A Collaborative Model for Speech-Language Therapy Services
(Michelle Turkoglu, M.S., CCC-SLP; Speech-Language Pathologist)
Children with Autism Spectrum Disorder as well as many other children with developmental delays experience a constellation of symptom that can affect many areas of development. The SLP’s (Speech-Language Pathologist) scope of practice includes evaluating and treating many of these areas, including: speech (articulation disorders, oral-musculature disorders, apraxia, stuttering), language (vocabulary, syntax, grammar), social-pragmatic skills (eye-contact, body spatial awareness, tone of voice), play skills (turn-taking, pretend play), eating/feeding skills, swallowing (dysphagia), reading (phonemic awareness), auditory processing, voice & cognitive skills.
Typical private speech-language services are often performed 1:1 in a clinic setting. In the school system, therapy is often performed in small groups within the classroom (push-in model) or in the speech room (pull-out model). Overall therapy time can range from 20 minutes to a couple of hours per week. While each of these therapy types is important, treating the wide range of needs for some of these children is challenging if not impossible. Since speech, language and social skills occur all day, every day, in various settings and with various people, forming a collaborative model with teachers, parents, aides and other therapists becomes essential.
Many children with Autism receive Applied Behavioral Analysis (ABA) therapy and/or attend a specialized classroom or school. These children will spend a significant amount of time each week working with their ABA team and attending school. Also, many of the goals of the ABA team, the school and the speech-language pathologist will overlap. Therefore, it makes sense that a collaborative model will give each child an extended period of time to work on their goals as well as to have the opportunity to generalize these goals into various settings and with various people.
The following are some examples of how a collaborative model would work:
With ABA’s expertise in behavior analysis and behavior management techniques, the ABA staff can advise the SLP on types of rewards and consequences that work or don’t work for the child. For instance, the SLP is working on labeling actions in pictures with a child. Whenever this task is attempted, the child “tunes out” and/or tries to leave the table. After many hours of behavior analysis, ABA has found that all labeling tasks are difficult for this particular child and he greatly benefits from the use of a token economy system with a reward at the end. Now, the SLP has the tools she needs to keep the child engaged during labeling tasks.
Some children will need to use some form of augmentative or alternative communication system such as Picture Exchange Communication System (PECS) or an electronic system such as a tablet equipped with a communication app (i.e. Proloquo2go). The ultimate goal for the child would be that he/she is using their communication devices independently to communicate their wants and needs throughout the day. If the child were to only practice communicating with their device during speech-language sessions, the goal of truly learning the system and using it independently would be unlikely. Again, collaboration with the ABA team, parents & teachers would help shape what types of words & phrases will be needed for the device or the PECS system. The staff and family who spend the most time with the child will know best the types of things that are important to the child and the types of things that will help the child succeed at communicating with others. The SLPs knowledge of language development can help guide the team in choosing a realistic amount of vocabulary or sentence structures that would be most helpful.
For children who have speech disorders, it is often very difficult to understand the child when he or she is speaking. Some speech disorders can be as simple as misarticulating a sound or two. Other disorders could be muscle-based making speaking sound mumbled and imprecise. And still other speech disorders could be neurologically based such as apraxia, causing the child to speak infrequently and/or speak with unusual speech patterns/errors. These types of disorders will require direct therapy from the SLP in a 1:1 or small group setting. But the ability to learn to have clearer speech will take a significant amount of practice. This is where a collaborative model will be exceptionally helpful to the child’s growth. Speech exercise is much like physical exercise in that if you don’t engage in it consistently and with purpose, it’s unlikely that you’ll see change. Collaboration could include the SLP providing lists of sounds/words to practice (accompanied by pictures if needed) as well as techniques for eliciting sound production to parents and ABA staff so they can incorporate the needed repetition and practice into the child’s day. For teachers of a classroom, the SLP can consult with her and perhaps come up with a cuing system (such as a visual reminder on the board or a hand signal) that will remind the child to “use their clear talking” when it’s the child’s turn to speak aloud in class.
Children with processing difficulties often benefit from learning strategies that will help them “listen better” and “hold on to information”. Again, these types of strategies should be taught by a SLP during speech-language sessions. But the child is only going to truly benefit from these strategies if they can use them in school or social interactions. Collaboration with the school and having the teacher involved in helping the child with processing difficulties could really make a difference in whether or not the child will succeed in group settings. Ideas for collaboration for children with processing difficulties would include: having the child sit at the front of class, asking the teacher to use visuals aides and supports, using an amplification system if possible, recognizing signs that the child is “getting lost” and then asking the class if anyone would like clarification. Additionally, children with processing difficulties have great difficulty processing novel words within a lesson and being able to try to figure out how that new word is associated with the lesson. Asking a teacher to provide lesson plans ahead of time could help the SLP or parents go over the information and new vocabulary ahead of time so when the lesson is taught during class, the child can “keep up”.
On a personal note, I have worked in both the schools (typical K-8 programs, Montessori schools & specialized classrooms) as well as private practice where children were typically seen 1:1 in the clinic or in small social-development groups. These were all amazing opportunities where I’ve had the pleasure of consulting and collaborating in a variety of ways. The collaboration here at Alternative Behavior Strategies has been a whole new experience in working cooperatively with an ABA team. It is so helpful to sit down with a member of the ABA team and talk about the child’s needs and goals. It’s nice to brainstorm ideas with other professionals and come up with strategies that will help a child succeed. It provides great insight into what the child is like during his/her day. This collaboration helps me to understand the child better; to see what makes them happy or triggers their behaviors. This information enables me to plan therapy and visual supports to help the child become more successful. It’s been amazing to watch the growth of the children who have had their speech-language goals incorporated into their ABA programs. The consistent practice has truly made a difference in seeing progress!