say it right, llc missing...

10/14/2017

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Module 1R Makeover

Course

Missing Links#1-4

© 2016 Say It Right. All Rights Reserved.

Developed and Written by Christine Ristuccia, M.S. CCC-SLPWith Consultation and Edits by Leslie J. Dulay, M.A. CCC-SLP

Say It Right, LLC

This handout is for reference only. It may not include content identical to the PowerPoint.

Any links included in the handout are current at the time of the recording of this course, but are subject to change and may not be current at a later date.

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Need assistance or technical support?

Click on technical support at the top of the course registration page.

Email: Help.commpartners.com

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Financial Disclosure

I am the owner of Say It Right and the author of The Entire World of R.

What is a Missing Link With /R/ Remediation?

A Missing Link is a Misunderstanding

Misperception

About what how to evaluate or treat the /R/ phoneme.

Missing Links #1-4 Learner Outcomes

Describe the 4 Missing Links to /R/ remediation.

Describe prior education and knowledge about /R/ remediation.

Explain 4 personal beliefs about /R/ evaluation and remediation.

Explain the 4 categories of /R/ and the 32 /R/ allophones.

Describe at least 3 main components of a comprehensive /R/ assessment.

Explain 3 ways to choose a customized target for each individual /R/ student.

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Module One: Missing Links # 1-4Course Agenda

Introduction

Missing link #1: /R/ education.

Missing link #2: SLP beliefs.

Missing link #3: Comprehensive assessment.

Missing link #4: Choosing a customized target.

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1. Lack of /r/ education-phonemic approach

2. SLP perceptions with /r/

3. Lack of comprehensive evaluation

4. Lack of customized target

5. Lack of success with tongue placement

6. Lack of phonetically consistent production practice lists

7. Lack of strategy for chronic /r/ students

8. Lack of customized homework

9. Lack of generalization

10. Lack of timely graduation

10 /R/ MISSING LINKS


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Graduate school — Learned limited amount about /r/.

CFY year — Made little to no progress with /r/ students.

Very embarrassed in front of administration and parents.

Adult — Asked resource specialists how to work with /r/ with reading disorders.

Today — Working with the necessary links for /r/ makes it a systematic and scientific process.

MY /R/ STORY


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Change your mind about /R/.

I have always been successful with /R/.

It’s not because I’m special, but because I’ve developed a ton of faith in my scientific process.

BE OPEN TO A NEW APPROACH


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• Evaluate 32 variations of /r/

• Find the “key word” —successful production

• Keep a running list of key words

• Choose a customized target

• Determine natural tongue position

• Practice using targeted production practice lists

• Practice at least 150 correct productions per session

• Use homework consisting of key words

• Measure carryover — key words tracked in session and words heard in conversational speech

THE /R/ THERAPY RULES


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32 /r/ allophones

MISSING LINK #1

/R/ EDUCATION


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4 categories of /R/

32 total /R/ allophones

We implement Van Riper’s traditional articulation approach with /R/ therapy utilizing the phonemic approach.

/R/ EDUCATION


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REFLECTION: WHAT WAS YOUR EDUCATION WITH /R/?

What did you learn in school?

What do you learn in clinic/school placement?

How does this education impact the way you service students?


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FOUR MAIN CATEGORIES OF /R/

Prevocalic

R Blends

Vocalic

RL© 2016 Say It Right. All Rights Reserved.

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REFLECTION: EDUCATING PARENTS

Knowing about the 32 /R/ allophones or sounds, how will this impact the way you educate?:

Students Parents Teachers/administrators


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THERE ARE MORE /R/s THAN YOU THINK

Prevocalic

/R/

AR

Initial

AR

Medial

AR

Final

AIR

Initial

AIR

Medial AIR

Final

EAR

Initial

EAR

Medial

EAR

Final

IRE

Initial

IRE

Medial

IRE

Final

ER

Initial

ER

MedialStressed

ER

MedialUnstressed

ER

Final

OR

Initial

OR

Medial

BR

KR

DR

GR

THR

SHR

FR

STR

PR

SPR

Medial &

Final

RL

OR

Final

TR

MANY UNIQUE /R/’s TO CONSIDER!


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[er]Ernie

buttercup

feather

[or]Orville

corn

four

[ar]Archie

barn

star

[air] Erin

ferry

fair

[ire]Ireland

fire

fireman

[ear]Erie

cereal

deer

666 CATEGORIES OF VOCALIC /R/


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OVERVIEW OF /R/ BLENDS


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There is no consistent placement as there is for other phonemes

(e.g. /t/ or /s/ is on the alveolar ridge)

PLACEMENT: /R/ IS DIFFERENT FROM OTHER PHONEMES


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THE PLACEMENT CHANGES 32 TIMES WITH EACH OF THE 32 /R/ ALLOPHONES

The /r/ is produced the same (retroflexed or retracted) but changes depending upon the word and the sounds that proceed it or come after it.

Blends: /r/ comes after the consonant (brown)

Vocalic /r/: /r/ comes after the vowel (Archie)

Prevocalic /r/: the vowel after the /r/ can affect the error patterns of w/r substitution (read, red, rid)

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Recognize your beliefs

MISSING LINK #2

SLP BELIEFS ABOUT /R/


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What are your negative beliefs about /R/?

