Curriculum-Based Language Interventions

LSHSS

Tutorial

Curriculum-Based Language Interventions: What, Who, Why, Where, and How? Ashley Bourque Meauxa and Janet A. Norrisb

Purpose: School-based speech-language pathologists (SLPs) have been asked to be contributors to the educational curriculum (American Speech-LanguageHearing Association, 2010). The aim of this tutorial is to provide elementary school-based SLPs with a guide to explore curriculum-based language interventions (CBLIs) in their practices. Method: In this tutorial, the authors (a) describe CBLI, (b) review the existing literature available to guide this type

of practice in elementary school, (c) provide examples of how we have explored CBLIs, and (d) discuss the existing barriers for implementing CBLIs in schools. Conclusion: SLPs have language and literacy expertise qualifying us to be well-suited for playing an important role in supporting CBLI. The information presented in this article provides school-based SLPs with support to implement CBLIs in early elementary school and illustrates the need for additional evidence to support CBLIs.

“Language is a pervasive part of each life, and SLPs can serve as the glue that unites the child with his or her environment.”

success (Common Core, 2010, p. 4). In the lead article of a clinical forum, Powell (2018) states that with the adoption of educational policies (i.e., Common Core [2010], Every Student Succeeds Act [2015], and No Child Left Behind [2001]), it is critical that SLPs take an instrumental role in literacy education. Additionally, American Speech-LanguageHearing Association’s (ASHA) Professional Issues Statement in Roles and Responsibilities of SLPs in Schools indicated that SLPs play an integral role in supporting language and literacy by providing unique contributions to the curriculum for students with communication disorders and those who are at risk for school failure (ASHA, 2010). SLPs engage in evidence-based decision making to guide intervention selection by integrating clinical experience, external scientific evidence, and client perspectives (ASHA, Evidence-Based Practice [EBP], n.d.). Taking these factors into consideration, SLPs can determine best intervention practices on the basis of student performance. According to ASHA Schools Survey Report (ASHA, 2016), school-based SLPs’ caseloads included a high number of students with speech sound disorders and a fairly high number with reading and writing difficulties from the years 2000–2016. Powell (2018) suggests that the school-based SLP’s expertise in language and literacy offers a unique role in remediating the skills profiled in the standards for students who have difficulty acquiring language and literacy skills. She further proposes that school-based SLPs might have identified speech and/or language skills to target for intervention in the past without regard to the classroom curriculum. Since Nelson first outlined curriculum-based language interventions (CBLIs) in 1989, proponents of

–Judy Montgomery

L

anguage is a complex system and is critical to build foundational skills for reading. In elementary school, students are exposed to language through classroom discussion and literacy-based activities to support their skill development. With the adoption of the Common Core State Standards (CCSS; Common Core, 2010), skill level has been unified across 43 states. The CCSS identify critical skills in numeracy and literacy, profiling the development of these abilities beginning in kindergarten and showing the progressive increases in complexity of these same skills through high school. With this unified view, all individuals working with students, including speech-language pathologists (SLPs), are expected to provide instruction in writing, speaking, listening, and language to assure student

a

Department of Health and Human Sciences at Southeastern Louisiana University, Hammond b Department of Communication Sciences & Disorders at Louisiana State University, Baton Rouge Correspondence to Ashley Bourque Meaux: [email protected] Editor-in-Chief: Shelley Gray Editor: Shelley Gray Received June 7, 2017 Revision received August 11, 2017 Accepted October 19, 2017 https://doi.org/10.1044/2017_LSHSS-17-0057 Publisher Note: This article is part of the Clinical Forum: Exploring Curriculum-Based Language Assessment and Interventions.

Disclosure: The authors have declared that no competing interests existed at the time of publication.

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context-based language and literacy interventions have explored building skills within the context of classroom curriculum. While the dialogue for CBLIs continues to evolve, robust studies supporting CBLI are sparse. In this tutorial, we review the key concepts surrounding CBLI and empirical evidence to support CBLIs, and discuss ways we have attempted to provide CBLIs in schools and barriers we experienced when developing and implementing CBLIs.

