Intensive Intervention – The Way to Go?

The January 19th, 2010 issue of the ASHA Leader may have completely changed the way I think about SLP services in the schools.  In that issue, Drs. Ron Gillam and Diane Frome Loeb presented a study that has me rethinking the traditional model of schedule of services seen in many public schools today.  In the article, “Principles for School-Age Language Intervention:  Insights from a Randomized Controlled Trial,” Gillam and Frome Loeb really challenge the idea of twice a week intervention for a much for intensive daily for six weeks straight model.  They did a study with 216 students in Kansas and Texas.  They assigned these students to one of four interventions:  FastForWord, Individual Language Intervention, Computer Assisted Language Intervention and Academic Enrichment.  The intervention in all four conditions was received for 100 minutes daily for six weeks.  Further, each intervention promoted active attention, provided immediate feedback, and rewarded successes.  Before and after the intervention, participants were administered auditory processing, language and literacy assessments, including the CASL, the Test of Narrative Language, and the Comprehensive Test of Phonological Processing.

And the results?  Children in all four groups improved significantly on auditory processing, language and phonological awareness, and they continued to improve for six months after intervention ended.  Further, the CASL scores of more than 70% of the students improved into either the average range or “beyond the 95% confidence interval of their pretest scores” (p. 3, Gillam and Frome Loeb, 2010).   Children in the Individual Language Intervention group appeared to do the best.

The “intensity” part of these interventions is really important.  Gillam and Frome Loeb compared the results of their study to that of the Iowa Epidemiological Study (Tomblin et al, 2003).  In that study, 156 of same-age children received speech in a public school setting for 20 minute sessions twice a week over 2 years.  That was 48 hours of intervention.  The students in the current study received approximately a total of 50 hours, with approximately 12 hours of additional school intervention (total 62 hours).  The gains made in 6 weeks in the current study were greater than FIVE TIMES those made by the Iowa study in two years.  Wow.  That’s pretty incredible.  There’s a graph with the article on the ASHA website, and I would recommend that you go look at it.  Englarge it and hang it on your wall.  It’s shocking the difference in improvement.

We’ve seen intensive intervention work with our preschool-age populations.  Many districts have reported huge gains and rapid dismissal rates for preschoolers in intensive preschool speech and language programs.  The interventions in this study were provided individually, but personal communication with Dr. Gillam indicates that he has seen similar results with small group intervention.  Why can’t we consider similar programs for school-age students?  Or significantly expand what we are doing in preschool?

So what does that mean for us?

1.  We have to re-think the 30 minutes, twice a week service delivery model.  We’re making slow progress.  We could do much more in a shorter amount of time.

2.  We have to discuss the results of this study with our campus administrators, classroom teachers and special education directors.  I have yet to talk about this to anyone who wasn’t shocked.  This may help us gain momentum to look at changes in our service delivery models.

3.  We must consider creative ways of providing intensive intervention.  One group of special education directors starting talking about optional summer programs as a possible solution.  What ideas do you have?

4.  We need to start considering expanding our current intensive preschool programs, or starting one if we do not already have one.  If we can get them out before 1st grade, we’ve saved them (and us) a lot of time.

5.  We’ve got to get out of the broom closets and into the classrooms.  I cannot see it as a feasable solution to pull the student out of the classroom for an hour and a half a day and have him miss that much instruction.  SLPs will have to push themselves into the classroom, work and plan with the classroom teacher, and provide relevant intervention to meets both educational and therepeutic goals.

6.  We have to be more flexible and creative on how we write our schedule of services.  Districts that are limiting their SLPs to weekly service delivery will have to rethink those policies.  We’re waiting on revised guidance on schedule of services from TEA.  Maybe we could see students cyclically, in which we see a student for 6 weeks then have them generalize skills for 6 weeks.  If we’re providing intensive intervention, we may be able to dismiss much sooner than trying to see everyone just a little bit at once.

References:
Gillam, R. & Frome Loeb, D. (2010, January 19).  Principles for School-Age Language Intervention:  Insights from a Randomly Controlled Trial.  The ASHA Leader.

Tomblin, J.B., Zhang, X. Buckwalter, P., and O’Brien, M. (2003).  The stability of primary language disorder:  Four years after kindergarten diagnosis.  Journal of Speech, Language and Hearing Research, 46, 1283-1296.

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