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Email The purpose of this article is to describe the clinical decision making process that was utilized in implementing a speech sound intervention program delivered five times a week in individual telepractice therapy sessions lasting six minutes to school-age students in kindergarten through fifth grade K We utilized a clinical decision making process Kamhi, to help establish this alternate way to provide speech sound intervention that resulted in improved speech intelligibility in the classroom in an efficient manner.

Initial data collection on student outcomes will be provided. Limitations of this initial experiment are discussed with guidance provided for possible future research studies. Integrated Speech Solutions, a private practice based in Beckley, WV, has been providing speech-language therapy services to school-age students using a telepractice service delivery model since Students with speech sound impairments make up a substantial portion of our caseload of school-age students.

Clinically, we wanted to consider how to provide speech sound intervention that resulted in improved speech intelligibility in the classroom in the most efficient manner. This article describes the clinical decision making process we utilized to implement a high frequency how often therapy is provided and high intensity number of productions within a session speech sound intervention delivered to students in kindergarten through fifth grade K These individual, six-minute sessions were conducted using a telepractice service delivery model five times a week following a school calendar for an academic year.

The prevalence of SSDs, along with a long history of intervention, has led to a rich treatment efficacy research base Tyler, There is no debate that intervention for SSDs is effective Tyler, These models describe individual, intensive intervention sessions ranging from 5—30 minutes, five days a week, for a period of time ranging from two weeks to an academic school year. Historically, frequency and intensity of intervention have not received much attention in published research Kamhi, In a systematic review of treatment intensity amount of practice in speech disorders, Kaipa and Peterson suggested that currently available research promotes higher treatment intensity over lower intensity for SSDs.

Efficiency evidence exists for language and literacy training using intensive intervention sessions delivered five days a week for 2—4 weeks Kamhi, ; National Reading Panel, Based on the data from these related areas, it seems reasonable to consider providing SSD intervention using an intensive treatment schedule. In the school setting, intervention must involve removing barriers to accessing the general curriculum rather than targeting only specific speech skills Clapsaddle, n.

Time spent away from the classroom in pull-out speech intervention sessions may result in children missing significant classroom instruction. Given these requirements, a school-based SLP must consider time-saving, effective methods for speech sound intervention which result in improved speech intelligibility in the classroom. Students in both service delivery models made significant improvements in speech sound production.

In , Grogan-Johnson and colleagues investigated the progress made by 14 children ages 6—10 years with identified speech sound disorders who were randomly assigned to intervention delivered in a side-by-side or telepractice service delivery model. Intervention was provided twice a week for minute individual sessions during a five-week summer intervention program. Children in both service delivery models made improvement in their speech sound production during the program.

There were no significant differences between the two groups on post-intervention assessments including standardized assessment and listener judgments of word productions. These findings suggest that speech sound intervention can be conducted using the telepractice service delivery model and contribute to a promising body of research suggesting that telepractice is a reasonable service delivery option for SLPs.

Years of experience working with students with SSDs and working with a telepractice service delivery model varied among the SLPs. No unique, specific clinical expertise in the area of SSDs or remediation was identified for any of the SLPs involved in this project.

However, all of the SLPs expressed clinical concerns about caseload management, challenges with obtaining enough practice within small group therapy speech sound intervention sessions, and providing efficient and effective intervention within the confines of the public school setting daily schedule.

Discussion of these clinical concerns led to the SLPs volunteering to participate in this project. As a result, school districts, especially in the most rural areas of the state, face significant challenges finding adequate speech-language therapy services. Integrated Speech Solutions contracted with four rural school districts to provide speech and language therapy services through a telepractice service delivery model. The districts based their decision to utilize the telepractice service delivery model solely on the lack of access to in-person service availability.

All of the districts had access to in-person services but they were understaffed for the number of children who required intervention. We discussed the intensive speech sound production intervention program with the school administrators and teaching staff.

While they had no experience with this type of intervention, both administrators and teaching staff were willing to trial this service delivery method. The school administrators were interested in the potential for students to make more rapid progress in therapy thereby reducing caseload sizes and potentially staffing needs. The classroom teachers were interested in the model as the students were not missing 30 minutes of instruction on a regular basis.

In addition, the potential for children to more quickly achieve their targeted speech sound goals may result in less time away from the classroom. Initially parents were skeptical of the service delivery model and only became supportive after observing their child working in a telepractice session.

In addition, the educational consultant for speech and hearing from the WV Department of Education publically supported the use of telepractice and a daily intensive speech sound intervention model as a way that WV SLPs could reduce their caseloads and improve services for children in the public school setting.

The consultant recommended the use of these services in public schools in the state to improve access to adequate speech-language therapy services. Clinical Decision Making Process: Experimental Validation of the Therapy Approach With Individual Clients The clinical decision process led us to implement a high frequency and high intensity speech sound intervention program with school-age clients in our telepractice private practice.

How does six minutes of individual speech sound intervention delivered five times a week for an academic year compare with 30 minutes of small group speech sound intervention delivered once a week for an academic year for the school-age children with speech sound disorders that we serve in our private practice?

Are there unique characteristics of our telepractice service delivery model that would facilitate or hinder delivery of intensive individual speech sound intervention? Method Participants Participants were recruited from four school districts in WV during the school year. Students identified as having a speech sound impairment and currently receiving speech intervention services through an IEP were eligible to participate. A speech sound impairment was the only identified communication deficit for these participants as none exhibited concomitant language or fluency impairments.

Eighteen students in grades K-5 participated in this study. Twelve of the students were male and six were female. Nine of the students received intervention in a small group 2—3 students therapy provided in pull-out sessions once weekly for 30 minutes following their IEP goals, and nine students received intervention in individual pull-out telepractice sessions five times weekly for six minutes following their IEP goals. As seen in Table 1 , intervention targets varied by size and type of speech sound s.

Table 1. Participant Characteristics.



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FIM or Foe?

The FIM instrument consists of 18 clinical areas, including ambulation, self-care, cognition, and communication. All items can be scored by any trained health care professional. The FIM also requires that each patient be scored at admission and discharge on each of the 18 clinical areas. Since its inception, however, clinicians working in inpatient rehabilitation settings have reported dissatisfaction with the FIM. They have criticized its lack of sensitivity in measuring cognitive, communication, and swallowing skills, as well as its inability to adequately reflect speech and language services.

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