1. Jungle Chatter Speech-Language Therapy in Early Intervention With Cheryl Horn, M.S., CCC-SLP & EI Service Coordinators / Special Instructors: Jacynda Shepard, B.A. Anne Falkenhagen,B.A. Heather Sharp, B.S., Special Instructor /Parent 1

2. Objectives 1.Describe philosophy of the EI program and the roles of the SLP and special instructors 2.Provide a variety of practical therapy ideas to encourage sound production in children 1 to 3 years of age with a variety of diagnoses 3.Develop speech activity plans with team implementation 4.Describe measurements of articulation (sound production / phonology) and transition to preschool program 2

3. You Can’t Make a Turtle Come Out Words and music by Malvina Reynolds Sung by Paul Epstein 3

4. You can't make a turtle come out, No, you can't make a turtle come out, You can call him or coax him, shake him or shout, But you can't make a turtle come out, come out, No, you can't make a turtle come out. 4

5. If he wants to stay in his shell, Yes, if he wants to stay in his shell, You can knock on the door but you can't ring the bell, And you can't make a turtle come out, come out, No, you can't make a turtle come out. 5

6. Be kind to your four-footed friends, Be kind to your four-footed friends, A poke makes a turtle retreat at both ends, And you can't make a turtle come out, come out, No, you can't make a turtle come out. 6

7. So you'll have to patiently wait, Yes, you'll have to patiently wait, And when he gets ready, he'll open the gate, But you can't make a turtle come out, come out, No, you can't make a turtle come out. 7

8. And when you forget that he's there, Yes, when you forget that he's there, He'll be walking around with his head in the air, But you can't make a turtle come out, come out, No, you can't make a turtle come out. 8

9. EARLY INTERVENTION family focus Infants and toddlers with special needs receive services with a family focus to enhance their early development including special instruction, physical, occupational, and speech therapies, nutritional consultations and other family supports. These services are provided in the home, at the child's day care center or other locations in the community. 9

10. Common Core knowledge needed by all team members : Child DevelopmentBehavioral LearningNatural EnvironmentsFunctional skillsCultural Diversity 10

11. Separate therapy assessments Cooperative staffing Team consensus Interdisciplinary Arena assessment Therapists/instructors visit together Share responsibility for goals Transdisciplinary 11 Primary Service Provider (PSP)

12. 12 “The use of transdisciplinary or PSP models may be appropriate for SLPs. Early intervention is a field with many disciplines represented as practitioners and in which the roles vary according to the needs of the child. Teams benefit from joint professional development and can enhance each other's knowledge and skills as well as through role extension and role release for specific children and families. It is not appropriate or suitable for SLPs to be asked to train others to perform professional level services unique to SLPs or for SLPs to perform services outside of their scope of practice “ American Speech-Language-Hearing Association. (1997b). Multiskilled personnel: Technical report. Available from www.asha.org/policy www.asha.org/policy

13. Transdisciplinary Speech Therapy Services 13  Speech Therapist is responsible for: - evaluations / assessments in communication and swallowing skills - determine type of communication disorder - determine if referrals are needed in these areas - plan intervention / activity plan - reassess progress and adjust plan  Special Instructor implements: - activities to enhance child development in all areas - specific recommendations of therapists - literacy activities - special training / skills - assists caregivers in follow through

14. 14 Who sees the SLP…When? Caseload Established Risk Biological Risk Environmental Risk Medical Diagnosis Services begin as early as Birth History of Events At Signs of Delay/IFSP Early Experiences At Signs of Delay/IFSP Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. §1400 et seq.

