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In this week’s episode of the SLP Now podcast, I break down the research behind literacy-based therapy!
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Marisha: The first thing that we'll be talking about is just a review of the research so we can make sure that we're on the same page in terms of why we would even use this approach with our students. I know that trying something new is not always easy. And it's easy to doubt why... like why change things up? Is it going to be worth it? Is it going to be worth being a little bit uncomfortable, trying some new things? And I can totally relate. In grad school, a lot of my supervisors and in my placements, there was a lot of drill-based therapy. And I did get examples of some literacy-based therapy, but it was very different. It wasn't this contextualized approach that I later learned about in the research. And if everything that you've learned is more of that drill-based approach, it definitely makes sense that it can be hard to switch.
And I know I definitely had some doubts, like how in the world are we going to get enough meaningful exposures? Aren't a lot of these activities just fluff? Lots and lots of questions. If you have any feel free to drop them in the comments as well. Like how in the world am I going to make sure that I'm therapeutic? So my goal is to make sure that we answer all of those questions in this section so that we can dive into the framework and do all of the practical demonstrations and be all in. So we'll just start with a little bit of research. There actually is research to support using this approach. So there is several studies. This is just a small sampling of them, where they found that using a literacy-based therapy approach resulted in improved outcomes for receptive vocabulary, expressive vocabulary, narratives, just to name a few.
And I pulled out one specific study by Brandel in 2014... or Brandel in 2014 was talking about a study that Gillam and Reese completed in 2012. And they provided small group intervention three times a week, over six weeks. So most of us probably aren't seeing our students three times a week, but maybe we're seeing them one or two, which is comparable, but they were evaluating narrative interventions. And they were looking at a contextualized approach, which is literacy-based versus a decontextualized approach, which I think is what many of us learned about in grad school. So that's more of those games, drill-based approach. So literacy, contextualized literacy, decontextualize drill, that's what they were looking at. And both approaches were designed to increase vocabulary, sentence, complexity, social language all types of skills that we typically target. And they found that students' comprehension and story retell, story generation skills improved more with a contextualized approach than a decontextualized approach.
So that's just another example of the different... how that contextualized approach, it resulted in improved outcomes compared to kind of more of the traditional approach. So hopefully this is enough evidence to get us started thinking. And I definitely have lots of citations if you're wanting to learn more and dive more into the specific results, but that was enough to get me convinced. So there are also some additional benefits. So it does result in improved outcomes for our students, but it is easier for us to plan and I'll show you exactly what that looks like.
Having a structure to our therapy within the unit also makes things more predictable for our students. It also provides an extremely meaningful context for learning because we're using... especially if we use texts from the classroom or the texts that are related to the things that they're discussing in the classroom. It's just a really meaningful context, which will help with that generalization and helping our students actually use these skills in the classroom.
Because that's what got me... I was chugging along just doing my drill base therapy, playing my games, using my flashcards. And my students still made progress, but it happened, there were a handful of instances, where I sat at an IEP meeting and I was so excited to report how amazing the student was doing with progress towards their goals. And it just happened several times where with one instance, the student was working on following directions. They were rocking it in therapy. But the teacher said that the student really struggled with following directions. That was her biggest pain point. And here I was thinking that he had mastered that goal. So it's just, that was enough to make me start researching and looking into other options to really make sure that what happens in speech doesn't stay in speech. We really want to make sure that students are applying their speech and language skills that we're teaching them into the classroom.
Because otherwise, why are we doing what we're doing? And then another nice benefit is that we can use it to shape and to target larger goals. So we might start with basic vocabulary and grammar, things like that. But within the structure of the unit, if by the end of the unit, the students are creating their own story and they're using all of the vocabulary, all of the grammar skills, all of the things that we targeted in small little... like more discrete practice. And then we're really integrating it into the larger piece, which is incredibly powerful in terms of generalization and learning for the student. But it's also a lot of fun. I love how Karen pointed that out. It's so much more fun, which is absolutely true. So the ultimate goal is for us to be therapeutic in a functional context. That's what we've been talking about for the past several minutes.