What are your experiences about working with /R/ students?

REFLECTION: WRITE A NEW STORY ABOUT /R/


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/R/ is difficult

/R/ students are “lifers”

/R/ students have structural abnormalities

vocalic /R/

placement

no carryover

SLPs’ STORIES ABOUT /R/


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/R/ is difficult with the traditional approach of using initial, medial and final word positions

Compare the 2 approaches and contrast how the lists are the

same different

/R/ IS DIFFICULT


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CO M P A R E T H E T W O W O R D L IST S


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This course will teach you the 10 steps to achieve timely graduation.

Module 3, working with chronic /r/ students, will give you a step by step process for how to re-direct lack of progress.

LIFERS—/R/ STUDENTS DO NOT GRADUATE


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Before believing that statement to be true, and sharing your opinion with parents, please ask yourself the basis for your findings.

Perform oral mechanism exam

Check for mobility of frenulum

Check natural tongue position

DO /R/ STUDENTS HAVE STRUCTURAL ABNORMALITIES?


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According to research, 95% of students can produce at least one type of /R/ (Curtis & Hardy, 1959; Ristuccia, 2005).

It is important to screen all 32 /R/ allophones and do an oral mechexam.

/R/ STUDENTS HAVE STRUCTURAL ABNORMALITIES


BROCKBeginning of 4th grade year, 6 months years of therapy for R, 1 SLP.

Intervention in public school setting.

Mother shared with me that she was concerned because of regression.

Brock was unmotivated due to lack of progress.

SLP used retroflexed tongue position with all students.


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https://www.youtube.com/watch?v=jjuOcolCfv8

FINDING A CORRECT PRODUCTION


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REFLECTION: OBSERVATIONS OF BROCK

What was your impression of Brock during the video?

What did you hear in conversational speech/structured conversation?

What did you notice during conversation? What did you visually see?

What did you hear?

How natural did the conversation sound?


I ignored how he sounded in conversational speech.

How did he sound during the screening?

Process: administration of screening to find a successful production

INITIAL OBSERVATIONS OF BROCK


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• Did you hear any correctly produced words?

• If no “perfect” productions, did you hear any approximations or words that were closer to a correct production?

• Listen for student success

DID BROCK CORRECTLY PRODUCE ANY WORDS?


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SAN DIEGO UNIFIED SCHOOL DISTRICT (SDUSD) STUDY (2005)

• 31 students aged 6 to 14 years

• tracked for 6 months

• single subject design

• two baseline screenings per student


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STUDY (2005) SUPPORTS USING A PHONEMIC APPROACHT /R/

• Between 15 to 20 hours of treatment

• Method: treat single target until 80% accuracy achieved at the sentence level for 5 sessions.


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CORRECT PRODUCTIONS AT BASELINE SCREENING

0

10

20

30

40

50

60

70

prevo

calic

r

ar initia

l

ar medial

ar final

ear initia

l

ear medial

ear final

air initia

l

air m

edial

air fin

al

ire in

itial

ire m

edial

ire fi

nal

or initia

l

or medial

or final

er initia

l

er med s

er med us

er final rl


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IMPROVEMENT BY OVERALL PERCENTAGE FOR EACH OF THE 31 STUDENTS FROM BASELINE SCREENING TO END OF

INTERVENTION


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STUDENT SAMPLE 1:IMPROVEMENT % BY # OF HOURS OF THERAPY


STUDENT SAMPLE 1:IMPROVEMENT % BY # OF HOURS OF

THERAPY


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Study findings supported the Every Child Succeeds Act and helped add accountability for students’ /R/ therapy goals.

Study Results

80% of students corrected 5 or more /R/ variations.

58% ended with 3 or fewer errors.

7 students were dismissed.


100% OF STUDENTS GENERALIZED

/R/ ALLOPHONES!


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SLPs IN STUDY HAD COMMON FEEDBACKScreening proved to be an excellent tool to

determine present level of performance.


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SLPs IN STUDY HAD COMMON FEEDBACK

Having one intervention target proved effective in achieving generalization.


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Goal: Find “key words”

MISSING LINK #3

LACK OF A COMPREHENSIVE /R/

ASSESSMENT


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ASSESS /R/ PRODUCTION IN A VARIETY OF CONTEXTS- STAGE 1

Single Word Screening Advanced Screening If necessary: Elicitation Probe administration Structured conversation: Rainbow passage Conversational speech sample-note correct /R/’s

Goal: Find student strengthsFind at least one correct /R/ production


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32 ALLOPHONES OF /R/ NEED TO BE EVALUATED

Standarized assessments tend to evaluate limited

amount of /R/ sounds.

32 /R/ allophones provide more opportunities to

find an /R/ that the student can successfully

produce.


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THERE ARE 2 SCREENINGS AVAILABLE TO HELP YOU WITH YOUR /R/ EVALUATIONS


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THE ENTIRE WORLD OF R SCREENING FORM


EXAMPLE OF SINGLE WORD SCREENING

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Click here to Advance Slide

Click Here for Video

THE ADVANCED SCREENING TOOL FOR /R/

© 2016 Say It Right. All Rights Reserved © 2016 Say It Right. All Rights Reserved.