CBLI: The Foundation What is CBLI? For several decades, efficacy of various service delivery models for language assessment and intervention using evidence-based decisions has been explored. Almost 30 years ago, Miller (1989) and Nelson (1989) outlined the state of CBLI, and this framework remains today. Nelson (1989) defined CBLI as “the use of curriculum contexts and content for measuring a student’s language intervention needs and progress” (p. 171). More recently, with the adoption of the CCSS and implementation of other educational policies (e.g., Every Student Succeeds Act, 2015; No Child Left Behind, 2001), there has been a resurgence in dialogue among school-based SLPs to explore CBLI for students who have difficulty acquiring oral and written language. It has long been recognized that children need sufficient language systems as they navigate various language uses and discourse types during the school day (e.g., lunch room conversations, different school subjects, and teacher-led discussions; Nelson, 1989). As Nelson (1989) stated, children in literate societies spend the majority of their waking hours in the school setting. Therefore, the student’s primary influence during the school day is the classroom teacher, presenting school-based SLPs with a unique position to systematically target language and literacy skills with the classroom teacher through CBLI to align with skill mastery necessary to succeed in school.

Why is CBLI Important? With language as one of the most important variables in any classroom, especially for literacy learning, Nelson (1989) stated that the use of CBLI “might help the student to acquire more effective communication skills (both oral and written)” (p. 171) and goes on further to establish that a curriculum-based approach “directs the focus of intervention toward functional changes that are relevant to the child’s communicative needs in the academic setting” (p. 171) while using the formal “course of study” adopted by a school system (Tucker, 1985, p. 199 in Nelson, 1989). For students who have difficulty with oral and written language, the classroom curriculum may not be the only challenging curriculum they are facing. Types of Curricula The language skills, as presented on the CCSS, are categorized by strands that represent the instructional language used within the classroom and increase in complexity with each academic year. The language strands

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require working knowledge of language, which increases in syntactic structure, vocabulary, length of utterance, conceptual complexity, and fluency of expression. In conjunction with these language skills, the five types of curricula (see Table 1) encountered when working with languagelearning impaired children illustrate that children are not only faced with navigating language through the de facto curriculum (i.e., classroom curriculum); these language demands are present throughout every facet of the school day (i.e., other curricula; Nelson, 1989). Ehren (2006, 2009) proposes that the SLPs need to consider the language knowledge and skills that underlie academic tasks. Benefits of Implementing CBLI The use of CBLI provides potential for improved generalization of skills learning to occur in a natural setting and reaches at-risk students (Green, Kopel, & Roesser, 2006). Implementing CBLI also allows speech and language skills to be worked on in meaningful contexts (Scheule & Ehren, 2016). Miller (1989) recognized classroom-based service delivery models generally rested on the premise of school success, particularly the achievement of literacy, and resulted from a combination of multiple school personnel working together.

Who Participates in CBLI? Recall, the CCSS propose that all school personnel working with students are responsible for student success. Possessing expertise in language and literacy development, it only seems natural that SLPs would combine resources with various educators to increase academic outcomes for students. According to Idol, Paolucci-Whitcomb, and Nevin (1986), the essence of collaborative consultation is as follows: An interactive process that enables teams of people with diverse expertise to generate creative solutions to mutually defined problems. The outcome is enhanced, altered, and produces solutions that are different from those that the individual team members would produce independently (p. 1). Typically, students only explore the classroom curriculum in the general classroom delivered by the teacher. But as SLPs possess an understanding of spoken language production and comprehension, which extends into literacy foundation, collaboration with the primary classroom teacher, special education teacher, school administrators, and/or parents benefits all students.

Where Does an SLP Provide CBLI Services? For several decades, studies have documented various service delivery models for providing effective speechlanguage interventions. Powell (2018) suggested that ASHA’s 2010 Scope of Practice for SLPs in schools has invited a shift in the way SLPs think about service delivery. But we believe that the CCSS, educational policies, and ASHA guidelines have reinvited SLPs to examine service

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Table 1. Nelson (1989) various curricula encountered during school day. Curricula Official curriculum Cultural curriculum The de facto curriculum School culture curriculum Hidden curriculum

Definition Material that is to be learned at each grade. aFor the states which have adopted the CCSS, the objectives and content to be covered are systematically outlined for literacy and numeracy. Includes the world knowledge that students must acquire to become literate, educated members of their societies. May be different for students from different backgrounds. Curriculum that is based on the textbook chosen by the school district. aLocal communities and educators who have adopted the CCSS choose their own curriculum. Revolves around the set of implicit and explicit rules established to govern student behavior for both the school and the classroom. The “hidden” agenda behind educational contexts.

