and identifying the “ active ingredient ” of an inter-vention, representing the place in which learning and development takes place. Baker refers to this as an evidence-based kernel (as infl uenced by the work of Emby & Biglan, 2008), whereas Warren et al. (2007) refer to this as teaching episodes, representing the “ locus of learning ” (p. 71). For studies of interven-tion intensity to move the fi eld forward and, ulti-mately, to have impacts on clinical practice, we must learn a great deal more about when, exactly, learning takes place. This will require both basic research seeking to identify these episodes of learning within the therapeutic context, as well as applied investiga-tions involving systematic manipulations of those episodes. A small body of work on emergent literacy intervention has provided some helpful inroads into how intensity might be infl uential in designing inter-ventions for young children. In the remainder of this commentary, we will explore how Baker ’ s description of optimal intervention intensity applies to current research on emergent literacy, and highlight aspects of the literature that support as well as refute com-ponent factors of intensity as outlined by Baker (2012). We will begin this commentary with an overview of current research that is improving our understanding of intensity of emergent literacy interventions. Then, we will discuss a need for future research that can

Introduction

Intensity of intervention is a complex and multidi-mensional construct evoking considerable interest by clinical speech-language pathologists for many years but little interest or attention by the research com-munity. We are optimistic that this trend will change in the near future, given efforts by Warren, Fey, and Yoder (2007) to operationalize the intensity construct for the speech-language treatment community and experts such as Baker (2012) to explicitly frame the need for attention to this issue. Our research team has been particularly interested in addressing issues related to improved understanding of intervention intensity as it relates to delivering emergent-literacy focused interventions to children at-risk in this area of development (see McGinty, Breit-Smith, Fan, Justice, & Kaderavek, 2011; McGinty, Justice, Piasta, Kaderavek, & Fan, 2012; Piasta, Justice, McGinty, & Kaderavek, 2012; for an overview, see Breit-Smith, Justice, McGinty, & Kaderavek, 2009; Kaderavek & Justice, 2010).

Our own efforts have been infl uenced by the con-ceptualization of intensity as discussed by Baker (2012) and based on Warren et al. (2007) in which intensity must be considered in terms of dose, dose frequency, and total intervention duration. As Baker points out, central to such effort is understanding

Correspondence: Mary Beth Schmitt, Department of Speech and Hearing Sciences, The Ohio State University, 356 Arps Hall, 1945 N. High St. Columbus, OH 43210, USA. Tel: 972-345-0943. Fax: 614-292-7696. E-mail: schmitt.143@osu.edu

International Journal of Speech-Language Pathology, 2012; 14(5): 451–455

ISSN 1754-9507 print/ISSN 1754-9515 online © 2012 The Speech Pathology Association of Australia LimitedPublished by Informa UK, Ltd.DOI: 10.3109/17549507.2012.687057

COMMENTARY

Optimal intervention intensity for emergent literacy: What we know and need to learn

MARY BETH SCHMITT & LAURA M. JUSTICE

The Ohio State University, Columbus, OH, USA

Abstract In response to Baker (2012) unpacking critical components of optimal intervention intensity, this article explores what is currently known regarding intervention intensity for emergent literacy for children at risk for delays in this area of develop-ment. Studies specifi cally addressing intervention intensity related to phonological awareness and print knowledge suggest that more intensity does not always yield better results, and other factors suggested by Baker may infl uence the impact of intensity on children ’ s outcomes. However, none of the research to date includes speech-language pathologists or children with diagnosed language disorders in the intervention models. Future research involving large-scale, systematic focus on intervention intensity in emergent literacy for children at risk for future reading disorders is needed to fully understand this construct within speech-language pathology services.

Keywords: Literacy , treatment , intervention , pre-school.

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452 M. B. Schmitt & L. M. Justice

allow a direct assessment of the interplay among the intensity components viewed as uniquely and cumu-latively infl uential (Baker, 2012, Figure 1) towards children ’ s literacy development during speech-language intervention.

Current research on intensity of emergent literacy intervention

A large body of experimental research has sought to determine the effi cacy and effectiveness of emer-gent literacy intervention for young children (see National Early Literacy Panel, 2008, for a review), including children with communicative impair-ments (e.g., Gillon, 2000; Justice, Kaderavek, Bowles, & Grimm, 2005; McNamara, Vervaeke, & van Lankveld, 2008). As a rule, the issue of intensity is central to the design of these interventions: it is generally accepted that effective emergent literacy interventions need to be intensive, explicit, and sys-tematic to achieve their idealized outcomes (i.e., reducing children ’ s risks for future reading prob-lems). Interestingly, however, very few studies have actually assessed planned variations in intensity components; thus, conceptualizations of intensity as they are embedded in various approaches to emergent literacy intervention approaches seem to be uninformed by any empirical or even theoretical notion of optimal intervention intensity.

