Interprofessional collaborative practice is rare in schools

7.png

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

Throwback (2010): Supporting preschool vocabulary growth with “talking buddies”

6.png

We know that it’s important to support breadth and depth of vocabulary development in our school-aged kids.

(We’ve talked about this before here and here.)

But, did you know that it might be even more important if you work with preschoolers, specifically? There’s actually evidence that typical preschool classrooms lack quantity and quality of talk (Wells & Wells, 1984; Wilcox-Herzog & Kontos, 1998). And, kids who have lower verbal abilities are talked to less in the preschool setting (!!!!) (Kontos & Wilcox-Herzog, 1997). So, obviously if you’re a preschool-based SLP, vocabulary development definitely should be on your radar!

This study provides a simple, yet effective, way to embed word learning in everyday conversation. If you’re looking for a low stress, low prep, naturalistic method of teaching kids new words, this is it.

For the intervention, the researchers trained undergrads to be “talking buddies”. The buddies worked with 3- and 4-year-olds in pairs to…

use recasts to expose them to rare words,

Child: Look, that one’s really small!

Adult: Small! What’s another word for small?....How about tiny?

expand and restate their utterances,

Child: Red car go.

Adult: The red car is going fast!

and ask open-ended questions to encourage further conversation.

Child: See this?

Adult: I do see that! Can you tell me more about it?

After talking with the buddies for 25 minutes a week for 10 weeks, the kids who received the intervention (even those with initially low vocabulary skills!) improved in the number and variety of words that they used.

And, possibly the best part? The talking buddies only received 4 hours of training in general techniques to stimulate conversation as well as the specific strategies that were used to introduce new vocabulary. For this study, undergrads worked with the kids, but it would likely be just as easy to train day care providers, classroom aides, or preschool teachers. Any of these professionals could include these focused conversations in their interactions with small groups of kids during snack time, on the playground, or during center activities. This type of easy-to-implement, inter-professional collaboration is exactly what we need to make sure that the preschoolers on our caseloads are achieving their vocabulary goals!

 

Ruston, H. & Schwanenflugel, P. (2010). Effects of a conversation intervention on the expressive vocabulary development of prekindergarten children. Language, Speech, and Hearing Services in Schools. doi: 10.1044/0161-1461(2009/08-0100).

Throwback (2012): One way to support your older students with DLD

If you serve students with developmental language disorders (DLD) in middle or high school, you’ve probably grappled with most of these problems: large caseloads, the impossible Tetris-game of scheduling pull-out sessions, a disconnect between therapy and classroom activities, time diverted to supporting missed or misunderstood class assignments, and difficulty connecting with general education teachers to co-plan or co-teach… to name just a few. So how do we navigate these hurdles to make meaningful changes for our students?

Back in 2012, Starling et al. took a novel approach to improving the language skills of a group of middle-grade students* (Australian Year 8, corresponding to the same grade in the U.S.) with language disorders: teaching the students’ teachers to modify their instructional language. This is taking a systemic approach to supporting students by targeting their environment and some of their most impactful communication partners—the ones delivering core academic instruction.

Teacher training addressed a few different areas, focusing on “practical and useable techniques”

  1. Modifying teacher’s written language in worksheets by breaking up large chunks of information, adding visuals, giving descriptions of vocab terms, and putting questions on the same page as the text they refer to.

  2. Modifying oral language by making directions explicit, giving extra processing time, rephrasing/repeating important points, and looking at the class when speaking.

  3. Visual strategies like lesson outlines, mind maps, and anchor charts/posters that the whole class participated in making.

  4. Vocabulary instruction techniques using the 3-tier system, adding extra opportunities to work with new words, and breaking down new words into roots and affixes.

Teachers met weekly individually or in small groups with the SLP for 10 weeks, and the SLP sat in on a few of each teachers’ lessons during that time to monitor how they put the strategies into practice. Click through to the article for specific examples of how lessons were modified based on the coaching process.

(An aside: We hear you, secondary-school SLP friends. This is WAY more access to gen-ed teachers than any of us are likely to have. Despite that, there are probably creative ways to implement something similar in your setting, even if you can’t follow the same schedule. If your school uses Professional Learning Communities, invests in peer coaching, or has other, regularly-occurring chances for professional development, you might be able to squirrel your way right in there! Administrators in charge of professional development stuff love coaching models—that’s how adults often learn best, after all—especially when they aren’t paying for an expensive outside consultant to deliver them.)

8.png

Compared to another school, randomly chosen to wait until the next term for the intervention, trained teachers successfully adopted the new strategies and kept up with them, even after the coaching was ended. Even better, their students with identified language disorders improved in a standardized measure of listening comprehension and written expression compared to the students at the other school, and maintained those gains after three months. Similar improvements didn’t show up in oral expression or reading comprehension, though. The authors acknowledge that this teacher-focused intervention isn’t enough for students with significant language needs—of course it’s not. Many (most… all…) of them will still benefit from individualized instruction in some areas. But this can be one layer in a “comprehensive model of service delivery in supporting secondary students with [language disorders].” And bonus? These kinds of teaching practices have benefits for ALL students, not just the ones with disabilities. If your school or district follows RTI/MTSS or Universal Design for Learning, SLP-delivered teacher coaching fits perfectly with those values.