Note. CCSS = Common Core State Standards. a

Authors of this tutorial updated definition to reflect curricula considerations with the adoption of the CCSS.

delivery using CBLI. Profiled in Table 2 are three types of service delivery models employed in schools: pullout, classroom based, and collaborative. The State of Service Delivery Models Over two decades ago, ASHA (1993) issued a position statement recognizing integrated (i.e., classroom based) therapy as an appropriate service delivery model. In the late 90s, empirical evidence documented that schoolbased SLPs were exploring classroom-based interventions (Farber & Klein, 1999). But according to ASHA’s 2016 Schools Survey data, SLPs documented spending between 18 and 19 hr each week in pullout therapy services but, on average, 4.5 hr each week in classroom-based services. Results from this survey suggest that SLPs have not fully implemented classroom-based services in the schools. Service Delivery Models: Moving Forward So far, this tutorial has defined CBLI through the CCSS, established the benefit of implementing CBLIs through various school curricula, identified school personnel responsible for implementing CBLIs, and outlined the various service delivery models available to school-based SLPs. The evidence presented thus far suggests the call to explore CBLI has existed for several decades. The next section of this tutorial considers exploration of CBLIs in schools in the southeastern United States and the existing barriers to implementing alternative service delivery models.

How to Implement CBLIs? The language used by both educators and students determines what is learned, the depth of the learning, and how the learning takes place (e.g., Starling, Munro, Togher, & Arciuli, 2012; Wilkinson & Silliman, 2000; Zucker, Justice, & Piasta, 2009). Nelson (1989) suggests the “effectiveness of curriculum-based language intervention depends largely on making good decisions about what kinds of language behaviors to target for change, how to measure them, and in which contexts” (p. 180). For students with language-learning disabilities, the classroom curriculum materials can provide context and content for language intervention. Specifically, Nelson (2010) suggests that CBLI and assessment activities are guided by four questions: 1.

What oral and written language skills does the curriculum require?

2.

What oral and written language skills does the student currently have?

3.

What future language skills and strategies might the student develop?

4.

In what way can the curriculum be modified to make it more accessible?

Once SLPs have considered these four questions and areas of intervention are identified, the SLPs’ intervention plan should implement an evidence-based model.

Table 2. Service delivery models defined. Pullout therapy Classroom-based therapy Collaborative models

Intervention services are provided to the student in an environment removed from the typical classroom placement (e.g., primary classroom and resource room). Intervention in which SLPs provide speech-language intervention to individuals or to small groups of students in their general and special education classroom settings (Cirrin et al., 2010). Classroom-based models are extended to also include a team approach whereby SLPs may team teach with general and special education classroom teachers (e.g., collaborative model; Cirrin et al., 2010). Within the collaborative model, it is acknowledged that not one person or professional can solely execute all educational services necessary for the student’s success (Hadley, Simmerman, Long, & Luna, 2000).

Note. SLP = speech-language pathologist.

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Accessing EBP Literature for CBLI SLPs’ traditional training began with principles of the medical model (Magnotta, 1991), leading to the adoption of EBP in the field of speech-language pathology. Over time, EBP material became available to school-based SLPs to guide decision making through an educational model. The ways in which SLPs gather current EBP varies. With ASHA membership, SLPs have access to ASHAWire (i.e., The ASHA Leader and ASHA journals; with Special Interest Group affiliation, SLPs can also access Perspectives of the ASHA Special Interest Groups). Hoffman, Ireland, HallMills, and Flynn (2013) found that both early career SLPs and seasoned SLPs explored most of their informal EBP training via The ASHA Leader (68% and 67%, respectively) and articles in ASHA journals (55% and 45%, respectively). Results of the survey collected by Hoffman et al. also indicated that most early career SLPs relied on graduate level courses (62%) for formal EBP training, whereas most seasoned SLPs indicated that they received formal EBP training through state association conferences or convention EBP sessions. Below, we present both EBP and experiences from our lab to explore collaborative and consultative models of service delivery.

