Treatment planning and Writing Fluency IEPs

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Treatment planning and Writing Fluency IEPs

• (adapted from Kathleen Whitmire
• Director of School Services, ASHA)

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What is an IEP?

• An IEP is an Individualized Education Program
• The IEP documents the free and appropriate public
  education that must be provided to children with
  disabilities under IDEA, Part B.
• It is developed by a team, consisting of regular
  and special educators, parents, and related
  service providers

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IEPs and IDEA 97

• IDEAs goals
• To help the child advance toward achievement of
  annual goals
• To have the child participate in the general
  curriculum
• To have the child participate in extracurricular
  and non-academic activities
• To participate with both disabled and
  non-disabled children in the least restrictive
  environment

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Assessment and the IEP

• The IEP should emerge from the assessment
  findings and should drive/guide the intervention
  process

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How do we determine who needs services?

• 1. Does the child have a disability? ?
• 2. Does the disability have an adverse effect on
  educational performance? ?
• 3. Does the child require special services in
  order to participate in the full range of general
  curriculum activities?

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Team determination of disability and eligibility

• Teams typically consist of
• The childs parent
• At least one regular education teacher
• At least one special education teacher or special
  education provider
• A school representative
• An individual who can interpret the instructional
  implications of the evaluation results
• When appropriate, the child
• One person may assume more than one role

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Guidelines for assessment

• Multiple forms of assessment should be used
• This does not mean multiple norm-referenced
  tests, rather..
• Information should be gleaned from parents,
  teachers, the child, and others as appropriate
• Information can be obtained from interviews,
  observation, checklists, samples of the childs
  work, as well as standardized assessment
  instruments.

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Professional judgment is encouraged

• When valid standardized measures are lacking or
  insufficient
• When students do not transparently meet
  eligibility criteria
• When team members believe that the child has a
  disability that adversely affects
  educational/school performance
• The basis for judgement should be clearly
  documented, using description of formal and
  informal measures

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Content of the IEP

• Present levels of educational/school performance
• How the childs disability affects involvement in
  and progress in the general curriculum
• For Pre-K, how the disability affects
  participation in appropriate activities.
• Ability to meet the states educational standards

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Knowing your states educational standards

• Both in terms of qualifying a child for services,
  and writing an educationally relevant IEP, you
  should know your states educational standards.
• Examples
• Maryland
• Virginia (Standards of Learning)
• All states at http//edstandards.org/Standards.htm
  l

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An example of IEP documentation of present level
of performance

• Johnny has a score of 21 on the SSI-3, and a
  score of 19 on the CAT-R. His predominant
  disfluency type is sound prolongation, with
  concomitant behavior of head raising during
  disfluencies. His teacher reports that he does
  not participate in class discussions, and eats
  alone at lunch time. His parents report that he
  is unwilling to use the phone or interact with
  others to obtain service in restaurants, stores,
  etc.

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Sample Standards from the General
CurriculumEnglish Oral Language (Virginia)

• The student will participate in and report small
  group learning activities.
• 3rd Grade - Ask and respond to questions from
  teachers and other group members.
• 6th Grade - Communicate as leader and
  contributor.
• 10th Grade - Evaluate ones own role in
  preparation and delivery of oral reports.

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Sample Fluency TargetsGoals or short-term
objectives/benchmarks3rd Grade

• Ask and respond to questions in small group
  activities.
• Will maintain eye contact during disfluency while
  responding to questions in small group activities
  (behavioral)
• Will respond with factual information about
  stuttering when probed by peers in small group
  interaction (cognitive).
• Will use fluency shaping strategies on initial
  word when initiating a question in small group
  activity (behavioral).

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Sample Fluency TargetsGoals or short-term
objectives/benchmarks6th Grade

• Communicate as leader and contributor.
• Will voluntary stutter to advertise as a pws in
  academic and nonacademic small group activities
  (scouts, band, sports) (affective).
• Will use stuttering modification strategies to
  move through stuttering blocks when contributing
  to group discussion with peers (behavioral).
• Will write an article on stuttering for school
  literary magazine to promote stuttering awareness
  at the school level (cognitive).

