They tell us to “provide evidence-based intervention” and “develop strategies to facilitate this child’s attention and behavior regulation.” They ask us questions such as, “Are you capable of providing more services to clients in need?” and “Is this child ready to navigate the demands of school and access classroom instruction?” Clearly, our role in meeting the complex cognitive-linguistic needs of our clients extends well beyond communicative disorders. That is, we often find ourselves collaborating with applied behavioral interventionists, teachers, psychologists, occupational therapists, physical therapists, and one another. Our plates are full, and that is an understatement. Therefore, what are we to do?
Local university programs are not only seeking to train graduate student clinicians using the most recent research and teaching methodologies, but also individual professors are looking to make a deeper impact within their communities. For example, collaborate with them and their students to provide an exciting take on “summer camp.” Be sure to include your colleagues to form an inter-school “camp” aimed at providing intervention that focuses not only on speech and language, but also on school readiness, behavior regulation, and gross/fine motor skills. However, that seems like a lot to tackle, and you may be unsure about how to manage 15 children in a group. Moreover, you might even ask, “Is that evidence-based practice (EBP)?” To answer these questions, let us look at group therapy.
At several universities and even with Therapy Abroad, faculty members are asking local school districts and therapists to provide them with children who need improvement with a diverse range of skills beyond communication (e.g., behavior regulation and school readiness).
The philosophy is simple: Provide EBP in a systematic fashion that is contextually driven and in a group setting. That is, speech and language goals should be targeted in the broader context of play, academic skills, and activities of daily living. This philosophy is important for three reasons: (a) group interventions are effective, fun, and create a social network; (b) treatment intensity (i.e., frequency and dose) predicts the best outcomes; and (c) strong behavior regulation leads to high-quality language intervention and academic instruction. But what do we know about group interventions?
First, group interventions that utilize a collaborative service delivery are more effective than traditional pull-out treatment with respect to language outcomes (Throneburg, Calvert, Sturm, Paramboukas, & Paul, 2000). Additionally, parents, clients, and student clinicians form social networks that not only provide communicative disorders resources but also provide an advocacy-based resource (e.g., “Let’s talk to your school district about implementing augmentative and alternative communication intervention. We can show them what to do.”). Second, research supports the implementation of intensive intervention for young children with speech and language impairments (Warren, Fey, & Yoder, 2007). Specifically, children with language impairment may benefit more from high-frequency, low-dosage intervention or
low-frequency, high-dosage intervention (Justice, Logan, Jiang, & Schmitt, 2016). Frequency is
the number of sessions per week, and dosage is the time in which active ingredients (e.g., expansions, models, prompts) for language intervention are provided. However,
because the group intervention is in the natural context of play, clinicians target pretend play, social, behavioral, and gross/fine motor skills in addition to speech and language skills. Therefore, the dosage of direct language instruction is low. By keeping the dosage
low, clinicians have the opportunity to target several skills that will enhance academic readiness. Third, data indicate that expulsion rates of preschool-age and school-age children have been rising in the past two decades, and that academic readiness and behavior regulation may be the primary culprits (Gilliam & Shabar, 2006). We know that children with high behavior regulation ignore extraneous stimuli and persist with challenging activities (i.e., spend more time learning). Children with low behavior regulation, on the other hand, are easily distracted and are less likely to persist (i.e., more time being redirected to learn rather than learning).
Now that we have a theoretical and evidence-based framework, let us look at how we created a group intervention for preschool-age children. Our inaugural camp had a budget of $75 per day. Clinicians purchased basics such as butcher paper, themed toys, lamination sheets, and sensory bins with sand to name a few items. With that said, it is likely that you and your colleagues may have some of these items already or can borrow them. Clinicians prepped seven stations for our “campers”: (a) arrival/fine motor (e.g., writing skills); (b) literacy& active retell; (c) basic concepts (e.g., big vs. small); (d) behavior regulation; (e) gross motor (e.g., balance); (f) snack time; and (g) pretend play. You probably already notice that this group intervention model calls for interdisciplinary co-treatment; so track down that OT and a teacher!
