SKILL Program for Teaching Story Grammar Elements

an overview of the SKILL program for teaching story grammar and story retell

Last week I had the great privilege of hearing Sandi Gillam speak about her SKILL program. Sandi works at Utah State University and has been conducting tons of research to improve narrative skills in children. Through her work and research, she has developed the SKILL (Supporting Knowledge in Language and Literacy) program. It was so inspiring to hear Sandi speak! Teaching story grammar elements was not something that was included in my graduate program coursework, but narrative skills are highly emphasized in Iowa, so I'm very grateful to my employer for bringing in Ms. Gillam to speak with our SLPs for a couple days. I wanted to write a blog post or two about the information I learned as a way to help me summarize and sort through all the great information. Today's post will focus on the importance of narrative language skills and an overview of the SKILL program.

WHY TEACH STORY GRAMMAR?

The ability to give accounts of real or imagined events is a critical skill for children to develop as they grow. Narration, or storytelling, has a rich history in many cultures, and has ties to classroom instruction, early literacy, and the development of conversational discourse. Developing narrative skills allows children the ability to express complex ideas, interact socially with their peers by explaining things they've experienced, and it's a skill clearly stated as a required skill in the Reading and Speaking/Listening Common Core State Standards from Kindergarten on! This is a life skill we're talking about.

It's especially crucial to address these skills in children with language impairments. These children often don't get the gist of what is being said, have difficulties inferring, aren't actively engaged in comprehension, and may have poor vocabulary or semantic skills. Addressing narrative skills allows the SLP/teacher to address multiple goals: story comprehension, conversational discourse, vocabulary, semantics, inferencing - it's kind of an all-in-one package to improve multiple goal areas!

PROGRAM OVERVIEW

The SKILL program is one resource for teaching story grammar elements and improving narrative language. The program consists of three phases:

PHASE 1: Teaching Story Grammar Elements - Character, Setting, Take-off, Feelings, Plan, Action, Complication, Landing, Wrap-up

Highlights:
- The use of scripts for teaching the various elements helps you develop a systematic instructional routine and become more efficient with your teaching (students can focus on the content rather than the task).
- Icons are included for each story grammar element and are used consistently throughout the program.
- Various teaching strategies include co-telling, bingo, parallel story development/retelling practice through the use of storyboards.

PHASE 2: Moving from Simple Stories to Elaborate Stories

Highlights:
- Students are taught to add dialogue to their stories (which assists in increasing linguistic complexity).
- The addition of Complications to stories helps make them more complex.
- Lessons in adding adverbs to help elaborate on Action

PHASE 3: Becoming Independent Storytellers

Highlights:
- Students move from creating stories based on sequential pictures, to single-picture scenes.
- Self-scoring rubric gives students independence by internalizing the story grammar elements and moves them away from using the icons.

Each phase of the program includes an exit checklist of tasks a student must be able to perform before moving on to the next phase. By administering exit tasks, any areas of weakness are exposed and teaching suggestions are provided to address those areas.

I hope you'll consider adding the SKILL program to your teaching repertoire. It is designed to be used by speech-language pathologists, classroom teachers, special educators, and ELL specialists.

Stay tuned later this week for more information about instructional strategies for teaching story grammar elements!

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Abby is overwhelmed by the insane amount of useful knowledge she learned from Sandi Gillam. Who is the best speaker you've heard during professional development opportunities?

SLPs Blogging about Research - July edition

Once a month SLP Bloggers are blogging about research related to the field of speech pathology. You can learn more here.

Imagine this scenario: You're prepping for an initial IEP meeting for a preschool student with moderate phonological needs, and you need to determine the frequency of services you will be recommending at the meeting. What do you suggest? Two 30-minute sessions per week? Three 20-minute sessions per week? Five 10-minute sessions per week? Many factors can influence this decision including the severity of the child's needs, the child's age and grade, parental input, your professional judgment...How do we as SLPs - the communication professionals on the IEP team - make sound decisions about frequency and intensity of services when so many factors can influence that decision? I reviewed the following article, hoping to get a little clarity on the subject.

Article:

Intervention Efficacy and Intensity for Children With Speech Sound Disorder

by Melissa M. Allen

Purpose:
In the words of the author, this research study aimed to investigate "...the effect of intervention intensity on phonological production skills for preschool children provided the multiple oppositions approach." In the multiple oppositions approach, treatment targets are selected which are as different as possible in place, manner, and voicing in order to have a greater overall impact on a child's phonological system.

