«CHAPTER 5 Hands-On Core Skills: The Speech-Language Pathologist as Facilitator of Positive Communication Change Introduction A brief discussion in ...»
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Hands-On Core Skills:
Facilitator of Positive
A brief discussion in Chapter 1 of this text addressed words used for characterizing the
role of the speech-language pathologist (SLP) in the therapeutic process, words used to
describe the facilitative role of the SLP in the therapeutic process. The role of the SLP in therapy is to facilitate, or promote, increased communication skills in clients. SLPs accom- plish this by blending a thorough knowledge of the profession with the skillful, even art- ful, implementation of core skills in the therapeutic process. These core skills, called therapeutic-specific skills, are fundamental skills that the SLP employs as an ongoing, underlying, and integral part of therapy. Therapeutic-specific skills are skills that actu- ally constitute the underlying fiber, the essence of what SLPs do, fundamentally, to facil- itate increased communication skills in clients; therapeutic-specific skills are what the term implies: skills that are specific to the act of providing speech-language therapy in a manner conducive to effecting communicative improvement in clients. As an illustration, consider the architectural profession and the task of building a home.
Though, perhaps, unable to cite the specifics of design, materials quantity, safety or durability codes, and so forth, the lay public probably has some understanding that, in order to build a home, there needs to be some place to locate the structure, something 83 05_Dwight_Pages 10/24/05 2:22 PM Page 84 84 Here’s How to Do Therapy from which to build it, and some way of ensuring that it holds together over time. Archi- tects know these things, as well. In fact, architects know that no matter how great, or small, the job, there are some underlying basic considerations that must be made in the daily task of operating as an architectural professional; factoring gravitational pull is probably one of those considerations. The architect may also consider the impact of natural elements such as rain, heat, cold, wind, and so forth when working through a project. Regardless of the size, or cost, of the project, it is inconceivable that an architect would design, or oversee, the construction of even a small storage building without considering the basic, underlying principles that serve, so powerfully, to impact activities of that profession. SLPs should view therapeutic-specific skills in the same manner: no matter how easy, or difficult, a case, no matter how old or new the clinical techniques employed, there are some basic considerations that are required as a function of operating as a clinician in the speech-language pathology profession; basic hands-on therapeutic-specific skills are among those considerations. Certainly, therapeutic-specific skills are not all particular to the speech-language pathology profession, for many of these same skills are used by educators, psychologists, and others. However, if used well by the SLP, in conjunction with a good knowledge base of the profession, these skills may well separate the SLP who is adequate, from one who is excellent.
By design, therapeutic-specific skills are basic and global skills; they remain the underlying skills that SLPs bring to the implementation of most, if not all, speechlanguage therapy intervention programs and techniques. For example, when designing a specific fluency program aimed at reducing repetitions, blocks, and prolongations, authors of the program typically outline specific components for intervention, specifying how, when, and why the SLP should implement various aspects of the program. Rarely does the author of a fluency intervention program take the time, however, to teach or remind the SLP of the importance of pace, volume, proximity, enthusiasm, antecedents, direct teaching, and so forth, unless one or more of these therapeutic-specific skills is viewed as an integral part of the fluency intervention program itself; in this case, pace, for example, may be discussed as an integral part of some fluency intervention programs. Yet, it is believed that the authors of any intervention program expect SLPs to inherently know that in addition to learning the specifics of the intervention program, the SLP must also exhibit good clinical use of the core skills mentioned: pace, volume, proximity, enthusiasm, antecedents, direct teaching, and so forth. However, as mentioned, rarely does the author of a specific intervention program build in instruction in the core skills of therapy. How, then, is the SLP expected to acquire these core skills? Other than random occurrences of therapeutic-specific skills dispersed among various intervention programs, clinical supervisors are left to teach therapeutic-specific skills on an “as needed” basis as situations arise during clinical training for SLP students. Fortunately, most clinical supervisors have done good jobs of teaching these core skills, perhaps, using “teachable moments” as a major factor in instruction design. However, it is believed that information presented in this text, particularly in this chapter, serves to systematically help SLPs learn and implement underlying basic core skills that are integral to speechlanguage therapy.
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Individualized SLP Outcomes/Performance Objectives:
Figure 5–1. Therapeutic-Specific Workshop (TSW) Form. This example is for Workshops without the DVD vignettes. Workshops 1, 2, 12, 13, and 14 do not have DVD vignette accompaniments.
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Practice the skills discussed in Sections A–D above. Revisit Sections A–D as needed to increase comfort with this section. Use SLP peers, friends, parents, other relatives, large dolls positioned in a chair in front of you to pose as the “client(s),” etc., for your practices. If no one is available to serve as your client(s), use yourself as the client(s) by standing or sitting in front of a large mirror as you practice; the effect of “using yourself as client(s)” is the same, and sometimes more powerful, than having another pose as client(s).
Repeat practices until items 1–3 below are accomplished. (You may require more or less than the practice check boxes provided.) Check one box each time a skill is practiced. Enter date each skill is accomplished to your satisfaction in the date spaces provided. (Dates may/may not be the same for each skill accomplishment.)
