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Sunday, August 6, 2017

EBP - Part 2


Welcome to Part 2 of EBPs for SLPs! In case you missed it, EBP stands for Evidence-Based Practices. As Speech Language Pathologists, EBPs are an integral and natural part of what we do everyday. Part 1 introduced 15 of these 27 EBPs, established by the National Professional Development Center on Autism Research as being effective for students on the Autism Spectrum. Let's dive in to the final 12. 
16. Reinforcement (R+): A response occurring after a behavior resulting in an increased likelihood of future recurrence of that behavior. While it would be nice if all our students were intrinsically motivated to work on their speech goals all the time, the truth is this stuff is hard for them! That's why "great jobs," high fives, and stickers are a regular occurrence in our speech rooms. Social, tangible, maybe even edible, I think we can safely say positive reinforcement is a regular part of our practice. 

17. Response Interruption/Redirection (RIR): Use of prompts or distractors during an interfering behavior that diverts attention and reduces behavior. Now I'm super careful to not REINFORCE a disruptive behavior, but ignoring and moving forward with an engaging activity, letting a child take a turn when he's calm, can be very effective. SLPs working in early intervention are masters at this. I mean it's pretty hard to cry and blow bubbles at the same time right? Music is another great distractor and my personal favorite when my little ones are upset. We SLPs always have a few RIRs tucked away to pull out in case of a meltdown. Because hey, it's what we do. And guess what? It's Evidence-Based. 
18. Scripting (SC): A verbal or written model of a skill or situation that is practiced before use or in context. As SLPs we understand first-hand how powerful visual support and repetition are for our students, especially those on the spectrum. We use scripting all the time when role-playing social scenarios, scaffolding sentences, and summarizing texts. 

19. Self-Management (SM): Instruction on discrimination between appropriate and inappropriate behaviors and accurate self-monitoring and rewarding of behaviors. Again if you're familiar with Michelle Garcia Winner's Social Thinking curriculum and the concepts of "Expected" and "Unexpected" behaviors, then you're familiar with this EBP. Working with children with pragmatic language challenges, this one's right up our alley too. 

20. Social Narratives (SN): Descriptions of social situations with examples of appropriate responding. Carol Gray's Social Stories provide a great framework, but sometimes the best narratives are the ones we create spontaneously in the moment, to help an anxious student deal with a fire alarm or a young child learn to share. We may not all be amazing artists, but we've seen how a few sketches paired with simple explanations can go a long way in helping our students understand social expectations. So keep it up! It's Evidence-Based!

21. Social Skills Training (SST): Direct instruction on social skills with rehearsal and feedback to increase positive peer interaction. Check! As SLPs we're bound to have at least a few students on our caseloads working on social skills. And I'm not going to lie, breaking these skills down to explicitly teach can be TOUGH. I don't get it right every time, but with our natural empathy and commitment to our students we're perfectly suited to the task. This Conversation Tracker has also been huge for me in simplifying these complex skills. 
22. Structured Play Group (SPG): Adult led small group activities that include typically developing peers and use prompting to support performance. Any decent special education program will provide time for mainstreaming. But proximity to typical peers is not enough. Research suggests our students learn best from their peers in a structured environment with adult support. Offering a "lunch bunch" with peers is one idea for a SPG, or consider a reverse mainstreaming model by volunteering to run a small speech center in the general education classroom. 

23. Task Analysis (TA): The process of breaking a skill into small steps that are systematically chained together. For some of our students, even simple tasks can seem overwhelming. That's where TA comes in. Anytime we break a task down into a sequence of steps we're using this EBP (think functional motor activities like washing hands, tying shoes, or making a sandwich). We can also coach teachers in this powerful EBP to help our students be more successful in their general education environment. For example instead of saying, "Everyone get ready for the spelling test" our students may need to be told, "First take out a piece of paper and a pencil, then fold the paper in half lengthwise, and last write your name in the top right hand corner." 
24. Technology-Aided Instruction and Intervention (TAII): Intervention using technology as a critical feature. Nothing will ever take the place of face to face social interaction but SLPs understand that technology absolutely has its place in speech language therapy, either as speech generating device such as Proloquo2Go or tool to build listening comprehension and language concepts like syntax, vocabulary, grammar, and pragmatics. Each student's individualized goals will always guide the programs we use, but a couple of my favorites for school-age and middle school students include Auditory WorkoutRainbow Sentences, and Between the LinesMany of these track data as well, so it's no surprise they're evidence based.  

25. Time Delay (TD): Delaying a prompt during a practice opportunity in order to fade the use of prompts. Another EBP we use intuitively. Giving our students the opportunity to respond on their own, prompting only when necessary, is how we move them toward the ultimate goal of independence. 

26. Video Modeling (VM): A video recording of a targeted skill that is viewed to assist in learning. The interactive iPad app, Social Expressmodels a variety of social behaviors and has been a hit in my speech room. And having students analyze videos of their own interactions can increase self-awareness of eye contact, facial expressions, body position, and proximity. Admittedly this is one I'm trying to incorporate more.  

27. Visual Support (VS): Visual display that supports independent skill usage. Research suggests that visual supports can help students on the spectrum process information easier and more quickly. It can also reduce reliance on verbal prompts, increasing  independence. Using a Picture Exchange Communication System (PECS) for functional communication, referencing a list of expected behaviors, or checking a visual schedule, I can think of so many examples of how SLPs use this EBP. 

Well there you have it. See? EBPs are a huge part of our therapy practice everyday!

So the next time someone asks you . . . 
You can respond with confidence. Because as SLPs we've got this EBP thing on lock.   

I know I'm just scratching the surface here. I'd love to hear more examples of the EBPs you use in therapy. I'm always fired up to hear new ideas so drop me a line in the comments below!



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