 

*An important note: English learners were not included in the target student group.

Starling, J., Munro, N., Togher, L., & Arciuli, J. (2012). Training Secondary School Teachers in Instructional Language Modification Techniques to Support Adolescents With Language Impairment: A Randomized Controlled Trial. Language, Speech, and Hearing Services in Schools. doi:10.1044/0161-1461(2012/11-0066)

Training natural communication partners how to model AAC

Model, model, model! We all know how important and effective AAC modeling can be (see here and here, for example)—however, modeling is only as good as the partners who are implementing it. If you’re working with kids who use AAC, chances are there are communication partners who need guidance in how to model, and that’s no simple task. If you’re thinking “I agree, but HOW do I teach the partners?”, this review is for you!

The authors of this study gathered 29 studies in which more than 250 communication partners (including peers, teachers, paraprofessionals, parents, and other adults) implemented modeling strategies across various settings. Although they looked at a handful of research questions, the most clinically relevant questions were: How were the communication partners trained and what did they have to say about the training they received?

The most common training strategies were:

  • orally sharing information

  • modeling the strategies, and

  • allowing the partners to practice in controlled settings (role plays), or with a child, while providing feedback

1.png

Overall, partners rated instruction as worth the time, easy to understand, practical, and transferable to other children. Some additionally offered the suggestion to provide more direction on how to model during a child’s regularly occurring activities (something to consider when you are providing training).

Seems pretty straightforward, right? We train the partners using those strategies and then off they go? Not so fast. The authors found that most communication partners also benefited from simultaneous support while learning to model. So after you train the partners, it’s important that you stick around to offer coaching and consultation as necessary.

If this seems daunting (how can I possibly fit this into my already jam-packed day!?), it’s important to remember that teaching communication partners can drastically improve the reach of our interventions—the amount of time we spend with our students is so limited compared to their interactions with natural communication partners.

If partner instruction is something you’d like to improve, be sure to check out the full article (specifically Table 2) for a list of the included studies and the training strategies used in each.

 

Biggs, E. E., Carter, E. W., & Gilson, C. B. (2019). A scoping review of the involvement of children's communication partners in aided augmentative and alternative communication modeling interventions. American Journal of Speech–Language Pathology. doi: 10.1044/2018_AJSLP-18-0024

AAC carryover: Buy-in is only the beginning

One of the biggest frustrations for clinicians who support AAC are the devices that don’t get used. You know, the ones that sit in the cabinet unless you’re in the room, or the ones that parents ask you not to send home. There are a lot of factors that contribute to this kind of device abandonment (can’t you just picture a lonely device feeling sorry for itself?). We need to understand these factors, so we can focus our work on the key ingredients that will promote AAC device use and help students—and their support teams—be successful.  

You won’t be surprised by two of the most common caregiver-related barriers to device success: 

1)    The adults don’t know how to use the device (or, they lack operational competency).

This includes finding words, programming, troubleshooting, and navigating the device settings. Parents and teachers often report that they don’t get enough training in this stuff.

2)    The adults don’t have positive attitudes about the device (or, they lack buy-in).  

Specific aspects of buy-in can include considering the device the child’s voice and believing that it should be available at all times.

These two barriers are important, for sure, but how important? And what else are we missing? This study delved into this issue, focusing on the operational competency and buy-in of parents and teachers of school-aged (3–16 years) children with autism, and whether they related to how frequently the children’s AAC devices were used. The 33 children in the study all used a personally-owned PRC device or the related LAMP Words for Life app as their main method of communication at both home and school. To measure how much devices were used, the researchers analyzed data from PRC’s Realize Language feature across three school days and one weekend. Parent and teacher surveys were used to measure operational competency and buy-in.

The good news? Overall, buy-in and operational competency was high for everyone. The bad news? No one was using devices that much. In this group, teachers reported greater buy-in (or at least answered their surveys that way, but that’s a whole different topic...), but parents and teachers were equally comfortable operating the devices. The devices were used more frequently at school vs. home (over half of the kids didn’t use the devices at home at all). 

15.png

A big grain of salt here: the study looked at really a pretty small window in time (Is one weekend at your house representative of how your family works?), and only one device company—that uses a relatively complex language system—was in the mix. We also don’t know if looking at students with diagnoses other than autism would make a difference. Even so, it’s clear that something’s going on here. We can see that good intentions, valuing the device, and being trained in its use just isn’t enough. It looks like we need a broader conversation about barriers, including the practicalities of incorporating a device into daily activities and routines, especially at home. We definitely need to address operational competency and buy-in, but our families and other stakeholders are likely to need more support than that. The authors remind us to keep communication at the center of the conversation, rather than the technology. After all, the device is only the tool—communication is the point.

 

DeCarlo, J., Bean, A., Lyle, S., & Cargill, L. P. M. (2019). The Relationship Between Operational Competency, Buy-In, and Augmentative and Alternative Communication Use in School-Age Children With Autism. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0175