To our knowledge, only two programs of study have systematically looked at experimental manipula-tion of intensity as related to emergent literacy inter-vention: Ukrainetz ’ s work related to phonological awareness (Ukrainetz, Nuspl, Wilkerson, & Beddes, 2011; Ukrainetz, Ross, & Harm, 2009) and Justice ’ s work related to print knowledge (Justice, Kaderavek, Fan, Sofka, & Hunt, 2009; McGinty et al., 2011, 2012; Piasta et al., 2012). We will look at each con-struct separately.

Phonological awareness

Phonological awareness is an emergent literacy skill considered a critical precursor to skilled word recog-nition; it refers to an individual ’ s sensitivity to the sound structures of spoken language. There have been numerous studies of the effi cacy of phonologi-cal awareness intervention for young children over the last three decades, following the seminal work of Bradley and Bryant (1983). A meta-analysis that included systematic assessment of this body of work (National Reading Panel, 2000) drew some conclu-sions specifi c to the issue of intensity, specifi cally as related to the overall duration of intervention. In par-ticular, study results suggested that 5 – 18 hours of total phonological awareness instruction seemed to relate strongest to improvements in phonological awareness, whereas instruction persisting more than 18 hours appeared to result in diminishing returns.

Relevant to Baker ’ s (2012) theoretical model for calculating optimal intensity, these correlational results suggest that more may not always be better. In other words, it may be relevant not just to study how much treatment is provided to see changes in children ’ s outcomes, but also at what point increased intensity is no longer effective in causing change.

Such fi ndings were extended in an important way by Ukrainetz et al. (2009), who conducted a thought-fully designed study of phonological awareness intervention that specifi cally manipulated session frequency. This randomized control trial involving kindergarten students (all viewed as being mildly or moderately at risk for reading delays) who were assigned into one of three groups: regular classroom instruction only (control), classroom instruction plus a short duration supplemental phonological awareness intervention, and classroom instruction plus a long duration supplemental intervention. The two experimental groups received a total interven-tion frequency of 24 sessions (12 hours). The short duration group received instruction 3-times per week for a total of 8 weeks, whereas the long duration group received instruction once a week for 24 weeks. The dose (i.e., 20 teaching episodes) and length of session (30 minutes) was kept constant for both groups; thus this work provides an explicit assess-ment of the potential infl uence of one aspect of inter-vention intensity, namely session frequency with a direct contrast of high frequency intervention (3-times weekly) and low frequency intervention (1-time weekly). Study results showed that, in gen-eral, there was no benefi t of massed practice (3-times weekly sessions over 1-time weekly sessions) for stu-dents; in short, there was no difference in immediate or end of year outcomes between the more con-densed intervention condition and the more dis-persed intervention condition.

There are several take-away points from the research on phonological awareness intervention. First, correlational evidence suggests that there may be a point of diminished returns on phonological awareness intervention lasting longer than 18 hours (NRP, 2000), although the range of possible effective intervention intensity recommended is quite broad (5 – 18 hours). Second, the National Reading Panel report (2000) suggests, as does Baker (2012), that many factors could contribute to the frequency with which an intervention should be applied to see improvements in phonological awareness, such as number of tasks targeted, the diffi culty of the tasks, the size of the intervention group, and the risk status of children receiving the intervention. Third, results from Ukrainetz et al. (2009) suggest two main points: (1) that more frequent intervention sessions may not be better than less frequent intervention sessions in terms of immediate and long-term reading outcomes for children, and (2) that the time and method of instruction required to see gains in phonological awareness may differ for children mildly at risk vs

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Emergent literacy intensity 453

moderately at risk for future reading problems. For those moderately at risk, their results suggest that additional, supplemental instruction is critical for improved phonological awareness skills, regardless of the dispersion of those sessions. Further research is needed to understand what other aspects of inter-vention infl uence recommended duration of phono-logical intervention.

