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SMILE for Young Children: A Bilingual Program for Improving Communication Skills
Katherine Marting, M.A., CCC-SLPScott Prath, M.S., CCC-SLP
Beat the Heat ConferenceJuly 24, 2012 Austin, TX Region 13 Education Service Center
Background
• Development:▫ Bilingual SLPs ▫ Home-based ECI Services▫ Need for family involvement When families are involved in the intervention
process, language enrichment is ongoing rather than during “therapy” only (Rosetti, 2001)
Without family involvement, intervention is unlikely to be successful (Bronfenbrebrenner, 1974)
Learner Objectives
Participants will list, identify, describe…
1. the importance of family involvement2. factors affecting parent involvement3. theoretical models of social systems4. strategies to increase family involvement in
intervention
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1. Importance of Family Involvement
Researcha. Language enrichmentb. Empowermentc. Self-Efficacyd. Why family participation is critical
a. Language Enrichment
• Parents use of language-based strategies leads to ▫ Increased receptive language skills in the first year
(Baumwell, Tamis-LeMonda & Bornstein, 1997) ▫ Increased receptive and expressive language skills in
the second and third years of life (Olson, Bates & Bayles, 1986)
▫ Greater receptive vocabulary at 12 years of age (Beckwith & Cohen, 1989)
a. Language Enrichment (cont’d)
• Mother’s use of labeling and increased periods of interaction lead to increases in receptive vocabulary and greater expansion of expression in older children (Tomasello & Farrar, 1986)
• Participation by fathers in early childhood programs has been shown to be beneficial to the child, father and other family members (Frey, Fewell, & Vadasy, 1989; Krauss, 1993)
b. Empowerment
• Empowering parents increases their likelihood of accessing information pertaining to their child’s development
c. Self-efficacy
• Empowerment leads to self efficacy or the belief that they can make a difference in their child’sdevelopment (Dempsey & Dunst, 2004)
d. Why family participation is critical
• Parents are the most consistent language models in the child’s life
• When families are involved in the intervention process, language enrichment is ongoing rather than during “therapy” only (Rosetti, 2001)
• Without family involvement, intervention is unlikely to be successful (Bronfenbrebrenner, 1974)
Family Involvement
• Why do we need family involvement?▫ Social Learning Theories (Vygotsky, 1967)
▫ Family members are the guides and the child is the apprentice who learns from adult models (Rogoff, 1990)
▫ Parents are the most consistent language models in their children’s lives and their first teachers
Family Involvement
• Parents use of language-based strategies leads to: ▫ Increased receptive language skills in the first year
(Baumwell, Tamis-LeMonda & Bornstein, 1997) ▫ Increased receptive and expressive language skills in
the second and third years of life (Olson, Bates & Bayles, 1986)
▫ Greater receptive vocabulary at 12 years of age (Beckwith & Cohen, 1989)
▫ 30 Million Word Gap by age 3 (Hart & Risley, 1995)
Family Involvement
• Mother’s use of labeling and increased periods of interaction lead to increases in receptive vocabulary and greater expansion of expression in older children (Tomasello & Farrar, 1986)
• Participation by fathers in early childhood programs has been shown to be beneficial to the child, father and other family members (Frey, Fewell, & Vadasy, 1989; Krauss, 1993)
Family Involvement
• Empowering parents increases their likelihood of accessing information pertaining to their child’s development
• Empowerment leads to self-efficacy or the belief that they can make a difference in their child’sdevelopment (Dempsey & Dunst, 2004)
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Models of Service Delivery: Find a balance
Consultative Model
Child Focused Model
Not on the same pageDifferent Perspectives
Family’s Perspective
The therapist just plays with
my child.
They just sit and talk with
me and do nothing with
my child.This is all too overwhelming.
I forget what to do after the
therapist leaves.
I don’t have time in my day
to do this.
SLP’s Perspective
Families don’t always follow through with
my suggestions.
I can’t get families to
incorporate ideas into daily
routines.
I don’t have easily accessible
resources to share with families.
Many times families don’t
keep appointments.