And I just have a couple of quotes to drive that home. So this is from Gillam and Ukrainetz, in 2006. And I don't usually love to read slides, but I think this one is really important. "So our primary goal with literature-based therapy intervention is not to teach the students to read. So we're not literacy coaches, but our goal is to improve the many aspects of language. So we're talking about vocabulary, grammar, pragmatic language, phonological awareness, conversation, narrative skills. We're targeting the aspects of language that influence their ability to participate in and profit from instruction in the general education classroom."
So that is like we said, in the last site, that's our ultimate goal. And by using this approach, we're thinking about that right from the start. It's not something that we're thinking after the student makes a bunch of progress. We're thinking about it right from the start. And we're laying the groundwork to enable the student to generalize those skills as quickly as possible. And there's nothing worse than seeing our students... just the classroom observations. A lot of times I saw students who were very disengaged and I wasn't doing anything to help them participate in the classroom, until I started using this approach. And granted, we're not going to help them in all areas all at once, but it's really amazing to see how one... like helping with one area can really impact the student in the classroom.
So just to address one of the common concerns, like how in the world am I going to be therapeutic if I'm doing something that's this contextualized? So this is a framework that Dr. Ukrainetz shares and I use it to just check myself. So if I'm not feeling great about a session, I will go through this framework and just kind of ask myself, okay, so we've got the RISE framework, R-I-S-E. Like what did my R I S and E look like? So just to break that down a little bit. So the framework is called RISE. And R stands for repeated opportunities, I stands for intensity or intensely delivered, S stands for systematic support and E stands for explicit skill targets. So the R for repeated opportunities. That just means we want to make sure that our students have enough opportunities to practice their targets.
So if we're working on initial K for example, for articulation, if we give the student two opportunities to practice their word, that is not going to be enough. However, if we are working on some vocabulary words, like let's say, we're working on a basic concept and the student has opportunity to use that word or is hearing or saying that word 50 times in a session, that might be enough repeated opportunities. And there's not a hard and fast rule. It's really using our clinical judgment here. But if we're sometimes it's like, that session didn't feel so... it didn't feel very effective. Did I give them enough opportunities to practice their target skill? And if my gut answer is no, I might look at how to revamp the session to provide more opportunities for practice. I stands for intensity. So this is something that we decide ahead of time.
So when we're in the schools, we decide how long and how often we're going to see the student. So if we feel like they're not really making progress. One thing that we could consider is changing the intensity. So maybe it's one time a week for 30 minutes, or three times a week for 10 minutes, or maybe they need more intensity. So we're doing two times a week for 30 or three times, whatever it may be and adjusting that. Then the S stands for systematic support. And we'll give some different examples of what that might look like in the third and fourth sections of this presentation. But it's basically just making sure that we're providing scaffolding and support that the student needs to be successful. And then E stands for explicit skill targets. So we want the student to know... well, we want to know what they're working on.
And we want the student to know what they're working on. So if someone is watching our session, they should know which skill the student is working on. And some ways that I like to do this, I have goal cards for all of my students. And we review them at the beginning of every session. And then we... I'd like to do, and we're not going into a ton of detail on this, but we'll pick the primary focus for the session. I think my students really benefit from having one main skill that we're focusing on. So even if they have 10 goals, we're picking one goal to focus on in that session. And I make sure that I know what goal we're working on and that a student knows what that is. So we'll review that with a goal card. And then I typically have a visual that I use to teach the skill, but then I also pull up that visual, just so we are reminded of the skill that we're working on.
And I definitely want to fade the use of that visual over time to the point where I can just say, okay, we're working on your pronoun goal, or we're working on your complex sentence goal. And then the student knows what they're doing, but in the beginning, before they start getting towards that generalization, we really want to have those supports in place. And then Ukrainetz added a plus. So she calls it RISE plus. The plus stands for student factors. So that ties into the student goal awareness. A student is not going to be, especially as they get older, they may lose motivation to participate in therapy. So we want to make sure that they're aware of what they're working on and especially the why behind that can make a really big difference. So if they understand how being able to produce complex sentences or summarize a story, if they understand why that's important and how that relates to their goals, that can be incredibly powerful.
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