Communication and Language Support Services
Services related to communication and language support are provided by speech language pathologists (SLPs) in collaboration with occupational therapists and behaviors specialists when appropriate.
Each learner at Puddingstone Place is unique, and will receive a package of services designed to meet his or her specific needs. These services will be determined on an individual basis and may include:
Assessment
Before intervention can begin, each learner must participate in a comprehensive assessment. The goal of this process is to gain information that will be used to help develop goals, identify appropriate teaching tools and communication supports, and determine an instructional trajectory.
Questions we may explore during assessment:
- How does the learner currently communicate? What modalities are used?
- For what pragmatic purposes does the learner communicate (e.g., requesting, protesting, commenting)? What topics does he/she communicate about?
- How well does the learner currently understand language? What strategies support comprehension?
- Does the learner understand that visual symbols (e.g., photographs, picture symbols) represent real world objects, actions, and ideas? Can he/she use these symbols to express unique ideas?
- Which teaching tools and techniques are most likely to be effective for this learner?
- What is the optimal learning environment for this individual? How can we best support behavior, attention, physical access and other factors so that the individual can participate fully in the learning process?
Additional information about the assessment process:
The intensity of the initial assessment will vary. If a learner has recently been evaluated, there may be an abbreviated assessment process. For those who have not yet had an initial evaluation, the process will be more in-depth. Most initial evaluations can be completed over the course of a single, 2-hour visit with many requiring less time.
Assessment is ongoing. After an initial evaluation has been completed, the assessment process continues throughout the treatment period. Additional information is gained through further interaction with learners and their teams, goals are adjusted over time based on progress, and tools and teaching techniques are constantly modified based on learner response and preferences.
Assessment is dynamic. Our communication evaluations are typically fun and interactive, with both the learner and the examiner participating equally. Assessment activities are chosen based on learner interests and preferences. There is no specific script or agenda; interaction is allowed to occur naturally. Throughout the process, the evaluator introduces a variety of tools and teaching techniques and observes the learner’s response to each one, modifying as necessary to optimize performance. This type of assessment allows the evaluator not only to understand current abilities, but also to determine which tools and techniques are most likely to enhance those abilities for each individual.
Additional formal and informal techniques may be used. In addition to or as part of the dynamic assessment process described above, our SLPs may use any of the following means of gaining information:
- Interview: We recognize that regular communication partners know and understand the learner best, and that their observations and unique insight add valuable information to any assessment. The interview process is critical to understanding the learner’s personality, preferences, communication history, and family/team goals.
- Observation – Much information can be gained with regards to learning style and communication style from simply observing how each individual interacts with familiar and unfamiliar communication partners.
- Language Sample – A sample of utterances may be obtained to help gather information about the learner’s knowledge of syntax (grammar), semantics (vocabulary), morphology (word structures), and pragmatics (social skills). An utterance is a message expressed in any modality (e.g., speech, communication notebook, speech-generating device, manual signs).
- Standardized language testing – Formal, standardized testing follows a structured procedure and protocol and helps the examiner gather information about one or several specific skill areas. This type of testing allows the examiner to compare the learner’s performance to that of his or her peers.
- Non-standardized protocols – Non-standardized assessment protocols, such as the VIS protocol, provide some structure to the assessment process and allow the examiner to gather a great deal of information in an organized manner. However, non-standardized protocols do not yield scores that can be directly compared to those of other learners.
Intervention
At Puddingstone Place, the intervention process is tailored to each individual learner based on information obtained during assessment.
Important information about intervention:
Treatment will vary in format and duration. The number of treatment sessions required is different for each individual. The nature of these sessions will also vary from learner to learner and visit to visit. Some treatment sessions will focus on direct teaching while others may involve caregiver training and counseling, device programming or troubleshooting, creation of materials, consultation with occupational therapists or behavior specialists, or continued assessment activities. Most sessions include a time for discussion regarding the learner’s progress and response to treatment in other environments (e.g., home, community).
Caregiver attendance is strongly encouraged. We recommend that caregivers and other interested mentors attend therapy sessions, either in person or remotely via a video conference link (set up at the center). Mentors often supply information and feedback that can help clinicians provide more effective treatment. Additionally, mentors who regularly attend therapy sessions will be better positioned to support carryover of skills to other environments.