Exploring CBLIs Many approaches to CBLIs address the foundational language skills needed to support academic language, such as interventions for syntax, vocabulary, figurative language, phonemic awareness, and pragmatic/social language (Bowyer-Crane et al., 2008). This approach is used by most SLPs in the schools, with 90% having large caseloads in both language disorders for semantics, morphology, and syntax, as well as language disorders for pragmatics/ social communication (ASHA Schools Survey, 2016). However, far fewer SLPs actually use the academic curriculum directly, as reflected by only 33% of the respondents to the survey who report intervention for reading and writing (literacy). Those who do see children for literacy serve a large number of students (a mean of 15 compared with 18 with speech sound disorders), suggesting that literacy problems are at least as prevalent as speech sound disorders. This is supported by over 20 years of research showing a strong relationship between speech and language disorders with learning disabilities beginning in preschool and extending through high school and beyond. The prominent model in schools is to teach foundational speech and language skills and hope they generalize to literacy. However, except in the case of phonemic awareness, there is little or no evidence to support that this actually occurs (Bowyer-Crane et al., 2008). In their study, Bowyer-Crane et al. identified 152 children from 19 schools with poor oral language at school entry and randomly assigned them to either a phonology with reading group (i.e., letter–sound knowledge, phonological awareness, and book level reading skills) or oral language treatment (i.e., vocabulary, comprehension, inference generation, and narrative skills). All children continued with regular reading instruction in the classroom. Following 20 weeks of

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daily instruction, the phonology and reading group had higher decoding skills, and the oral language group had better vocabulary and syntax skills. Regardless of the intervention type, more than 50% of the children remained poor in literacy. Below, we share four examples of CBLI we explored in inner city schools in the southeastern United States.

CBLI Example I: Communicative Reading Strategies An alternative CBLI model is to teach speech and language skills in the context of literacy and determine the effects on both language and literacy. In this manner, the language to be addressed is provided by the curriculum, such as a reading book, and intervention is focused on learning the content, form, and use of that language (Norris & Hoffman, 1993). To illustrate, the following author-created passage has a readability level of approximately midfourth grade (Flesch–Kincaid 4.4; SMOG Index 4.6). The Flesch Reading Ease score is 86.4 or “easy to read.” Passage 1: (1) Everyone in the community helped get the town ready for the big parade. (2) Working together was part of the small town way. (3) Jared and his brothers helped to sweep the streets of the parade route. (4) Other groups picked up trash and trimmed bushes. (5) Some painted old houses around town. (6) They all wanted their town to look its best for the visitors who would soon arrive from all over the county. (7) Jared was happy that the town looked so great, but he was even more excited for the parade to start. The syntax within this passage provides a host of challenges. The noun phrase of the first sentence is an indefinite pronoun (everyone) plus a prepositional phrase or greater complexity than a simple noun phrase. It is followed by a verb and an infinitive verb with an ellipsis (helped to get). The verb phrase then has an object noun (the town), adjective (ready), and prepositional phrase. The noun phrase in Sentence 2 is elided (Townspeople working together…) and an idiomatic expression (small town way). Sentence 3 has a compound noun phrase and another infinitive verb construction (helped to sweep). Sentence 4 has a particle following the verb (up) and a conjunction with an elided noun phrase (groups picked up trash and groups trimmed bushes). Sentence 6 has an infinitive (to look) and a relative object clause (…for the visitors – who – would soon arrive). Sentence 7 combines sentences using a subordinating conjunction (that the town …) and a coordinating conjunction (but he was …), as well as an infinitive (to start). Syntactic complexity can result in reading errors, called miscues, and comprehension problems. By talking through the passage as it is read, termed communicative reading strategies (Norris, 1991, 1998), the complex language can be acquired. Communicative reading strategies are scaffolding strategies used by a facilitator to enable communication to

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occur between the reader and the author of the text. If the reader does not recognize a word, the facilitator can prompt with a synonym or definition [“town” – point to word and say “It’s a small city] or help the child decode the word. Other strategies address syntax, meaning, or pragmatics. To begin working through this passage, choose a reading level that is challenging (at least one error per sentence or poor comprehension) but not frustrating to the student. For example, the following strategies can be used for the first sentence: 1. Everyone in the community helped get the town ready for the big parade. (a) Point to the beginning of the sentence and say, “Find out who is helping.” (b) As the child reads the noun phrase, point to “everyone” and model an interpretation of the indefinite pronoun [“Oh, all of the adults, kids, everyone in the community.”]. (c) As the child reads the verb phrase, point to the words and restate it with the infinitive present [helped to get ready; helped get the town ready]. (d) Ask a question to connect the prepositional phrase in meaning and form and have the child answer by reading [What is the town getting ready for?]. (e) Ask the child to retell (reread) the idea again. It should be read fluently, accurately, and with appropriate expression because the language is processed for content, form, and use. (f )

Reinforce the student by responding with an inference that indicates that the child communicated by reading [That must have been a lot of work!] or setting up the next sentence [I wonder why everyone helped?]. It is important that the interactions remain at the level of communication rather than reading words correctly (i.e., never “Good reading”).