At the arrival fine motor station (8:00 to 8:20 a.m.), clinicians had a series of responsibilities. First, clinicians briefed their clients on the theme and had the children drop off their backpacks in an assigned locker. Second, children reported their attendance at the sign-in desk. Clinicians taught penmanship and appropriate pen grasp based on occupational therapist recommendations. Children then wrote or traced their name to check-in. Finally, the children engaged in sensory bin activities with sand, floam, and pools of water to develop fine motor skills such as pinching. The additional benefit of these sensory bins included exposing children to different sensations that allowed them to organize their sensory systems and attend to only the important sensations involved in the activity. As we ended each station, it was important to note that we implemented a gross motor transition activity. This activity allowed our children time to end one station, mentally prepare to transition, and let out
Figure 1. Superhero puppet show as the pre-reading task.
energy before engaging in the next station (i.e., sensory organization). For example, the clinician might say, “Our time with floam has come to an end, and we learned that floam sticks in our friend’s hair. Now it is story time! I want you to pretend to be a superhero and jump down the hall to our reading room.”
Figure 2. Post-reading activity.
In the second station (8:20 to 8:40), and quite possibly my second favorite, literacy was targeted. The lead clinicians (i.e., those who planned the intervention) engaged clients in a pre-reading activity that focused on improving comprehension and learning the story grammar elements important to the story. For example,clinicians created a puppet show that highlighted important parts of a story (see Figure 1). Next, the clinicians read the story and used the pre-reading activity puppets as an augmented input technique that supplemented natural speech with a visual representation of the linguistic construct. Finally, the clinicians implemented a post-reading activity that fell under the term “active learning.” Figures 2 and 3 depict an activity where children drew the story grammar elements independently or with the use of a visual prompt. ReadingRockets.com has wonderful resources for literacy activities.
Figure 3. Visual story grammar chart to facilitate post-reading drawing.
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Figure 4. Basic concepts for categorizing land, sea, and air animals.
The third station (8:40 to 9:00) included targeting basic concepts. Clinicians were provided a list of basic concepts related to spatial (e.g., far/near), temporal (e.g., early/ late), quantity (e.g.,many/few/one), and quality (e.g., safe/dangerous) topics. We cycled through basic concepts throughout the two-week period making sure a concept was targeted two times (see Figure 4).
The next station (9:00 to 9:20), behavior regulation, focused on teaching impulsive children to inhibit those behaviors through practice. This allowed children the opportunity to resist extraneous stimuli and persist with a challenging activity. For example, we used games such as red light/ yellow light/green light/purple light and Slap Jack. For many children, red light/green light was too simple, so we added a yellow light to slow down and a purple light as a foil (i.e., ignore the light and continue). Slap Jack is a card game where clinicians created rules (e.g., only pick up the orange circles) and children earned points by slapping cards that followed the rules. Depending on the regulation skills of the children, you can create several rules and use a variety of foil
cards (e.g., motivating or distracting cards such as Disney characters [“Let it go, Jimmy, and follow the rules.”]).
Next up was gross motor (9:25 to 9:45). Recall that we wanted to have an evidence-based balance between frequency (number of sessions) and dosage (active intervention ingredients).
Therefore, in the gross motor station, we did not actively target speech and language goals.
However, we still collected data on goals and used indirect instructional techniques (e.g., expansion and environmental scaffolding) to measure client progress in a more natural communicative setting. Additionally, we utilized resources from occupational and physical therapists to create activities that allowed children to cross midline, maintain balance, and improve hand-eye coordination. In Figure 5, we targeted different gross motor skills by crossing the bridge, hopping on stones to cross the river, and crawling through bug-infested caves. In the left corner of the figure, we created animal track shoes by cutting sponges in the shape of bear paws and deer hooves. Children made large-scale steps by lifting their knees up to their waists like a large animal traipsing through the forest. Those paws were then painted on our mural.
Figure 5. The gross motor station for camping day accompanied by the song, Going on a Bear Hunt.