15. EI Functional skills once every several weeks in home/daycare IFSP IEP Schools Educationally Relevant Classroom or resource room once or twice weekly Treatment Plan Clinic Medically relevant Two or three times weekly 15

16. EI Speech Therapy: Frequency of Service 16  One hour a week = 1% of the child’s waking time (LeLaurin, 1992)  Intervention throughout child’s day = caregiver has to be primary interventionist (Swigert, 2004)  Home visits = mothers reported perception of more control over life events (Affleck et al, 1989)  Intense professional services = increase stress on families (JAQM, Vol.2, No.3, Fall, 2007)  Limit number of professionals & visits to needs of child = decrease stress on families (JAQM, 2007)

17. Parents caregivers Consult Direct service Service Delivery Features 17

18. 18 Menu of Parent / Caregiver Involvement  Grieving  Circumstances  Provides choices to child  Has routine / schedule  Cultural Beliefs  Home language(s)  Willing to modify learning environment  Uses strategies to make positive changes in behavior: adult / child child / child  Participates during visits  Carries through – activities completed between visits

19. 19 Child Development in Communication Speech Communicative Signals: eye contact body movements Gestures: P ointing, showing, waving, head shake/nod Babbling Vocalizations

20. Language Stimulation: Imitation Animal SoundsPlay Sounds 20 Brrrm…Brrrm Moo…neigh-neigh… Baa..oink…quack….

21. GesturesFacial Expressions 21 Imitation

22. Gesture Imitation 22

23. Vocal Imitation 23

24. Sensory Activities and Language Stimulation 24

25. Oral Motor “Using Movement to Help the Mouth” pp.145-146 25

26. 26 Enhancing Communication Development Keyword Signing

27. Mybabycantalk.com 27

28. When something else is needed.. Pointing to PicturesPoint to communicate choice 28

29. When something else is needed.. Receptive Language Visual Supports Expressive Language: 29 Get your shoes

30. PECS: Picture Exchange Communication System

31. Brody 31

32. 32

33. Helpful Resources 33 http://www.childrensmercy.org/healthcar eprofessionals.aspx

34. Beckman Oral Motor Protocol 34

35. Pamela Marshalla Oral Motor Therapy 35 SEVEN STAGES OF PHONEME DEVELOPMENT: 1. PREPARING : getting the voice ready for speech Ex. Use Speech / Sound Activation Toys to encourage voicing kazoo Vowel sounds learned at this Stage: ä, ē, ū, ō, Consonants: m, ng, n Available online for $14.99 at: http://www.trainparty.com/products/ipl4571.html (don’t use whistle at this stage)

36. Using Sound Activated Toy 36

37. 37 Pamela Marshalla Oral Motor Therapy 2. SPEECHIFYING: making “speech-like” sounds & laughing aloud Ex. Use Natural Sound Amplifiers such as bowls & cups, toy microphones, bathtub, to encourage child to play with his voice. Parent Tip: Try recording your child’s voice on your cell phone.

38. 38 Pamela Marshalla Oral Motor Therapy 3. HONING – learns oral motor movements for hissing sounds, popping sounds and stop sounds: sh, z, p, t, b, d, g EX. Raspberries (11 different kinds ) Assign meaning: Lip raspberries = motor sounds Tongue-lip raspberries= rejection Tongue-back of throat=crashing sounds Ex. Pat mouth (like playing Indian) to teach concept of building up inter-oral air pressure. Ex. Vowelizing - “eieio” Old MacDonald

39. 3. Honing …continued…. Uses one syllable words: bee, boo, boe, dough, Dee, day, go 39 Pamela Marshalla Oral Motor Therapy

40. 4. OSCILLATING – Classic Babbling CVCVCV Ex. Use puppet to model babbling Let's Play Elmo Says! Hand Puppet Book 40 Pamela Marshalla Oral Motor Therapy

41. 5. SOLIDIFYING – Baby Talk Ex. “All done” pronounced “aw du” Ex. “What’s that?” pronounced “^ d ă ?” Ex. Banana becomes “nana” Ex. Bird becomes “birdie” adding y or ie 41

42. Pamela Marshalla Oral Motor Therapy 6. ADVANCING - expressive jargon, whispers, sings talks on telephone Ex. Encourage child to “read” familiar storybooks to you 42