For complex sentences, point to relative pronouns and demonstrate how two sentences are combined, as in Sentence 6: (6) They all wanted their town to look its best for the visitors who would soon arrive from all over the county. (a) Point to “the visitors” and state the first proposition [The people want their town to look good for the visitors.], and then, point to the second proposition starting with the word “would” [The visitors would soon arrive.]. Then, point to the relative pronoun “who” and say [I could break this long sentence into two sentences, “They wanted it to look its best for the visitors” and “The visitors would soon arrive.” Or I can use this special kind of pronoun called a relative pronoun instead of repeating “the visitors.” Let me hear you say the sentence with the relative pronoun.”] and prompt the child to read from the beginning of the sentence. (b) Work through any additional aspect of the sentence that is not read with accuracy, fluency, and expression.

CBLI Example II: Oral and Written Language A variation of teaching language using written text was implemented by the authors using an animated PowerPoint termed Four Leaf Luck (Norris, 2010). The PowerPoint instruction was implemented with 10 children for 6 weeks in a low socioeconomic status, poor-performing fourth grade class. The students ranged in decoding skills from very poor to above average. All but one were below average in reading comprehension, with two comprehending at a first grade level, four at second grade, and three at an early third grade level. The Four Leaf Luck PowerPoint (Figure 1) was presented in class for 30 min three times weekly. This PowerPoint has a readability level of fifth grade, with each sentence presenting challenging syntactic structures. The PowerPoint “unpacked” the complex sentences into constituent simple sentences that were read together with the students. The students were interactively invited to tell how to recombine them into complex sentences and then watched the animation show the answer one change at a time. A second classroom in the school served as a control. The Reading Comprehension subtest of the Peabody Individual Achievement Test–Revised (Markwardt, 1998) was used as the written language measure. The preintervention scores of the control group (M = 2.82, SD = 0.80) and the experimental group (M = 2.89, SD = 0.44) did not differ significantly ( p < .83, two-tailed t test). The average gain made by the experimental group (M = 0.77, SD = 0.88) was significantly greater ( p < .036, one-tailed t test) than the gain made by the control group (M = 0.24, SD = 0.73). These results represented nearly 8 months of gain in reading comprehension at the end of 6 weeks using grade equivalency scores. In contrast, the control class made slightly over 2 months of gain, a level consistent with 2 months of school. When individual gains were examined, the lowest decoders made the least gains. However, the Peabody Individual Achievement Test–Revised required students to read the comprehension text and then pick a picture that represented the meaning, and so, their comprehension was limited by decoding. This included one of the students on the SLP’s caseload. When the test items were read to her, her comprehension score increased to the average range. The other child with an Individualized Education Program made more than 1 year’s gain in comprehension in this same 6-week timeframe. The two students who were good decoders at the beginning of the study, but more than a year behind in comprehension, improved by more than 1 year and were at grade level at posttest. The Sentence Combining Subtest of the Test of Language Development–Intermediate: Fourth Edition (Hammill & Newcomer, 2008) was used as a measure of oral language change. Results indicated that the PowerPoint group averaged 1.9 raw score points in gain following the intervention, whereas the control group decreased their scores by −0.8. Seven of the 10 PowerPoint group subjects made gains greater than the standard error of measurement, compared with only four of the control subjects. This small pilot study provides preliminary

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Figure 1. Example of an animated PowerPoint for complex sentences. This figure appears courtesy of the authors. Copyright © 2018 The Authors.