The author had three main questions:
1) Does frequency of phonological intervention affect the outcome?
2) Does duration of phonological intervention affect the outcome?
3) Does either frequency or duration lead to continued gains during a maintenance period?

Summary:
A total of 54 children ranging in age from 3 years 0 months to 5 years 5 months were chosen for this research study. All met state eligibility requirements for an IEP, had at least 6 sound errors from three different manner classes, passed a hearing screening, presented with typical speech structures and functions, and did not present with childhood apraxia of speech. Of these children, 72% were boys, and 28% were girls.

There are four main factors that can influence the total intensity of an intervention. The author does a nice job defining these terms:

dose = the number of trials or responses per session
dose form = the contexts of the activities (i.e. child-directed vs. clinician directed; play-based vs. drill-based)
dose frequency = the number of sessions in a designated period of time, and the length of each session (for example, one 30-minute session per week)
total intervention duration = can be a specific number of sessions, or a length of time 

The current study controlled the dose and dose form, but manipulated the dose frequency and total intervention duration, resulting in three separate study groups:

Group P1 received one 30-minute session per week for a period of 24 weeks, followed by 6 weeks of no treatment
Group P3 received three 30-minute sessions per week for a period of 8 weeks, followed by 6 weeks of no treatment
Control Group received a storybook intervention targeting print awareness (one 30-minute session per week for a period of 8 weeks)

All subjects were assessed prior to treatment, at the end of 8 weeks, and following the 6 weeks of no treatment. Subjects in the P1 group were also assessed again at the end of their 24 weeks of intervention. Percentage of Consonants Correct in single words was measured using the GFTA-2.

Sessions consisted of sharing rules explaining phonemic constraints (such as singletons vs. consonant clusters), familiarization of target words, practice of contrastive pairs, and summarization. Productions moved from single words to words in carrier sentences. The dose for each session aimed to be approximately 80 responses per session. The author provides additional details regarding criterion for moving along through the phases of intervention.

Results:
Looking at the author's original three questions, results were as follows:

Does x1/week or x3/week make a difference after 8 weeks?
- Yes! The intervention group that received x3 sessions/week for 8 weeks significantly outperformed the group that received only x1 session/week for 24 weeks.
- Interestingly though, only the x3/week group outperformed the control group. The x1/week group did not perform much different than the control group. So in this instance, receiving intervention x1/week was not much different than receiving no therapy at all!

Does x1/week or x3/week make a difference after 24 weeks?
- Yes! When looking at the results in this light, the x3/week group again significantly outperformed the x1/week group. This group did not receive as many weeks of intervention, but they had more frequent sessions per week.

What about after the 6 week maintenance period?
- In this case, both treatment groups showed improvement during the maintenance period, but these gains were not significant for either group.

My Thoughts:
*The researchers used the GFTA-2 to measure percentage of consonants correct in single words. Perhaps a spontaneous speech sample could have provided a better picture and even better data of each child's true abilities and their response to intervention.

*I loved that the interventions occurred in the children's Least Restrictive Environment (according to their IEPs). The treatment sessions were provided in preschools, Head Start classrooms, daycare, and family homes!

*Examining the results, it looks like (in this particular instance) more frequent sessions can result in a shorter length of time children could possibly be in therapy. Makes sense to me. If we provide a period of really intense instruction for our students (especially younger ones like in this study), perhaps they'll respond and be ready to exit services sooner. On the other hand, ages 3-5 are a bit young for a lot of speech sound to be appropriate therapy targets. But that early support can really provide a strong platform for later development, and perhaps those students wouldn't need services down the road.

*No homework was provided for any of the groups. That extra boost from home can definitely increase carryover and treatment outcomes.

*I feel there is definitely a need in the speech therapy world to establish treatment intensity guidelines. This research study does a nice job adding to the information and previous research that is out there. Most treatment protocols have established frequency/intensity parameters, but honestly, these aren't always feasible in the 'real world'. 

*The fact that the x1/week group barely showed any difference over the group receiving no treatment threw me off. I've always believed 'therapy is better than no therapy', but is this truly the case?

*Keep in mind that these results only look at the effects of treatment intensity when using the multiple oppositions approach, and only with preschool children. Other treatment approaches may have completely different outcomes if subjected to the same methods. Follow-up studies need to be done measuring treatment outcomes for other intensity variables, such as dose form.

