1. Basic Principles and Procedures in Treatment of SSDs

2. Remember….** You don’t have to read chapter 7 basic unit
PowerPoint notes only 

3. As we begin to discuss tx, remember Fogle 2019—parents report that SSDs impact their children in the following ways:

4. I. SELECTING POTENTIAL TARGET BEHAVIORS**
A. Introduction
Target behavior
We need to select short term objectives and long-term goals
In the schools, we say “benchmarks”

5. B. General Considerations**
Select tx targets that are linguistically and culturally appropriate for the client
Select targets that will make an immediate and socially significant difference in the client’s communication skills

6. Remember…** Connect tx to classroom curriculum
Always keep Common Core State Standards in mind
I always tx speech sound errors and lang together

7. Izzy brings class reader to work on /r/

8. For Kiree, what would make an immediate difference?

9. C. Select More Readily Taught Treatment Targets**
Stimulable sounds treated before non-stimulable sounds
Teach visible sounds before non-visible sounds (e.g., /th/ before /r/)
For a phonological process to be treated, should occur at least 40% of the time

10. D. Select Targets that Affect Intelligibility the Most**
Select phonological processes that affect the most sounds; processes that contribute the most to the child’s lack of intelligibility
E.g., stopping affects many sounds

11. II. DECIDING ON THE NUMBER OF SOUNDS OR PATTERNS TO TEACH**
If the child only has 1-2 errors, the decision is easy
If the child has multiple errors, then we need to decide: do we train many sounds at once, or just a few?

12. Variables impacting this decision include child’s:

13. III. ESTABLISHING BASELINES**
A. Introduction
When we give artic/phono tests and gather conversational speech samples, usually each phoneme is not adequately sampled
For example, an artic test may sample /r/ one time in initial, medial, final position of words

14. Because of this very limited sampling, mistakes can be made**
For example, a child might not make the /f/ sound correctly, substituting /t/ for /f/ tan/fan, ot/off
But later, lo and behold, the child makes the /f/ with 90% accuracy on repeated measures!

15. We counteract this problem…**
By establishing baselines of potential treatment targets before starting therapy
Baselines are measured rates of behaviors in the absence of treatment

16. Baselines in our own lives:**
How much you weigh before you start that diet 
How many pounds you can bench press when you start a new workout program
How fast you can swim a lap before you start that swim class

17. B. 3 purposes of baselines:

18. Count the # of times**
That Dr. R. makes a th/s substitution when presented with picture cards
There will be 20 opportunities for /s/--how accurate am I? What is my %age of accuracy in /s/ production?

19. C. Baseline Procedures**
Specify the treatment targets in measurable terms
For example:
-produce /r/ in word-final position with 80% accuracy
Reduce use of final consonant deletion from 70% to 20% in conversation

20. We need to be sure to specify response topography**
This refers to the linguistic level of training
For example, do we want to begin with /r/ in isolation?
Do we want to begin with /r/ in word-initial position in sentences?

21. IV. SELECTING THE INITIAL LEVEL AND SEQUENCE OF TRAINING**
Baselines help us create appropriate tx objectives
PBH: best to start tx at word level— functional words especially

22. V. DEVELOPING MEASURABLE OBJECTIVES**
Treatment or short-term objectives are the skills the clinician plans to teach on the way toward achieving the selected treatment targets or long-term goals
Appropriate long-term goals might be:
“Increase the client’s intelligibility of speech”
Improve the client’s phonological skills”

23. However, measurable short-term objectives are needed**
These objectives specify how a goal will be achieved
The objectives must be measurable so that external observers can verify the results of the clinical services provided
Many 3rd party payers like insurance companies demand detailed documentation of improvement

24. To write a good objective:**
Use observable behaviors (e.g., point to, say, write, read aloud, sing, match)
Don’t use words with non-observable behaviors (e.g., know, understand, remember, learn, perceive, memorize, think about, consider)

25. Remember that data collection**
Should be done throughout tx
A good baseline will support this

26. VI. PLANNING AND DEVELOPING A TREATMENT PROGRAM OR PLAN**
A. Introduction
Phonetic placement techniques are direct methods to teach clients how to position the articulators and produce the sound appropriately

27. In this youtube video… The SLP uses the direct technique of Mr. Mouth
Articulation Disorder Teaching /r/
Ashley Mcgeehon’s channel

28. B. Successive Approximation or Shaping**
We take advantage of a sound the client can already make (e.g., /g/ if they cannot produce /r/).
We have them make the /g/, and gradually move toward /r/.

29. We can begin training the sound at one of several levels:

30. If the child cannot create a phrase or sentence with the target word…**
We can use a carrier phrase such as:
“I see______”
“Here is a ____”

31. VII. STRUCTURING TREATMENT SESSIONS**
Initial tx sessions highly structured
Tx sessions gradually loosen up to replicate natural “real world” more
Helps child generalize target sounds to spontaneous speech

32. VIII. INCREASING AND STRENGTHENING ESTABLISHED BEHAVIORS**
A. Selecting Potential Reinforcers
Positive reinforcer—rewards and strengthens the behavior

35. The treasure chest rocks! 

36. Noah loves the treasure chest….

37. So does RJ!

38. IX. GENERALIZATION**
Generalization usually refers to the child’s producing learned responses in settings outside the clinic

39. Generalization across situations**
Ch uses sound in other locations with other audiences

40. X. IMPLEMENTING A MAINTENANCE PROGRAM**
A. General Considerations
Maintenance = ultimate goal
Skills sustained over time
Select stimuli from client’s natural environment
For example, classroom language arts book

41. We should vary the physical setting**
Conduct therapy in different environments

42. We Need to Teach Multiple Exemplars**
For example, “quick” children working on /r/ in word-initial position may get up to 90% accuracy after 20 pictures
Some children may need 50 pictures, 30 objects, and 10 books with /r/-initial stimuli before they achieve 90% accuracy

43. B. Manipulation of Response Contingencies**
Most important aspect of maintenance
Move from continuous to intermittent reinforcement schedule
Fade primary reinforcers, rely more on natural reinforcers

44. We can also…**
Train parents and others to reinforce children for correct speech productions in natural environments
Teach self-monitoring/self-correcting skills (I use the terms interchangeably)

45. C. Involve Family Members and Significant Others