support for the efficacy of working on language within a written language context. Teacher Observation In addition to measuring progress in students, teacher learning also was measured using a language observation form, adapted from Rudebusch (2008). Observations were to include strategies used by the SLP during the PowerPoint interactions and the student responses. The observation forms were used to determine if the teacher was cuing in to language strategies modeled and student learning. The form was highly effective in this and showed change across time. For the first observation, the teacher merely checked off strategies she observed and made two comments (i.e., “Students are highly engaged.” and “Students responded well to prompts.”). The teacher then began to use language found on the forms (i.e., “Students responded well to the cloze procedure.”). Successive observations became more specific and focused (i.e., “The strategy of talking about nouns and what replaced nouns using the animated PowerPoint was a perfect strategy for helping the kids understand regular pronouns and relative pronouns.” and “Student X couldn’t understand the difference between singular and plural forms of ‘you,’ but having the children act out the difference really made it clear.”). The observation forms let the SLP know what the teacher was learning from the modeling and what needed to be made more explicit. Immediately following the lesson, the SLP photocopied both the teacher’s and the SLP’s forms and left them in the teacher’s mailbox. Sometime in the next 2 days, they would conference about the observations (i.e., often in the hallway during bathroom breaks but sometimes at grade level meetings

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where others also heard and learned from the discussion). The teacher’s observations, thus, became closer in content and focused to what the SLP was emphasizing. The teacher reported that, at the end of the 6 weeks, she had a much better understanding of strategies she could use in her own teaching when children did not understand a concept.

CBLI Example III: Increasing Higher Level Language Another approach that can be taken to improve oral and written language simultaneously is to use text to ask and answer a continuum of increasingly more abstract and decontextualized questions about the passage (CCSS standard). Passage 1 will be used again to illustrate this process (see Table 3), beginning with lower level questions and progressing to higher levels (Arwood, 1983; Monroe, 1951; Norris & Hoffman, 1993). Passage 1: (1) Everyone in the community helped get the town ready for the big parade. (2) Working together was part of the small town way. (3) Jared and his brothers helped to sweep the streets of the parade route. (4) Other groups picked up trash and trimmed bushes. (5) Some painted old houses around town. (6) They all wanted their town to look its best for the visitors who would soon arrive from all over the county. (7) Jared was happy that the town looked so great, but he was even more excited for the parade to start. Unlike oral language, written language remains in view and can be reread as many times as needed. This provides students time and an unchanging context to think

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Table 3. Elicitation levels associated with abstract and decontextualized language. Elicitation levels Label: Description: Attribution: Interpretation: Inference: Evaluation:

Analogy: Metalanguage:

Questions SLP can ask

Response students may provide

What was the town getting ready for? Who swept the streets? What did other groups do? What happened to old houses? Which houses did they paint? Describe the parade they expected. What does it mean “to get the town ready”? Explain where the visitors are coming from. What are some other things the community might do to get ready? Who do they mean when they say “everyone” helped? Can you think of some words to describe the reason why the people want their town to look its best? Should Jared be excited? Why? What does “the small town way” mean? I could say “Jared was as happy as a ___” How many syllables are in the word “community”? How many prepositional phrases are in the paragraph? Spell “visitors.” Are there other words that have an “-or” suffix? What does the “-or” suffix mean?

A parade Jared and his brothers Picked up trash and trimmed bushes They were painted Old houses A big parade To fix it up, make sure it looks good Other towns in the county Mow lawns, put toys and bikes away Parents, kids, teachers, mayor Pride, satisfaction, pleasure, self-respect, pretentious He’s eager to see the parade, celebration, special, people share talents, designer floats People in small communities help each other, work toward a common goal A boy at a baseball game (or any simile) Four Eight Violator, instigator, predator, legislator, demonstrator

Note. SLP = speech-language pathologist.

about the information on many levels, developing critical thinking and higher level language skills. This approach can be adapted to any grade level, including illustrated stories at preK or kindergarten and grade level texts from first grade through high school.

CBLI Example IV: Articulation and Phonics According to the ASHA Schools Survey (2016), 89% of school-based SLPs have large caseloads of students with speech sound disorders, the highest area of intervention cases except for language. Considerable research shows a moderately strong relationship between speech sound disorders and reading deficits. Gosse, Hoffman, and Invernizzi (2012) found that of the 6% of kindergarten and first grade children identified by the SLP, 25% of those with articulation-only deficits had a comorbid reading disability, whereas 66% with a speech and language impairment also had a reading disability. This was supported by Overby, Trainin, Smit, Bernthal, and Nelson (2012) who showed poor reading ability among first and second graders with speech sound disorders despite good vocabulary skills. Conti-Ramsden, Botting, and Faragher (2001) found general academic difficulty and deficits in reading, writing, spelling, and mathematics among children with early phonological disorder, 50%–70% of which persisted through high school. Many additional studies have concluded that the long-term literacy outcomes for students with speech or speech and language impairment are poor (e.g., Bird, Bishop, & Freeman, 1995; Catts, 1993, 1997; Larrivee & Catts, 1999; Leitão & Fletcher, 2004; Snowling, Bishop, & Stothard, 2000; Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998).