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• Create space for progress through knowing student’s strengths and weaknesses

• R can be worked on with ease.

• The doubt of thinking that a student cannot be successful takes up a lot of energy.

• Worry-the nagging feeling of past of perceived failure.

• What does this failure feel like for you?

• What things contribute to your funky beliefs about /r/?

THE /R/ SCREENING IS POWERFUL!


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Use “key words” to determine the optimal target

MISSING LINK # 4

LACK OF CUSTOMIZED

TARGET


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The most ideal set of words to practice (gauging student success/comfort during speech production) to achieve carryover into everyday conversations.

Generally it is choosing one specific allophone or sound from the possible 32 /r/ allophones.

Example: serious (ear medial), herbal (er initial), wonderful (ermedial unstressed)

WHAT IS A TARGET?


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1. Effective target selection — Module One.

2. Tongue placement.

3. Phonetically consistent practice words based upon student’s success.

4. Student mass practice (150 correct productions) is essential to progress-based upon student’s success.

5. Effective homework-student correct production list.

THERE ARE 5 WAYS TO CUSTOMIZE /R/ INTERVENTION


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Target selection is not based on student's ability. Teaching one allophone of /R/ which is customized

results in the production of other related allophones (Gierut, 1986).

INTERVENTION NEEDS TO BE CUSTOMIZED


REFLECTION: IS YOUR INTERVENTION CUSTOMIZED?

Do you treat all of your students as individuals?

If so, what is your process?

If not, where can you customize intervention so it is more tailored to meet your specific student’s needs?


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1). Key word list-student correct production list• Generated in Stage One

• Taken from screening assessments

• More detail in Module 3: Ear Training Course

2). Baseline results page• Stage One

• Score allophones on Advanced Screening Tool

• Choose allophones that are 50-80% correct

THERE ARE 2 METHODS FOR CHOOSING A TARGET


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TARGET SELECTION: CONTRASTING CORRECTLY PRODUCED OR “KEY” WORDS WITH OTHER WORDS

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Click Here for Video Click here to Advance Slide

POSSIBLE TARGET OPTIONS WITH STUDENT CORRECTLY PRODUCED WORDS: FEEDBACK FROM

ADVANCED SCREENING RESULTS

• Area

• Serious

• Ireland

• Wonderful

• Herbal

• Printed

• The trash

• Strung the lights

• A straw hat

• The cat played with string

• Joe strung the lights

• Cereal

• Fireman

• orange

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CORRECTLY PRODUCED WORDS: CONTRASTED WITH WORDS THAT ARE EFFORTFUL

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Click Here for Video Click here to Advance Slide

OBSERVATION: CORRECT “KEY” WORD

PRODUCTION PRACTICE- (STAGE 2 ) TO CHOOSE A NEW TARGET

What word sounded the best to you?

What word looked and sounded natural?

What are your thoughts about involving the student in choosing a word category to practice?

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CONTRASTED WORDS: CORRECTLY PRODUCED “KEY” WORD LIST

Take the… BEST word from list

&

one of the WORST productions

&

contrast:

Ireland/serious herbal/Ireland area/serious

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CORRECTLY PRODUCED“KEY” WORDS LIST

Use key words for Warm up To reach goal: Practice 150 correct

productions/session

Comfortable speech Natural sounding and looking speech Students have a relationship to these words

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Work with student’s correct productions on the screening.

Use “correctly” produced key words from screening assessment.

GOALS FOR CHOOSING A TARGET TO PRACTICE FOR CARRYOVER


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Increase student’s kinesthetic awareness of what the tongue is doing during correct productions.

Student success is the priority: If the student is not successful, 60% or greater with one of the 7 carryover levels then choose another target from students correct productions or key word list.

KEY WORDS LIST or STUDENT CORRECT PRODUCTIONS LIST:

WHY USE STUDENTS’ STRENGTHS?


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TARGET SELECTION-USING KEY WORD ASSESSMENT TOOLS

Target options determined from screening

1). Single word screening:

If less than 5 key words:

2). Advanced screening:

If less than 5 key words:

3). Elicitation probe

facilitating contexts


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CHOOSE ANYTHING BETWEEN

50% AND 80%:

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POSSIBLE TARGET OPTIONS FROM BASELINE RESULTS

Use EWR Book of Elicitation Techniques-for target lists

• Ar initial->see ar initial probe list on pg. 151

• Ar final->see ar final probe list on page 153

• Ire medial-> see ire medial probe list on pg. 184

• Ire final->see ire final probe list on pg. 185

• Or final->see or final probe list on pg. 196


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The list with the most amount of correct productions is the ideal target for your student.

1). Use the correctly produced words from the /R/ screening.

2). Have the student produce each word from the “Key” word list.

3). Determine which /R/ sounds the best.

4). Practice target until…

Student is unsuccessful.

80% success at the sentence level (mastery).

SUMMARY: STEPS FOR CREATING A CUSTOMIZED TARGET


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