How This Will Transfer to My Practice:
As the author stated, this study provided "...an initial investigation into the manipulation of one intervention intensity variable for one phonological intervention approach." More studies need to be done, manipulating additional treatment variables for additional treatment approaches. Perhaps then as SLPs we will have a 'quick reference guide' of sorts to help us make treatment intensity decisions. Of course, even then, we'd all have 'exceptions to the rules' on our caseloads :) Until then, keep on keepin' on, use your professional judgement and clinical expertise to guide your treatment decisions, and keep reading the current research to help you 'therapize' those kiddos to the best of your ability! 

Resource:
Allen, Melissa M. (2013). Intervention Efficacy and Intensity for Children With Speech Sound Disorder. Journal of Speech, Language, and Hearing Research, 56, 865-877.

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What do you think? Did this research intrigue you? Are you pondering your own therapy methods and procedures? What research topics would you like to read about in the coming months? Head over to Talks Just Fine to see all the other participants and read their research reviews.

Setting Professional Goals

"What are your long-term and short-term professional goals?"

This question always seems to come up during job interviews. Fresh out of graduating with my master's degree, my answer was "...to complete my Clinical Fellowship and obtain my ASHA CCCs."

Check! Thankfully I met that goal a couple years ago :)

The education agency I work for has us set personal goals and write an Individual Professional Development Plan every couple years. I have been completing my self-assessment this week and have spent time reflecting on where I am at as a professional and where I'd like to see my career as a speech-pathologist go. It has been challenging for me to figure out what my Long Term goals are as an SLP, but I've come up with a couple things.

As SLPs we are continually expanding our knowledge base. Many people don't realize how broad the SLP scope of practice is. We do way more than just "fix Rs" :) One of my long term goals has become

I love, love, love articulation therapy. Have a tricky R kiddo? Send them my way! Lateral S? No problem! Perhaps articulation will become my specialty area, but working in the schools requires us to be knowledgable in many areas. Unfortunately, I don't have much experience with AAC or fluency. I would really like to expand my knowledge and skills set in those two areas in particular.

I'm a true believer that supervisors can make a world of difference in the overall experience students have. In grad school I was gung-ho set on becoming a medical SLP. All I wanted to do was complete swallow studies. But then I experienced my school practicum and my supervisor was amazing and so helpful and the whole experience was just so. much. fun. From that point on I wanted to work with children.

My clinical fellowship supervisor went the other way. My supervisor had a baby two months after I joined the staff at her private practice. When she came back from maternity leave, her baby came with her and the success of the clinic and her patients no longer seemed to be her priority. It was a stressful time, but I grew a ton as a new SLP during that experience. There's a lot more to the story, and I won't go into details, but my supervisor was what ultimately led me to leave that position. She also inspired me to someday become a supervisor who provides freshly-hatched-out-of-grad-school SLPs with an amazing CF experience.

If all these previous goals come to fruition, I believe it will lead me to become a leader within the community of SLPs I work with at my current job. The education agency employs a couple hundred speech pathologists and a few of those serve as lead SLPs helping advocate and problem-solve for the profession, determine professional development opportunities for the group, and work to train other speech pathologists who are new to the agency. Down the road, I hope my knowledge and skills (see LTG #1) grow to the point where I could feel comfortable serving as a lead SLP.

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Now that my long-term goals are written down (and exposed for the world to see!), hopefully I'll be able to come back and update these with checkmarks once completed.

Leave a Comment: Have you set professional goals? What would you like to accomplish?

Conference Summary: Building Social Relationships

highlights from a social skills conference presented by Scott Bellini

On April 4-5 I was fortunate to be able to attend a conference presented by Scott Bellini regarding Teaching Social Interaction Skills to Children and Adolescents with Autism Spectrum Disorders (ASD). Mr. Bellini is an assistant professor in the Department of Counseling & Educational Psychology and Clinic Director of the Indiana Resource Center for Autism at Indiana University. This was a great presentation that was attended by speech-language pathologists, social workers, special education teachers and consultants, general education teachers, and school psychologists. This will be a long post, but there was just so. much. great information presented. I wanted to use this blog post as a way for me to hash through and review the information presented. The following information focuses mainly on the evidence-based strategies Mr. Bellini discussed.

SOCIAL COMMUNICATION: THE BASICS
Social Skills are defined as socially acceptable learned behaviors. These skills are important because they bring about positive responses from others when we interact. It is important to remember that children with ASD want to form meaningful relationships but may not have the skills to do so. A lack of such skills can result in anxiety and social isolation, poor academics, substance abuse, and even suicide in extreme cases. Also remember, however, that social skills are not just for students with ASD, and should be taught in every environment a child enters.