Several studies have shown that children with speech sound disorders as preschoolers have difficulty with phonemic awareness, decoding/phonics, and spelling (Catts & Kahmi, 2005; Justice, 2006; Nation, Adams, Bowyer-Crane, & Snowling, 1999). Durand, Loe, Yeatman, and Feldman (2013) showed that both decoding and oral fluency (i.e., rapid word recognition) in reading were highly correlated with speech sound maturity at age 3 years. These studies have led some to suggest that an underlying phonological processing deficit underlies both the articulation and reading code deficits (Bird et al., 1995; Leitao & Fletcher, 2004; Lewis & Freebairn, 1992). In our project, we examined seven second-grade students with Individualized Education Programs who were identified as speech only. We worked with the reading coordinator to get a better profile of their overall languageliteracy abilities and found that the majority were also low in reading according to Dynamic Indicators of Basic Early Literacy Skills (Good & Kaminski, 2002). All had scored poor (one student) to very poor (six) for Nonsense Word Fluency, Oral Passage Fluency, and Passage Retelling (two average, four very poor). Four scored low to very poor on the Second Grade Diagnostic Spelling test (Kottmeyer, 1970), and all were below average to very poor on an informal phonics inventory. Although they had passed a language screening at kindergarten, when we administered the Clinical Evaluation of Language Fundamentals–Fourth Edition language screening (Semel, Wiig, & Secord, 2004), all but one failed. Examination of the speech-only students’ profiles revealed significant weaknesses in written language, with phonological deficits in decoding, spelling, and phonics and higher level language problems with syntax and story retelling. We calculated that, over the 2 years they had been in

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treatment for speech sound disorders, they had amassed approximately 60 hr of intervention (i.e., approximately 30 [of 36] weeks per school year × 30 min twice weekly × 2 years). We conjectured that, if that time could be used to simultaneously address written and oral phonological needs, perhaps, SLPs could have a significant impact on reducing literacy failure in children with speech sound disorders. We decided to implement a 6-week intervention that simultaneously addressed articulation and phonological reading deficits (i.e., decoding and reading fluency) to determine if the SLP could address literacy but still achieve articulation goals. Lesson plans were developed that were a hybrid between an articulation word list and a phonics lesson. The SLP selects words on the basis of target sounds in a specified word position (i.e., initial /s/ words). A phonic worksheet selects words based upon a word structure skill, such as words conforming to the double vowel or the silent /e/ syllable pattern with no regard to an initial or final consonant. We developed worksheets (see the Appendix) that focused on a specific syllable spelling pattern using words that all had the target sound in either word initial or word final position. For the intervention, we re-evaluated the articulation of all of the children and found that most had resolved their articulation errors with a few distortions or inconsistent single-phoneme problems remaining. Thus, our initial plan to address a high-frequency sound was not feasible. None of the students produced a /th / sound, and we recognized that this issue was dialect. However, the question of whether we could change speech sound productions while simultaneously addressing written syllable patterns remained valid. We decided to address /th / words in all word positions and to use primarily two-syllable words that would have exemplars of the short vowel written syllable pattern in at least one syllable. The list also included one example of silent /e/ and one of a double vowel. The plans were designed to first teach syllable awareness. The child was asked to read the word; if unsuccessful, the child was asked to divide the word into syllables by finding the vowels. The child was reminded that each syllable corresponded to the sounds made in one jaw movement. If the child could not find the syllable break, the rule was stated and the word divided. The child then was asked to pronounce each syllable and derive the word. If the child mispronounced the /th / within the word, corrective feedback was provided. The child was then asked to read the list and to produce a correct /th / each time the letters were encountered. Once production within the isolated words was achieved; the words were then read in the sentences. Corrective feedback was provided for both reading errors and sound production. Finally, students were asked to maintain sound production while talking about the picture without the support of the text. The lessons were presented twice weekly for 15 min for 6 weeks. Results indicated that the Artic-Phonics group made as much change in articulation as a 7-min articulation drill group who received equal treatment time, and they gained 15 points on the phonics test. However, we were not able to control the interventions

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from other programs the children in this at-risk school were receiving, and so, the literacy results can only be viewed as preliminary, which brings us to our final topic—why so few studies have been conducted in schools measuring curriculum-based instruction.