Carryover is critical to success. It is vital that the tools and teaching strategies introduced at Puddingstone Place continue to be implemented once the learner leaves the therapy room. Continued use within home, school, and community environments will provide additional modeling and opportunities for practice, and will help to support generalization of skills. As part of every learner’s treatment, an individualized carryover plan is developed in collaboration with the learner’s team and mentors are provided with education and training as needed to ensure that they are able to execute it. Additionally, clinicians may in some cases be able to provide home consultations, either in person or via secure video connection, to further support carryover. Review our mentor participation contract.
Full AAC evaluations
Some Puddingstone Place centers are able to offer full AAC evaluations. Please contact your local Puddingstone Place for additional information. All Puddingstone Place Centers can provide support for programming and implementation of communication devices.
Behavior Support Services
*At Puddingstone Place, behavior support services are based on the principles of Applied Behavior Analysis (ABA). ABA is a science that studies the events preceding behavior and the consequences that maintain behavior. ABA focuses on changing socially significant behaviors in order to improve an individual’s quality of life.
Behaviors are targeted according to the family’s concerns and broken down into the ABC’s: A (Antecedents), B (Behaviors), and C (Consequences). Antecedents are the events that occur immediately before a behavior. Behavior refers to any action, from blinking to walking. Consequences are events immediately following a behavior which makes the behavior more likely to re-occur in the future.
Behavior Assessment
Behavior assessments are structured around the ABC’s of behavior.
*Our clinicians identify the ABC’s of behavior for a patient by carefully observing the patient and examining his or her environment. Our clinicians cater their behavior assessments to the individualized needs of both the patient and the family.
Initial Behavior Assessment Steps:
- Family Interview: Our clinicians begin the behavior assessment by gathering information about the patient, including concerns about behaviors both in school and at home.
- Record Review: After receiving the family’s written consent, our clinicians review the patient’s cumulative record file and medical records.
- Indirect Observation: Next, with the family’s consent, our clinicians collect information about the patient’s behavior through individuals who work closely with the patient such as teachers, speech and language pathologists, and caregivers.
- Direct Observation: The clinician then observes the patient directly in his or her natural environment and collects data on the patient’s behavior.
- Skills Assessment: Finally, during the last stage, the clinician gathers information about the patient’s current skill level.
*After completing the initial assessment, our clinicians create a behavior support plan that is customized based on the unique skills and needs of the individual.
Behavior Support Plan
A behavior support plan (BSP) is a document outlining a plan of action for the patient and his or her family. The plan is designed so that parents and other individuals working closely with the patient can follow the procedures.
Components of a BSP:
- Operational Definitions include a clear and precise description of the behavior in measurable terms.
- Antecedent Manipulations describe environmental changes that may prevent the behavior from occurring.
- Reinforcement Procedures are structured guidelines explaining what, when, and how to provide the patient with reinforcement.
- Replacement Behaviors are new, more desirable behaviors that serve the same function as the behavior being addressed.
Service Delivery
*In-home Services: Our highly qualified staff works closely with families in order to provide the patient with therapeutic services in the patient’s home. Therapy sessions focus on skill acquisition, maladaptive behavior reduction, and effective management of crisis situations while maintaining the safety of the patient and their family. Our team also provides parent training services for direct behavior support.
Center-based services: In order to best promote each patient’s independence and improve his or her communication skills, our behavior professionals collaborate with our speech and language team to develop individualized communication and skills acquisition goals.
What can I expect during my first visit?
During your first visit, our clinicians gather as much information as possible about the case and request the necessary permissions for accessing medical and cumulative records. Once our clinicians receive that information, a family interview session is scheduled so that additional follow-up information can be gathered.
Occupational Therapy
The Puddingstone Place Occupational Therapist is part of an interdisciplinary team of professionals who is expected to provide the highest caliber of instruction in individual and/or small class settings. The Puddingstone Place Occupational Therapist will provide direct and indirect occupational therapy services for those learners requiring occupational therapy intervention. The Puddingstone Place Occupational Therapist is responsible for:
- Provide direct therapy to children and adults with autism spectrum disorders (ASD) and other developmental disabilities on a one-to-one and small group basis.
- Administer diagnostic assessments (formal and informal evaluations) to individuals with ASD and other developmental disabilities.
- Develop sensory-motor diets to be utilized throughout the learner’s day.
- Coordinate home-school occupational therapy programs. Consult with parents and school staff to ensure carryover of targeted skills.
Fact sheet on Occupational Therapy’s role in autism from the American Occupational Therapy Association:
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