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Articulation Treatment. The Baseline Phase. Step 1. Has your client already had a recent articulation evaluation or is s/he continuing in treatment from a previous quarter? Do you know what sounds are in error?

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Articulation Treatment

The Baseline Phase


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Step 1

  • Has your client already had a recent articulation evaluation or is s/he continuing in treatment from a previous quarter?

    • Do you know what sounds are in error?

    • Do you know what sounds are to be targeted in treatment from given recommendations?

      If NO, then go to Step 2

      If YES, then go to Step 3


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Step 2 – Articulation Evaluation

  • Conduct an evaluation using an articulation test.

  • Conduct a structural-functional exam


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Step 2 – Articulation Test

  • There are many to choose from.

  • Some easy to administer tests include:

    • Goldman Fristoe Test of Articulation – 2

    • Structured Photographic Articulation Test – II

    • Arizona Articulation Proficiency Scale


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Step 2 – Articulation Test

  • Of the errors you find on the test, choose sounds in error or patterns that are expected to be developed by the child’s age and/or affect intelligibility the most.

  • If there are multiple sounds in error, conduct stimulability testing first to determine which sounds you will target for treatment (see Step 4 – Stimulability).


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Step 2 – Structural-Functional Exam

  • Conduct a structural-functional exam to rule out any issues with the structure or function of the child’s articulators.

  • You will look at strength, range of motion, and coordination of the articulators.

  • You will receive instruction on this.


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Step 3 – Connected Speech Sample

  • The connected speech sample is an important component of the baseline probing process.

  • You need to conduct this and put your findings in the assessment section of the report.

  • This information is generally reported as “percent correct.”


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Step 3 – Connected Speech Sample

  • Usually having a conversation with a child is sufficient for eliciting a sample with plenty of examples of sound/s in error in multiple word positions.

  • There is no set time limit to the connected speech sample – the point is to obtain an adequate sample of sounds. If you can do that in a 3 minute sample, great. If you need more time, take it.


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Step 3 – Connected Speech Sample

  • If you are trying to elicit less frequently occurring sound/s you may need to try some other strategies to ensure you get an adequate sample.


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Step 3 – Connected Speech Sample

  • Possible strategies (not inclusive):

    • Using a story retelling task that is loaded with the target sound. For example, Storytelling Probes of Articulation Competence (SPAC) is a pre-made resource available in the Materials Room.

    • You might also provide the child with picture cards of words with the target sound/s in many positions and have them create a silly story for you.

      Note: You may have to provide an example to the child of how to create the story – use other cards.


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Step 3 – Connected Speech Sample

  • When you are recording data from the speech sample, you do not necessarily have to be careful to record by word position.

  • In general you record a “+” or “-” for all opportunities for the target sound and report it as a set.

    • (e.g., /s/ was in error in 60% of opportunities in connected speech)


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Step 3 – Connected Speech Sample

Caveat!

If, as you are analyzing your connected speech sample, you are hearing a pattern (e.g., /s/ is correct in all word final positions, but in error in all other positions), you must record and report that. That is a significant finding.


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Step 4 - Stimulability

  • Stimulability

    • Is trial teaching.

    • Is generally quick.

    • Informs your treatment: It tells you

      • what sounds (if there are multiple errors) are ready to be taught (or can be left alone to develop on their own!)

      • at what response level and cuing level to start in treatment for a single error sound.


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Step 4 - Stimulability

  • As with all treatment, it is important to think systematically when doing stimulability.

  • Different clinicians have different ways of approaching stimulability, but the next several slides will describe one way to do it.


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Step 4 - Stimulability

  • Study your Eliciting Sounds, 2E (Secord) focusing on the sounds you know to be in error.

  • Practice administering elicitation strategies on a peer, loved one, or child if you can.

  • Of course talk to your supervisor about any “tricks of the trade” s/he might have to share with you.


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Step 4 - Stimulability

  • Prepare word, phrase, and sentence lists that you will use during this trial teaching phase.

  • Available to you is a document to help you with this: http://courses.washington.edu/sop/ArticLang/Stimulability.pdf


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Step 4 - Stimulability

  • Start at the word level.

  • Try different word positions using a variety of teaching cues.

  • If the client is not succeeding, go down to the syllable level.

  • If the client is still not succeeding, try at the isolation level.


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Step 4 - Stimulability

  • Of course if the child is doing well at the word level, increase to the phrase level.

    • You might do short, functional phrases (e.g., “a white tooth”

    • You might use a “rote phrase” (e.g., I see a ___; “This is a ___”)

  • If the child is doing well at the phrase level, increase to the sentence level.


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Step 4 - Stimulability

  • On the following slide is an example of a chart that you might want to create for yourself to help record your data.



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Step 5 – Baseline Word Probes

  • Once you have established your target sounds you will administer word probes.

  • In general, you will probe all word positions or contexts.


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Step 5 – Baseline Word Probes

  • Prepare probe cards.

  • There are many materials available in the Materials Room Articulation/Phonology cabinet. Or you can create your own.

  • Ideally find 10 words per position/pattern (but remember you have to have words to use in treatment as well).

  • If that’s not possible, see next slide for a strategy.


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Step 5 – Baseline Word Probes

  • Can’t find 10 words per position?

    • Try to come up with at least 3 words per position/pattern.

    • Then present cards 2 times (not back to back though) to get a minimum of 6 opportunities.


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Step 5 – Baseline Word Probes

  • Probe cards may be either written words or picture cards.

  • Use good judgment in deciding whether it is appropriate to use only written words. Consider the age/educational level of the child.

  • Be sure to choose words that are appropriate vocabulary (consider age and experience of child as well as family religious/cultural beliefs).


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Step 5 – Baseline Word Probes

  • When selecting words try to keep the sounds in “pure positions.”

  • For example, some commercial materials may use a word like “mushroom” as a medial ‘sh’ word. But technically speaking, in this case it is a syllable final sound and the /r/ may make it extra difficult. This is in contrast with “fishing” where the sound is truly intervocalic. Try the best you can.


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Step 5 – Baseline Word Probes

  • When presenting baseline word probes you will instruct the child:

    “I’m going to show you a card with a word on it. I want you to say the word for me. If you are not sure what the word is, I will tell you and then we’ll come back to it later to see if you remember it.”


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Step 5 – Baseline Word Probes

  • In general we obtain 2 baseline word probe data points.

    • If the child was seen in a previous quarter (except for Summer), you can use a data point from the previous quarter as one of your baseline data points.

  • Once you have collected your baseline word probe data you will put these word cards away – probably until the end of the quarter.

    Do NOT use your baseline word probe cards for treatment (unless there is a special circumstance).


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Step 6 – Begin the Treatment Phase

  • You now have all the information you might need to get started with treatment.

  • Be sure to prepare adequate treatment materials to begin your teaching.


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Step 6 – Begin the Treatment Phase

  • Begin to think about Behavioral Objectives.

  • Think about what you can realistically achieve by the end of the quarter (consider stimulability results).

  • For the purposes of this clinical experience, you probably will not be writing your BOs at the level of generalization. Read on…


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Step 6 – Begin the Treatment Phase

  • You will likely write your BOs in terms of where in treatment you will get.

  • So your BOs will reflect that you will use “treated” words, not “untreated.”

  • You could write a BO that reflects performance at the conversational level, if that is appropriate (i.e., your stimulability testing indicated the child is ready to work at a high level – like the sentence level).


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Step 6 – Begin the Treatment Phase

  • You will talk about the child’s performance on “untreated” words in the generalization section after each behavioral objective.


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Questions?

  • If you have any questions about the baseline process –

    Ask your supervisor!


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