Social skills refers to behaviors, but social cognition is related to considering viewpoints, understanding humor, compromising, interpreting and inferring intentions of others, maintaining topic of conversation, and analyzing social situations. In social interactions, we are continually taking the perspectives of others. Children with ASD may know you have a different perspective, but can have difficulty figuring out what that perspective is. This especially comes into play when predicting what happens next in social situations because you have to attend to relevent cues around you and have prior knowledge about the individuals you are interacting with. Children with ASD may be over-attentive and have difficulty attending to more than one environmental factor at a time. This is huge! Without attention, you will not have learning!

Children can have difficulty in skill acquisition (or learning the skills they don't have) as well as skill performance (using the trained skills they have). When training skill acquisition, the best instruction stays within the zone of proximal development. The ZPD (Vygotsky ring a bell?) is the range of skills between what a child is able to do independently, and the skills the child can do with support.

EVIDENCE-BASED PRACTICES
A big portion of the information was about evidence-based and proven strategies to promote skill acquisition and performance. Strategies such as peer mentors, video modeling, social narratives, and prompting.

Social Narratives:
*A strategy for teaching specific social skills or concepts by presenting in the form of a story.
*Combine social narratives with behavioral rehearsal (role-playing) for maximum effectiveness. Doing so targets both "thinking" and "doing"

Prompting:
*Prompts are support and assistance that is provided to help the student experience success.
*Prompts can be physical, modeling, verbal, gestural, or natural.
*Use the least supportive prompt necessary to ensure success.
*Prompt attention prior to prompting behavior. Your student needs to be attending to the situation in order to perform the appropriate response.
*Fade your prompts as quickly as possible. The easiest way to do this is to pair a more supportive prompt with a less supportive prompt, then fade away the more supportive prompt.

Peer Mentors:
*Peer mentors should be similar age, be socially competent, and have a history of neutral or positive interactions with your student.
*Peer mentors are taught to appropriately initiate/respond to their peer with ASD before any structured interactions occur. Using peer mentors allows skills to be taught in a more natural setting.
*Adults facilitate the play, but are not directly a part of the interactions. This results in significantly reduced prompts to the child with ASD.
*Also select "generalization peers" to see how play skills and interactions transfer to other children.

Video Modeling and Video Self-Modeling:
*This is a highly effective strategy due to the strength of visual cues vs. auditory cues for students with ASD.
*Record your student participating in social interactions. You can provide prompts and instructions to the student while recording, but then edit those out so that the final video the student watches is him/her performing the desired behavior successfully. Think about it - athletic teams have been studying videos for a long time!
*Videos should be 1-2 minutes in length or student won't retain information in memory.
*Keep it POSITIVE and focus on SUCCESS!

HOW WILL I USE THIS INFORMATION?
There were some big ideas that stuck out to me throughout the conference. Ideas that made me think and double-think about my own strategies:

*Students with ASD can experience a fear response when asked to make eye contact. Since the conference I have found myself wanting to prompt eye contact, but catch it and prompt the student's attention instead. Mr. Bellini suggested teaching students to look at facial expressions or body language as a whole, and save eye contact for initiating and ending turns. He recommended maintaining eye contact not be a goal in and of itself.

*Peer mentors. When I grab students from a preschool or kindergarten classroom, there are always classmates (not students of mine) who beg me to take them too. Once in a while I oblige, but now I have an even better reason to do so. I'm excited to get parent permission for a few select peers to be involved in our social interactions, so that my students with ASD can receive fewer prompts from me, and so their skills can be targeted in a much more natural interaction.

*I am so, so excited to begin incorporating video modeling into my social skills interventions! Students seeing themselves successfully interact with peers is such a powerful tool! I am convinced it can be the difference in students acquiring skills and performing skills successfully at a faster rate. And is not to be solely used for students with ASD either. Video modeling and video self-modeling can be used to make differences in the performances of students with trouble behaviors, reading fluency and comprehension, articulation errors, selective mutism, and more. Good stuff!

SUMMARY
This post doesn't even begin to cover everything that we learned from Scott Bellini. If you'd like to read more about Mr. Bellini's systematic program for training social interaction skills, check out his book. If you ever get the chance to hear him present his research and methods in the area of Social Communication, I highly recommend you take advantage. I can't wait to get started implementing the strategies I learned!

Big thank you and high five to the Heartland Area Education Agency for bringing in Scott Bellini to educate us in the area of Social Communication!

Click here to read a Chirpstory highlighting all the information from the 2-day conference, including teaching emotions and perspective taking, additional strategies, and training students to self-monitor their skills.