates regardless of L2 classroom exposure, when in high-quality classrooms”, and thus “… Spanish use in the classroom at varying levels does not impede English acquisition.” And, basically, to support Spanish growth, we may need more balanced bilingual instruction.

Surprising to most Informed SLPs? Probably not. But this is a great article to share with others if you’re trying to explain the impact of dual language instruction.

 

Raikes, H. H., White, L., Green, S., Burchinal, M., Kainz, K., Horm, D., ... Esteraich, J. (2019). Use of the home language in preschool classrooms and first- and second-language development among dual-language learners. Early Childhood Research Quarterly. doi:10.1016/j.ecresq.2018.06.012

Throwback (2009): Individual or group sessions: How much does service delivery type matter?

In the schools, service delivery may differ (along with a myriad of other variables) in terms of session type—individual or group—and service provider—direct services by a speech–language pathologist (SLP) or services provided by a trained speech–language pathology assistant (SLPA) (or a combination of these). We know therapy leads to improved language skills in children with DLD, but how do we choose among the service delivery models out there? And how much does it matter? For example, can group therapy provided by an SLPA be just as effective as individual sessions provided by an SLP, all else being equal? The answers to these questions have implications for our treatment recommendations. Surprisingly (or maybe not so surprising), this question hasn’t received a whole lot of attention in the research world…

The authors of this study provided an intervention targeting receptive and expressive language to school-age children in elementary schools in Scotland. All students had language disorder, with no concomitant hearing loss, articulation disorder, or fluency disorder.  Students were randomly assigned to either an intent-to-treat control condition or one of four treatment conditions (all of which consisted of 30-minute sessions 3 times a week for a 15-week period):

  1. individual sessions administered by an SLP,

  2. group sessions administered by an SLP,

  3. individual sessions administered by an SLPA, and

  4. group administered by an SLPA

Receptive and expressive language (measured using the UK version of the CELF) were measured pre-treatment, post-treatment, and during a 12-month follow-up (to look at how well skills were maintained). Post-treatment and follow-up testing were conducted by other SLPs to avoid bias.

The results showed no significant differences between the treatment conditions. There were, however, differences in which outcomes improved: expressive, but not receptive, language gains were made between pre- and post-treatment. For the follow-up, across conditions, language gains were not maintained.

A strength of this study was its use of an RCT design with assessor blinding to promote replicability and minimize bias. Many of the intervention choices—length of sessions, number of sessions per week, and “active ingredients” of the intervention–were informed by previous research (all important things to consider!). In fact, one of the cool finds from this article is the structured intervention as detailed in McCartney (2007)—a therapy manual available free of charge

Of course, one of the limitations in applying this study’s results is that all services took place in the UK context. It’s very likely that there are differences in child and professional variables between the UK and the US (e.g. training standards for SLPAs). The authors also suggest caution in extending these results to children who differ from the study sample (e.g. those with speech sound disorders).

So what’s the take-away? This study provides some evidence that group sessions and sessions provided by SLPAs can yield similar results to individual sessions provided by SLPs, that children with receptive and expressive difficulties (compared to expressive alone) may require more intensive therapy, and providing continued support is likely important for maintaining language skills.

 

Boyle, J.M., McCartney, E., O’Hare, A., Forbes, J. (2009). Direct versus indirect and individual versus group modes of language therapy for children with primary language impairment: principal outcomes from a randomized controlled trial and economic evaluation. International Journal of Language and Communication Disorders, 44(6), 826–846.

Peers can help passive communicators learn conversation skills

Raise your hand if you know a student like this: ASD diagnosis, doesn’t initiate with peers, can’t keep a conversation going, always seen sitting alone or with other students with disabilities. Do you have an effective way to help?

The authors of this study crafted a peer-mediated intervention for a small group of high-school aged “passive communicators” with ASD. They picked four “focus students” who struggled with initiating and maintaining conversations, along with 16 peer mentors. Note that all the kids involved actually wanted to participate. Four mentors were assigned to each focus student, based on who shared the same lunch period.

The article goes into lots of detail about how the whole intervention was designed and structured (enough that you could pull off something similar!), but here are some key points:

  • Mentors joined the focus student for lunch, two at a time
  • Mentors learned specific strategies to promote initiation, conversation maintenance, and follow up questions
  • Focus students received some direct instruction as well, and brainstormed potential conversation topics daily with a teacher
  • Both focus students and peers used cue cards as supports
  • Mentors got regular feedback/check-in sessions with staff throughout the process
  • After a pre-training baseline period, intervention lasted 12–16 weeks
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So how did the focus students do, by the end of the intervention? They participated in more (and longer) conversations, initiated more often, and contributed more follow-up questions and comments (which weren’t directly taught!). In some cases, these gains generalized to new peers (both trained and untrained). Focus students and peers rated the process highly. And, if that wasn’t enough for you, teachers (who didn’t know about the intervention) noticed improvements in conversational skills. Even considering the small sample size, this is a really impressive result.

Okay, real talk. This model of intervention is a lot of work. You have to recruit and train peers, juggle schedules and logistics, and find a way to monitor the intervention and give/receive feedback. But as the authors point out, you get the advantage that “training can occur whenever peers and focus students are available, and intervention can be applied whenever and wherever conversation is appropriate.” The students also get the benefits of learning in a natural, inclusive (dare I say, least restrictive?) setting, and a chance to form meaningful relationships with non-disabled peers. This is big stuff. With some planning, creative thinking, and great team collaboration, a determined SLP could get it done. In many high schools, there are classes or clubs relating to community service, disability issues, inclusion, etc. These are great places to recruit and train peers mentors. And hey, if there isn’t one at your school, think about starting one! Remember, just sitting with peers isn’t enough, since “[peer-mediated intervention] must include explicit intervention strategies designed to elicit targeted outcomes.”

Bambara, L. M., Cole, C. L., Chovanes, J., Telesford, A., Thomas, A., Tsai, S.-C.,  Bilgili, I. (2018). Improving the assertive conversational skills of adolescents with autism spectrum disorder in a natural context. Research in Autism Spectrum Disorders, 48, 1–16. doi: 10.1016/j.rasd.2018.01.002.