Print knowledge

Print knowledge is another aspect of emergent lit-eracy development that refers to children ’ s knowl-edge about the written language system. Among young children, print knowledge is considered an important precursor to children ’ s successful transi-tion to learning the alphabetic principle. There are a number of intervention studies that look specifi cally at the effi cacy and effectiveness of promoting chil-dren ’ s early print knowledge, including a small set of studies focused on literacy-enriched play (e.g., Neu-man & Roskos, 1994; Vukelich, 1994) and a larger set of work focused on print-focused shared story-book reading (e.g., Justice & Ezell, 2002; Justice, Kaderavek, et al. (2009); Lovelace & Stewart, 2007). Our own work has focused on the latter, and in recent years our team has begun to systematically explore how intensity may be infl uential to moderat-ing children ’ s gains from print-focused storybook reading. In general, studies on print-focused story-book reading have involved highly variable schedules of implementation. For instance, an early study of print-focused reading featured parental implementa-tion of 16 reading sessions, each involving reading of two separate books with their children over a 4-week period and no systematic attention to issues related to dose form (e.g., the actual teaching episodes within each session; Justice & Ezell, 2002). A later extension of that work involved teacher implementa-tion of 120 reading sessions, each involving a single book, with children over a 30-week period with a recommended dose regiment of four teaching episodes per session (Justice, McGinty, Piasta, Kad-eravek, & Fan, 2009). In both studies, impacts of intervention exposure on children ’ s print knowledge were moderate-to-large in size. Given the large vari-ation in intervention intensity across such works, Justice and colleagues have recently sought to sys-tematically explore issues related to intensity of this approach to emergent literacy intervention.

In one such study, McGinty et al. (2011) con-ducted a randomized controlled trial for pre-school-ers participating in programs serving at-risk children. For this study, pre-school classrooms were divided into three groups: high frequency print-focused sto-rybook reading sessions (i.e., 4-times per week for 30 weeks), low frequency print-focused storybook reading sessions (i.e., 2-times per week), and a con-trol group (traditional storybook reading of similar frequency to that of the high frequency group;

4-times per week for 30 weeks). For the two exper-imental conditions, classroom teachers were trained to reference print during shared storybook readings with a proposed dosage of four episodes per session (see Justice et al., 2009). While dosage recommen-dations were the same for both groups, teachers were free to target print knowledge more or less than the suggested amounts — that is, to individualize implementation as they saw fi t. Classroom teachers employing the intervention techniques averaged ∼ 33.3 teaching episodes, or doses, per session, which is obviously much higher than that recommended. Study fi ndings showed a signifi cant interaction between frequency and dose; students in the high frequency group made similar gains to students in the low frequency group when the teacher ’ s dosage was high. Thus, increasing both dosage and fre-quency did not equate to higher outcomes. Further, Piasta et al. ’ s (2012) longitudinal assessment of out-comes of children in the high and low frequency conditions at 2 years post-intervention showed only very modest, signifi cant differences between two groups favouring the high frequency group. These fi ndings, in conjunction with McGinty et al. (2011), suggest increasing frequency alone, without concur-rent consideration of dosage, may not be suffi cient for changing child outcomes.

Results from McGinty et al. (2012) indicate that other factors, including context and child character-istics, may infl uence the impact of dosage of print referencing interactions on child outcomes. In this study, high doses of explicit print instruction had positive effects on children ’ s gains in print knowl-edge when the children were in low quality class-rooms. For children in high quality classrooms, dosage of the print instruction did not have signifi -cant effects on outcomes. Similarly, high doses of print instruction were signifi cant in print knowledge outcomes for children with low attention skills. For children with high attention, dosage did not have a signifi cant effect on outcomes.

Taken together, the fi ndings regarding the print-knowledge intervention studies indicate the impor-tance of empirical examination of intensity as a construct of interest. Results are not straightfor-ward and are, in some cases, paradoxical. For instance, it is tempting to consider that more inter-vention would always result in improved outcomes: McGinty et al. (2011) showed, however, that dou-bling the intervention sessions for children receiv-ing print-focused reading sessions did not necessarily result in “ double ” the outcomes for chil-dren and Piasta et al. (2012) showed only a slight advantage in gains for children receiving high dosage vs low dosage. McGinty et al. (2012) sug-gest even more that recommendations of intensity may not be a “ one-size-fi ts-all ” situation, with environmental and child factors infl uencing the impact intervention intensity has on children ’ print knowledge development.

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454 M. B. Schmitt & L. M. Justice

Additional considerations regarding intensity

While Baker (2012) suggests that optimal interven-tion intensity may not simply represent the calcula-tion of cumulative intensity, but may also be driven by what is being treated (the specifi c goals, such as emergent literacy) and how those goals are being treated, we would suggest that where goals are addressed is an equally salient point that needs to be considered in conversations about intensity. Emergent literacy interventions can be embedded within children ’ s homes (e.g., Justice & Ezell, 2000), speech-language intervention sessions (e.g., Love-lace & Stewart, 2007), and classroom activities (e.g., Justice et al., 2009). With respect to the latter, intervention might involve small-group contexts (Ukrainetz et al., 2009) or whole-group settings involving all children in a classroom (Justice et al., 2009). Where, and under what circumstances, the intervention is being implemented may greatly infl u-ence the cumulative intensity required to achieve optimal gains in children ’ s emergent literacy skills, especially for those children most at risk for future reading diffi culties. The two intervention studies ref-erenced in this commentary present confl icting results and point to the importance of continuing to explore this topic in empirical work. Ukrainetz et al. (2009) suggested that classroom-level instruction in phonological awareness was not suffi cient for improving the skills of children who were more seri-ously at risk for future reading diffi culties. For these children, additional small group instruction was necessary for changes to be seen in their phono-logical awareness.