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Sample Fluency TargetsGoals or short-term
objectives/benchmarks10th Grade

• Evaluate ones own role in preparation and
  delivery of oral reports.
• Will monitor word substitutions during
  presentation of bi-weekly current events
  (behavioral).
• Will formulate and carry out one speech challenge
  per month and evaluate own performance in terms
  of speech goals (cognitive).
• Will rate level of fear or desire to avoid during
  chalk-board problems at weekly math club
  meetings. (affective).

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Sample Speaking Standards (Maryland)

• use verbal (e.g., pacing, timing, emphasis,
  volume) and non-verbal techniques (e.g., posture,
  eye contact, facial expressions, gesture) to
  enhance communication (5th grade)
• speak and respond clearly to a variety of
  audiences in a variety of formal and informal
  settings(12th grade)
• How would you write behavioral objectives for
  these standards?

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Creating measurable annual goals

• Measurable annual goals need to be related to
• Involvement in, and progress in, the general
  curriculum
• Needs resulting from the disability
• The goals also need to be measurable and
  achievable within the specified time frame (e.g.,
  a year, although you may specify a different time
  frame)

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An example of annual fluency goals

• Johnny will answer questions in class when
  asked, at least twice a week. He will conduct a
  telephone conversation with an adult of his
  choice x times. He will order lunch in one
  restaurant. He will reduce the frequency and
  duration of sound prolongations. He will reduce
  his score on the CAT-R.

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IDEA and IEP flexibility

• A full range of service delivery options should
  be explored.
• Services should not be limited by narrowly
  specified time formats (e.g., you may specify x
  minutes/month or year, including direct and
  indirect services as mandated by current
  functioning).
• Many administrators confuse conventional delivery
  models with required delivery models they may
  very well not be in compliance it is your
  responsibility to know the law and defend your
  decisions.

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Dismissal issues

• How come the fluency kids never seem to get
  dismissed?
• Dismiss him? But, he still stutters!
• Does lack of progress justify dismissal?

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Web resources for IDEA and IEP development

• For guidelines on eligibility for services and
  dismissal criteria http//professional.asha.org/r
  esources/legislative/idea_caseload.cfm

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Treatment planning
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Sample list of goal content areas

• Reduce frequency of stuttering behaviors.
• Reduce severity, duration or abnormality of
  stuttering behaviors.
• Reduce escape/secondary behaviors.
• Increase social activity and speaking behavior.
• Improve self-esteem.
• Reduce negative reactions to stuttering.
• Deal with co-existing problems.
• Provide information/counseling to others.

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Developing task hierarchies for activities and
assignments
Book Report
More Disfluency
Cafeteria
Best friend
Clinician
Mom and Dad
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Expanding hierarchies to individualize objectives

• Where?

Classroom
Playground
Group therapy
Home
Therapy setting
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Expanding hierarchies to individualize objectives

• Who?

Critical listener
Teacher
Friend
Parents
SLP
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Expanding hierarchies to individualize objectives

• What?

Presentation
Conversation
Monologue
Sentence
Word
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Expanding hierarchies to individualize objectives

• When?

When nervous
When arguing
When hurried
Around bystanders
On telephone
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Maximizing progress and generalization

• Increase challenges gradually to ensure success
• Team with the client to develop assignments and
  activities
• Work with others as appropriate (see Zebrowski
  Cilek (1997) for guidelines)
• Identify environmental cues that should trigger
  speech strategies

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The "One-Minute" Test
What would help me get more out of this?
What needs to be changed?

• What is going right?

Using your client as your guide Developing an
ongoing assessment of the goals and effectiveness
of your therapy
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• A few programs therapy resources available in
  the dept. and on the web

• Yaruss, JS Quesal, R. Identifying appropriate
  therapy goals. The ASHA Leader Online.
• Cooper Personalized Fluency Control Therapy (DLM)
• Shine Systematic Fluency Training for Young
  Children (Pro-Ed)
• Fosnot Woodford Fluency Development System for
  Young Children (CSB)
• Blood POWERR (for older children and teens)
  (CSB)
• Guitar Reville Easy Talker (CSB)