After exploring the forest, we worked up a hunger at Titan Tykes. Snack time was a great way to re-energize and calm the sensory systems down (9:45 to 11:00). However, providing intervention during snack time was a difficult task to accomplish. We strove to avoid communication such as “Is that good?” or “What are you eating?” Rather, we thought of Thanksgiving dinner where conversation flows, for the most part, from one topic to the next. Therefore, clinicians briefly reminisced about the previous stations and then engaged in conversation focused on preparation for the next station, pretend play. Specifically, we used the last 10 minutes of snack time play planning. In a summary on the effects of pretend play, Bergen (2002) emphasized that high-quality pretend play enhances several cognitive-linguistic skills such as problem solving, academics, and language use. However, Casby (1997) noted that children with language disorders have a symbolic performance deficit rather than a symbolic competence deficit. This indicates that children with language disorders are unable to communicate their pretend play role, but they can still engage in the play. To overcome this symbolic performance deficit, we used a variety of no-technology and technology-based tools to teach the language behind pretend play. For example, student clinicians digitally recorded themselves engaging in the pretend play scenarios. Last year, we created an Ice Cream Shop, where student clinicians modeled language for the roles of ice cream scooper, cashier, and consumer. Then children were assigned a role to play and practiced the language with their clinician prior to engaging with another peer.
Finally, my favorite station was pretend play (11:00 to 11:25) because a 6'4" bearded SLP equipped with a nerf gun and a villain mask was just plain fun (Figure 6). As noted previously, every day was a different theme, and Figure 7 depicts the ocean/pirate day. Children boarded their pirate ships (large plastic storage tubs), disembarked to their orange row boats (dolly with plunger), and explored the nearby island and cave.Because of the play planning, children had the language to interact with their peers (e.g., “Let’s explore the island to find treasure.”). There may or may not have been a 6'4" pirate king in the cave.
Figure 6. The masked anti-superhero villain did not escape Superhero justice.
After pretend play, we did some cool-down yoga poses to orient our sensory systems for the transition to home. Our final wrap-up meeting included a preview of the following day’s theme and a goodbye song. Finally, our student clinicians provided parents with a daily technique to facilitate speech, language, cognition, and behavior regulation skills at home. Specifically, they provided a one-page protocol that listed the steps to complete a technique such as expansion or play planning. The handout utilized a large font and contained several photographs.
Figure 8. The Pirate’s journey to a treasure-filled island(ball pit).
Parents were asked to complete the strategy at home that night, and the clinicians followed upon their success. This allowed the student clinicians to counsel the parents every day. I believe that providing parents with one technique per day of camp, rather than a 15-page packet of techniques at the end of camp, may have resulted in higher technique adoption rates.
In sum, "camp"is a fun EBP intervention that has both pros and cons. Notably, the intervention adheres to the high-frequency, low-dosage model that provides the opportunity to practice cognitive, linguistic, and academic skills in a more natural setting. Additionally, this model allows for SLPs to treat several children simultaneously. However, the theme preparation is time intensive, but with colleague collaboration (e.g., teachers and SLPs), that time can
be mitigated. I genuinely hope this article has assisted in your continued development and inspired you to create your own “camp” or collaborate with a local university program. Go on! Adventure is out there!
References
Bodrova, E., & Leong, D., (2007). Tools of the Mind: The Vygotskian Approach to Early Childhood Education, 2nd Edition. Upper Saddle River, NJ: Merrill, Prentice, Hall.
Bergen, D. (2002). The role of pretend play in children’s cognitive development. Early Childhood Research & Practice, 4(1),n1.
Casby, Michael W. (1997). Symbolic play of children with language impairment: A critical review. Journal of Speech, Language, and Hearing Research, 40(3), 468-479.
Gilliam, W., & Shabar, G. (2006). Preschool and child care expulsion and suspension rates and predictors in one state. Infants and Young Children, 19, 228-245.
Justice, L. M., Logan, J., Jiang, H., & Schmitt, M. B. (2016). Algorithm-Driven Dosage Decisions (AD3): Optimizing Treatment for Children With Language Impairment. American Journal of Speech-Language Pathology, 1-12.
Throneburg, R. N., Calvert, L. K., Sturm, J. J., Paramboukas, A. A., & Paul, P. J. (2000). A comparison of service delivery models: Effects on curricular vocabulary skills in the school setting. American Journal of Speech-Language Pathology, 9(1), 10-20.
Warren, S. F., Fey, M. E., & Yoder, P. J. (2007). Differential treatment intensity research: A missing link to creating optimally effective communication interventions. Mental Retardation and Developmental Disabilities Research Reviews, 13(1),70-77.
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