Conversely, McGinty et al. ’ s (2011) research on print knowledge intervention reported substantial changes in at-risk pre-schooler ’ s emergent literacy abilities achieved from only classroom level instruc-tion; in fact, research on this intervention approach has shown there to be no differential impacts associ-ated with children ’ s skill levels (Justice et al., 2009). As noted, however, the intervention implemented in the McGinty et al. series of studies involved fairly high doses of intervention within each session; it may be that whole-group intervention is suffi cient to affect even children at very high risk for future read-ing diffi culties if it is a very high dose. Nonetheless, these fi ndings raise several questions in regard to where and under what conditions intervention is delivered. Is it the case that small-group supplemen-tal instruction is necessary for those most at risk for emergent literacy diffi culties, or can large-group classroom instruction be as effective as supplemental instruction when offered at very high dosages? Does the recommended location of intervention differ depending on the construct being targeted (phono-logical awareness vs print knowledge)? Or is it the case that the location doesn ’ t impact children ’ s out-comes as much as the level of training or experience by the intervention provider?

These are critical questions to consider with regard to the role of the speech-language patholo-gist (SLPs) in working with children at risk for reading diffi culties secondary to language disorders. It may be that SLPs are in a prime position to provide small group, supplemental instruction for children at risk for future reading diffi culties. ASHA ’ s (2001) position statement mandates that reading be a focus of SLP intervention for children with language dis-orders, and, as such, could potentially be addressed in language therapy settings. However, given the rise of response-to-intervention (RTI), many SLPs now fi nd themselves working collaboratively within regular classrooms helping teachers to tailor emer-gent literacy instruction to children ’ s individual needs. An alternative to small group, supplemental instruction may be whole-class emergent literacy instruction conducted by the SLP. Additionally, SLPs may be able to function as a trainer for class-room teachers. Would training classroom teachers to provide more intense instruction result in similar classroom-wide outcomes as those found in the McGinty et al. (2011) study? While these are all empirical questions for future research, it is impor-tant that studies of intensity not just focus on the what and how of intervention, but the where or under what conditions.

Future research directions and needs

While we still do not have a complete picture of what optimal intervention intensity looks like for children at risk for future reading diffi culties and who are therefore candidates for emergent literacy interven-tion, the research described in this commentary gives us a strong foundation to inform both practice and future research, especially with regards to cumulative intervention intensity. Perhaps of greatest impor-tance is recognizing that virtually none of the research discussed with respect to emergent literacy interven-tion intensity focused specifi cally on SLPs and none were concerned specifi cally with children with lan-guage disorders, who are highly susceptible to reading interventions. If we are to improve the reading-related outcomes of children with communicative impairments, our research community must put effort into understanding the role of intensity in designing optimal interventions.

While application of the cumulative intervention intensity formula described by Baker (2012) has limitations, it does highlight the multi-dimensional aspect of intensity which is important for both prac-titioners and researchers to recognize. In addition, it helps to highlight the importance of large-scale exploratory work that can statistically model the unique contribution of and interplay among inter-vention dose, session duration, session frequency, and total intervention duration as presented in Baker (2012, Figure 1). Presently, much of the research

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Emergent literacy intensity 455

being conducted on issues related to intensity is, at best, being pursued in piecemeal fashion, and very few studies consider intensity as a multi-dimensional construct. The work discussed in this commentary is an apt illustration of our point: while this body of work is interesting and useful for indicating how important intensity is as a construct of relevance, it seems to provoke more questions than answers. What is needed, in our opinion, is a large-scale empirical-ly-driven exploratory model of how each aspect of intervention intensity may (or may not) infl uence children ’ s emergent literacy growth over time.

Conclusion

From a fundamental perspective, the notion of cumulative intervention intensity is both logical and straightforward: determine the number of teaching episodes and duration of services needed to cause real change in children’s skills. Baker (2012) system-atically unpacks the fallacy in such a simplistic view, offering multiple factors that infl uence — for better or for worse — the quantifi able aspect of intensity. Research in emergent literacy has laid a strong foun-dation for determining cumulative intervention intensity necessary to see changes in outcomes for those at risk for future reading disorders. However, additional research is needed across the constructs of emergent literacy (e.g., phonetic awareness, alpha-bet knowledge, oral language) as well as child, SLP, and service-related variables, to allow for complete recommendations on intensity of emergent literacy intervention for children with language disorders.

Declaration of interest: The authors report no confl icts of interest. The authors alone are respon-sible for the content and writing of the paper.

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