Introduction to Intervention

An Overview

Is there “gold standard” intervention?

• Kamhi (2006) stated that it’s troubling to clinicians searching for a “gold standard” approach that works for all children– But a number of approaches have been

shown to “work”• Problem is they are theoretically

incompatible with each other• Some approaches provide transitional

methods to other approaches

Goal of Intervention

Goal is to align clinical characteristics of SSD to approach that has a strong evidence base that best meets the client’s needs.

Continuum of Intervention

Emerging – Developing - Elaborating

Book Organization

• Template for each chapter (Table 1.2)1. Target populations

2. Assessment methods

3. Theoretical basis

4. Empirical basis

5. Practical requirements

6. Key components

7. Evaluation/Progress monitoring

8. CLD populations

9. Case study

10. Study questions

11. Future directions

12. Suggested readings

Theoretical Basis: Level of Consequences Being Addressed

• World Health Organization (WHO): created a common language for comparisons of data across countries, health care disciplines, services, and time

• ICF-CY (International Classification of Functioning, Disability, and Health for Children and Youth)

– Provides a systematic coding scheme for health information systems

– Provides a scientific basis for consequences of health conditions

– Endorsed by number of professions, including ASHA in 2007

ICF-CY Components (Table 1.3)

• Body Functions• Body Structures• Activities and Participation• Environmental Factors• Personal Factors

Empirical Basis: Stages of Research

• 3 stages of programmatic research that fall along a continuum of research– Exploratory studies

• Consists of observation or feasibility studies

– Efficacy studies• Conditions of greater experimental control

– Effectiveness studies• Conditions that reflect more everyday practices

EBP

• Clinical services improve when practitioners become “data seekers, data integrators, and critical evaluators” of the application of new knowledge to clinical cases

Levels of Evidence

Clinical Decision-Making

1. Examine client’s needs– Assessment and analysis results

• Severity, intelligibility, consistency, stimulability• Differential diagnosis (PI ~ AI ~ MSD)• Breadth of problem (language, literacy, etc)

– Case history– Other information (child’s previous tx

experiences, communication experiences, academic settings)

Clinical Decision-Making (con’t)

2. EBP• Strongest available evidence given your

client’s needs, your clinical abilities, and the support available to you to implement the approach

3. PBE (Practice-Based Evidence)• What probe data, standardized testing, and

other methods will you use to document child’s progress?

Overview of 23 Intervention Approaches (Table 1.5)

Developmental Level Targeted Stage of Production

Targeted Outcomes

Emerging Sound Systems

Planning Production

Developing Sound Systems

Programming Perception

Elaborating Sound Systems

Execution Phonological Awareness

Oral Language

Literacy

Overview of Intervention Approaches (con’t)

• In addition to the 3 descriptors for each approach in previous table, each approach is summarized according to their:– Key Components– Technology/Materials required to implement

the approach– Populations for whom the approach is

designed

Structural Framework for Intervention (Figure 1.1)