43. Pamela Marshalla Oral Motor Therapy 7. FINISHING – Learning to add clusters Child uses phrases, sentences, and conversation. 43

44. Activity Based Scripted Play 44

45. 45NoveltySabotage Violating Expectation Forgetfulness Guided Learning Piece by Piece (Contingency) Incidental Learning (following child’s lead)

46. Literacy: Commenting and Role Playing the Story 46

47. Activity Based Scripted Play “To Her, To Him” (R34a, p.60) 47

48. Activity Based Scripted Play: P sound in “Pop the Bubbles” (S5b, p.127) Imitate / Identify environmental noises “Did You Hear That?” (P44, p.32) 48

49. SLP materials for sounds 49

50. Materials for Sounds Realistic Photo FlashcardsObjects in see through blocks 50

51. 51 How well words can be understood by parents By 18 months a child's speech is normally 25% intelligible By 24 months a child's speech is normally 50 -75% intelligible By 36 months a child's speech is normally 75-100% intelligible Source: Lynch, J.I., Brookshire, B.L., and Fox, D.R. (1980). A Parent - Child Cleft Palate Curriculum: Developing Speech and Language. CC Publications, Oregon. Page 102 Retrieved from Caroline Bowen’s web site: http://www.speech-language-therapy.com/intelligibility.htm

52. Test yields Oral Motor and Speech Sound Development Standard Scores 52 122 Oral Motor Developmental Milestones 12/1/2006 http://www.superduperinc.com/Handouts/Handout.aspx

53. Transition to Three Year Old Program 53

54. Thank you, UCP! 54

55. Now… “Let’s See You Try” 55

56. Heather’s Case Study: S. B. IFSP goals: 1.To say “dada” 2.To speak more clearly 3.To use 2 word phrases and short sentences Observation: does not have front sounds (t,d), likes books, hands-on activities 56

57. Heather’s Case Study: S.G. IFSP goals 1.Communicate with short phrases and sentences 2.Speak clearly so others understand what she says 3.Demonstrate airflow techniques through mouth and nose Clinical Observation & Records: medical diagnosis of repaired cleft palate 57

58. Anne’s Case Study: B.H. IFSP goals: 1.Tolerate food in his mouth 2.Drink from a cup 3.Use words to label familiar objects, people, etc. 4.Use gestures, signs, words to let his needs/ wants be known Observation: B.H. once ate a small piece of playdoh. 58

59. Anne’s Case Study: C.L. IFSP goals: 1.Make choices 2.Imitate sounds 3.Say ‘Mama’ and ‘Dada’ meaningfully 4.Follow simple directions 5.Wait and use words to get what he wants 6.Point to and name body parts Observation: Two older sisters are ‘talking’ for the child, he has difficulty imitating sounds 59

60. Jacynda’s Case Study: S.R. 60 IFSP goals: 1.Follow directions 2.Imitate animal sounds 3.Use gestures with speech games / sing alongs 4.Make requests with gestures/signs/ words Clinical Observations & Parent Report: Child likes Elmo, animals, music and movement

61. Jacynda’s Case Study: D.S. IFSP goal 1.Reach for objects 2.Make choices 3.Activate toys by himself Observation & Records: Can move arms with ‘big’ movements,has difficulty with fine movements, sits with support, has limited vision, has good hearing & responds to verbal directions such as “open mouth” “suck” (straw) “push”. 61

62. Case Study: A.A. IFSP goals: Indicate wants and needs Vocalize / Gesture greeting Use single words Point to pictures Clinical Observation / Family priorities: Child has cerebral palsy, vocalizing is difficult, can point to pictures with either thumb, family wants child to look as typical as possible, wheelchair and communication board mounted on lap tray are only used at school. Mom wants something portable that will fit in diaper bag. 62

63. Send your story to Ms. Willie at willie@gesgc.org BIG THANK YOU TO OUR EI PARENTS! willie@gesgc.org 63