2. Understanding families
• Demographics • Theoretical models of social systems• Factors affecting family involvement
Demographics of Families Enrolled in ECI in TexasResearch
a. Economicsb. Ethnicityc. Language
d. Gendere. Reason Eligiblef. Services on IFSP
a. Economics
• Percentage of ECI children receiving Medicaid▫ 2006: 61%▫ 2008: 60.3%
• Families at 250% of the poverty level or lower▫ Approximately 84%
b. Ethnicity
Race/Ethnicity PercentHispanic/Latino 47White 38Black/African American 12Asian/Pacific Islander 2American Indian/Alaskan <1
c. Language
Primary Language PercentEnglish 81Spanish 19Other <1
d. Gender
Gender PercentMales 63
Females 37
e. Reason EligibleReason Eligible Percent Medical Diagnosis 11 Chromosomal Anomalies 35 Congenital Anomalies--Brain/Spinal Cord 16 Symptoms and Ill-Defined Conditions 14 Disorders of the Nervous System 12 Congenital Anomalies--Facial Clefts 9 Conditions Originating in Perinatal Period 7 Congenital Anomalies--Musculoskeletal 7 Developmental Delay 71 Atypical Development 18 Areas of Delay/Atypical Development Speech/Communication 67 Physical/Motor 43 Cognitive 26 Adaptive/Self-Help 21 Social/Emotional 16 Vision 2 Hearing 2 Children with more than one qualifying diagnosis 22 Children with more than one area of delay 37
f. Services on IFSP
Percent of Children with Planned Service Types Percent Service Coordination 100 Developmental Services 78 Speech Language Therapy 58 Occupational Therapy 32 Physical Therapy 25 Nutrition 12 Family Training/Counseling 5 Vision 3 Audiology 3 Psychological/Social Work 3 Medical/Nursing 1
Theoretical Models on Social Systems
Research
a. Maslow’s Hierarchy of basic needsb. Kubler-Ross’ 5 stages of grief
a. Maslow’s Hierarchy of basic needs
b. Kubler-Ross’ Five Stages of Grief
• Denial (this isn't happening to me!)• Anger (why is this happening to me?)• Bargaining (I promise I'll be a better person
if...)• Depression (I don't care anymore)• Acceptance (I’m ready for whatever comes)
Factors Affecting Family Involvement
Research Findings Pertaining to Family Factors
• Mothers with limited family support tend to withdraw from programs early (Luker & Chalmers, 1990)
• Mothers engaged in family conflict show lower rates of involvement (Herzog, Cherniss, & Menzel, 1986)
• Mothers engaged in substance abuse showed lower rates of involvement (Navaie-Waliser et al, 2000)
• Mothers who are anticipating a change in residence also showed lower rates of participation (National Committee to Prevent Child Abuse, 1996)
Factors Affecting Family Involvement• Family Factors▫ over which we have minimal influence but need to
understand▫ over which we have more influence
• Minimal influence▫ Social-emotional needs▫ Economic needs▫ Cultural parameters
• More influence▫ Education about disability▫ Attendance▫ Engagement in the intervention process
Provider Factors Affecting Parent Involvement
▫ Consistency and reliability▫ Quantity (amount of
services)▫ Recognizing your
assumptions▫ Understanding family
needs ▫ Engaging all family
members▫ Ability to adjust strategies
to match family style
▫ Communicating rationale for intervention techniques
▫ Clearly specifying what families should do between intervention sessions
▫ Setting expectations ▫ Staff communication▫ Staff education and
training▫ Staff turnover rates
Research Findings Pertaining to Provider Factors
• The more services a child/family receives, the more progress the child makes
• High staff turnover rates reduce family involvement ▫ Gomby (2007)
• Quantity--There were some interesting studies that showed that white families received more services than others. Hispanics were rated as more engaged. African Americans received less child-focused activities.▫ Wagner (2003)
Case Study #1: Understanding Kubler-Ross’ stages of grief
How would you work with a family that is in denial?ExampleInterventionist: Lets work on the word “more”.Parent: She says that.Interventionist: Great, how about the words, mom or
dad?Parent: She says that too.Interventionist: She only says twenty words and she is
two years oldParent: We understand what she wants
Case Study #2:A client has been diagnosed with a receptive
and expressive language disorder. How would you explain the rationale behind these suggestions and strategies?
• Roll a ball back and forth with your child.• Add a word to what your child says and
repeat the words back together.• Give your spouse more time to form a
response.
3. Connecting Therapy to Reality
Applying research to our family sessions
How do we improve outcomes?
We know it’s important, how do we do it?
• Provide specific instructions • Provide a rationale• Keep it simple and consistent• Have it pertain to a family
event or routine• Set expectations• Have something written• In their native language• Follow through
• Make sure caregivers understand:▫ WHAT?▫ HOW? ▫ WHY?