Thought Processes/Emotions I Experienced Learning the Skill(s) Presented in this Workshop
Compared to What I Ultimately Learned from this Effort (Reflection Exercise):
Date Post Organizer Completed: (Enter date here and in upper right corner, page 1):
The Therapeutic-Specific Workshop Form (TSW Form) serves as a learning tool to guide students through the activities associated with learning new therapy skills; this form accompanies each skill to be learned. Additionally, 20 therapeutic-specific skills are highlighted on an accompanying DVD (found within the covers of this text) as demonstrations of how each respective therapeutic-specific skill might be represented within a therapeutic context. As a culminating experience for students learning therapy, two mini-therapy sessions (9–10 minutes in length) are provided for a synthesized view of several therapeutic-specific skills when used within the context of a therapy session. The completion of each TSW Form serves as an indicator that the SLP has both worked through the skills addressed in the selected workshop and has attained an adequate selfassessed level of comfort with the materials presented in the workshop.
The basic foundation for the tutorials SLPs receive in this chapter is the Explicit Instruction Model of teaching, an instruction model that is both highly organized and task-oriented (Miller, 2002). Using an adaptation of this model, SLPs will be provided five cognitive aids designed to help focus content, attention, and learning: advance organizers, descriptions/demonstrations, think-out-loud questions, practice opportunities, and post organizers.
These cognitive aids help the SLP process the components and requirements of each skill
addressed in this chapter.
Before going further, it is important that students obtain a basic understanding of what is required in the workshops for each therapeutic-specific skill. A TSW Form (see Figure 5–1 or Figure 5–2) is provided for each skill to be studied and contains specific procedures students are to follow in learning the selected therapeutic-specific skill. As an example, the Workshop Forms list sections for advance organizers, descriptions/demonstrations, think-out-loud questions, practice opportunities, and post organizers. An advance organizer is information introduced in advance of the new skill to be learned and is designed to bridge the gap between current knowledge and knowledge to be acquired (Williams & Butterfield, 1992). Advance organizers are presented before students proceed in acquiring a new therapeutic-specific skill. Advance organizers are an important part of understanding and gaining comfort in acquiring the therapeutic-specific skills presented in this chapter. Descriptions, well-organized explanations of the skills to be learned and the steps taken in learning the new therapy skill, along with demonstrations, written or visual presentations of skills implemented by the SLP, also serve to help students acquire the skills presented. Think-out-loud questions, which the learner verbalizes to him- or herself, help processing of new information by combining two modalities, auditory and visual, to reinforce retention of new concepts. Prompts for practice opportunities are designated points in learning to practice new skills with help from prompts in the vignettes or on the TSW Form. Prompts for practice opportunities provide the essence of the workshop opportunity; for it is the practice opportunities that ultimately lead to the desired comfort level that students achieve in the learning experience. Prompts for Practice Opportunities offer practice at three levels: (a) practice for accuracy in accomplishing the skill, (b) practice for personal comfort in accomplishing the skill—needed because students often report “feeling strange” practicing the skills, and (c) practice for speed/fluency in accomplishing the skill. Finally, a post organizer, a concluding activity that helps 05_Dwight_Pages 10/24/05 2:22 PM Page 93
Communicating Expectations (Therapeutic-Specific Workshop: Form 1; No DVD Track) The concept of communicating expectations is based on research regarding teacher expectations (Learman, Avorn, Everitt, & Rosenthal, 1990; Rosenthal & Jacobson, 1968;
Smith, 1980). Rosenthal and Jacobson (1968) found that gains in children’s IQs were related directly to the classroom teacher’s expectations for IQs to increase. Replications of the Rosenthal and Jacobson’s (1968) work, often referred to as the “Pygmalion in the Classroom study,” were performed within numerous contexts over several decades (Brophy, 1983; Eden, 1990; Edmonds, 1979), with results indicating that children will perform to the levels expected and communicated, even when such communications are inadvertent nonverbal behaviors (Ambady & Rosenthal, 1992). In fact, Feldman and Theiss (1982) found that teacher expectations influenced student achievement and that preconceptions influenced both student and teacher attitudes. The effects of communicated expectations have broadened to wider circles over the past 10 years in that researchers found relationships between communicating expectations and performance indicators in courtrooms (Blanck, Rosenthal, Hart, & Bernieri, 1990), in management (Eden, 1990), and in nursing homes (Brophy, 1983; Learman et al., 1990) Good and Brophy (1984) suggested ways in which educators may reduce communicating expectations that have negative impacts on students. Among these suggestions
were recommendations for:
something; a zest or zeal for a subject (Webster’s, 1996). Often enthusiasm is portrayed in body movements, changes in vocal pitch and volume, or general attributes of animation.
Webster’s (1996) defined animation as relating to spirit, movement, zest, and vigor. Some SLPs admit that they are not interested in portraying the animation suggested for working with very young clients, even though some of the same SLPs describe themselves as being enthusiastic. Clinical supervisors, must, therefore, survey student SLPs for expressions of enthusiasm and animation sufficient for effective speech-language therapy.
When that level of enthusiasm is not present, it must be taught. This is where the concept of Showtime becomes important.