• Assess the caregivers • Give positive reinforcement• Take risks
Daily Routines
Daily Routines
• 12 daily routines • Frequency and consistency • More natural • Extra time is not needed to implement strategies• Use objects in their environment as therapy
materials
Daily Routines
• Each routine includes:• Speech/language focus• Examples of each strategy• Suggested target vocabulary and 6 pictures of signs• Homework sheet • Activity sheet
• The amount of time spent on each routine varies
Strategies:
Speech
Language
Language Development
• Improved communication and bonding (Goodwyn, Acredolo, & Brown, 2000; Tompson et al., 2007)
• Children stop using sign when able to communicate orally (Pizer, Walters & Meier, 2007)
• Provide visual support during language learning
Language Development
• Frequency and consistency • The more a child hears a phrase the more likely
they are to use it• Use phrases that the child is able to imitate
Language Development
• Imitation is vital for speech and language development (Rogers & Williams, 2006)
• Teach the child how to imitate, by imitating their sounds and movements
Language Development
• Each routine focuses on different vocabulary• Multisensory learning for language targets• Label objects, actions and descriptors• Repeat object labels – the more a child hears a
word, the more likely they are to use it
Language Development
• Expand the child's utterances by adding semantic information or syntactic complexity can help their language grow.
• It is important to keep phrases simple enough that your child can repeat them.
Language Development
Speech Development
• Visual, tactile and motor cues
• Examples:
▫ Clap out syllables in words
▫ Put hand in front of mouth to feel air on plosives
Speech Development
• Auditory cues▫ Emphasize specific sounds in words▫ Melodic cues
• Model appropriate speech production▫ Break consonant clusters apart▫ Model target words slowly with emphasis
Speech Development
• Imitate sounds in the environment• Repeat an incorrect production correctly,
repeating the correct production several times
Speech Development
• Have a scavenger hunt• Label objects that begin with the same sound to
increase phonological awareness
Speech Development
• Follow the hierarchy of speech production • Help parents measure small successes
Speech Development
Example by Brianne Ruhnke on www.speakingofspeech.com
Speech Development
Sample session
Important Words
Practiquen estas palabras importantes y agreguen más:
Data Collection Sheet
Data Collection
• What words or gestures does your child use?▫ Greetings/Saludos: Cuando saluda mueve la mano. Translation: To give a greeting, he waves his hand.
▫ Getting Dressed/Vestirse: Todavía no puede vestirse él solo. Le tengo que
ayudar. He still doesn’t get dressed on his own. I have to help
him.
Data Collection
• What words or gestures does your child understand?▫ Greetings/Saludos: Sí entiende pero no puede pronunciarlas. Translation: He does understand, but he can’t
pronounce them.
▫ Getting Dressed/Vestirse: No response
Data Collection
• What words or gestures does your child use?▫ Toys and Playtime/Jugando: Sí juega con niños de su edad. Translation: He does play with children his age.
▫ Mealtime/Hora de Comer: Se sienta a comer pero en ocasiones le tengo que dar
en la boca. He sits to eat but sometimes I have to put the food in
his mouth.
Data Collection
• What words or gestures does your child understand?▫ Toys and Playtime/Jugando: Para salir a jugar, dice “quiero jugar.” Translation: When he wants to go out to play, he
says, “I want to play.”
▫ Mealtime/Hora de Comer: “Quiero comer.” Translation: “I want to eat.”
Homework
Homework
Homework
Homework
Homework
Activity page
Homework
Session Record Form
Click to visit www.bilinguistics.com
Difference or Disorder? Understanding Speech and Language Patterns in Culturally and Linguistically
Diverse Students
Rapidly identify speech‐language patterns related to second language acquisition to distinguish difference from disorder.
References• Goodwyn, Acredolo, & Brown (2000). Impact of symbolic gesturing on early language
development. Journal of Nonverbal Behavior, 24, 81-103.
• Kummerer, B., Lopez-Reyna, N.A., & Hughes, M.T. (2007). Mexican Immigrant Mothers’ Perceptions of Their Children’s Communication Disabilities, Emergent Literacy Development, and Speech-Language Therapy Program. American Journal of Speech-Language Pathology, 16, 271-282.
• McWilliams, R. (2007). Early Intervention in Natural Environments. Retrieved February 5, 2008 from http://naturalenvironments.blogspot.com/2007/10/toy-bags.html
• Pizer, G., Walters, K., & Meier, R. P. (2007). Bringing up baby with baby signs: Language ideologies and socialization in hearing families. Sign Language Studies, 7 (4), 387-430.
• Rogers, S. J., & Williams, J. H. G. (Eds.). (2006). Imitation and the Social Mind: Autism and Typical Development. New York: The Guliford Press.
• Rogoff, B. (1990). Apprenticeship in Thinking. Oxford: Oxford University Press.
• Thompson, R.H., Cotnoir-Bichelman, N.M., McKerchar, P.M., Tate, T.L., & Dancho, K.A. (2007). Enhancing early communication through infant sign training. Journal of Applied Behavior Analysis, 40, 15-23.
• Vygotsky, L. S. (1967). Play and its role in the mental development of the child. Soviet Psychology, 5, 6-18.