Barriers Encountered When Implementing CBLIs Many barriers are encountered when attempting to implement CBLIs and when attempting to measure the efficacy of these treatments. These barriers include time, place, participants, curriculum, school structure and culture, schedules, competing and overlapping programs, personnel, and many others. Four of these will be discussed. Time Time is a major barrier in schools. CBLIs often require frequent collaborations with different teachers, including one or more classroom teachers, special educators and, often, paraprofessionals. However, little time is available during the school day to plan or confer. The ASHA Schools Survey (2016) results reveal that schoolbased SLPs are assigned to noninstructional activities during the week, such as lunch or bus duty, further eroding time for collaboration. SLPs often compete with other support programs, such as response-to-intervention groups or special education services for time with the same students. Identified children at the same grade level are often in different classrooms making it difficult to deliver a classroom-based intervention. Retrieving students from several classrooms squanders valuable intervention time. Many schools have “protected time” during which special services are restricted from taking children. These barriers also make it very difficult to conduct valid research. In addition, school breaks, high-stakes schoolwide testing and special events limit the number of weeks in which interventions can be implemented and data collected. Participants Whether implementing CBLIs or conducting research, the heterogeneity of the participants makes it difficult to address the needs of students. A treatment group may have students of different ages and different disorder (e.g., language, fluency, and speech sound disorders). Participants present a significant challenge for research. Group designs require at least two groups of comparable participants (e.g., same age, presenting problem, and ability level), but this is unlikely to be found in a single school. Even when subjects are available, only some will return signed consent forms. Attrition is a problem, especially in at-risk schools where the population may be transient. Single-subject designs may overcome some of these problems, but the number of participants may be limited to a very small number, and it is difficult to control for competing and overlapping programs. Competing and Overlapping Programs It is difficult to ascertain how much of a change can be attributed to the efforts of the SLP when students

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participate in a range of programs. This may be particularly true of students with speech and language impairment who are likely to be poor readers and, thus, may receive extra time in a reading group with the teacher, help from a paraprofessional in a response-to-intervention group, or interventions from the special education teacher for a child with identified learning disabilities.

failure across the continuum from preschool through high school, we need to continue to explore interventions that address the oral and written language needs of our students. This does not require us to abandon our traditional speech and language goals but, rather, reconceptualize how we can obtain them using CBLIs.

School Structure and Culture The ASHA Schools Survey (2016) indicated that approximately 80% of SLPs from 2008 to 2016 used the caseload approach to determine the number of students they serve. From 2008 to 2014, approximately 20% of SLPs used the workload approach to determine the number of students they serve; in 2016, only 15.2% of SLPs used the workload approach, and 3.8% used both the workload and caseload approach. SLP feedback at our partner schools suggested that administrators did not support reconceptualizing the method in which students were served. With the addition of other barriers (e.g., scheduling and planning challenges), SLPs reported difficulty fully implementing CBLIs with a caseload approach. Teachers differ in their attitude regarding interventions by the SLP occurring within the classroom. Early elementary teachers are likely to embrace language lessons delivered to the entire class or small groups within the class using curriculum materials, such as illustrated books (see CBLI Example 3). However, upper grade levels are responsible for implementing a specific curriculum. While some embrace coteaching or collaborative teaching, others view the SLP as “one more person in the classroom.” As Russell and Kaderavek (1993) stated, in some instances, the relationship between the SLP and the teacher may not reflect a positive, collaborative partnership. Additionally, as Creaghead (1992) experienced, some SLPs had difficulty with teachers trusting that the SLP would give up their role as “expert” and integrate into the classroom as a collaborative partner.

Acknowledgments

Final Thoughts “Change is usually a difficult process in any aspect of life, but schools are one of the most difficult places to create change....Change must…occur in the way teachers view their interaction with speech-language pathologists” (Moore-Brown, 1991, p. 148). At the end of the 20th century, no consensus could be reached in the field of speech-language pathology regarding the efficacy of integrated treatment plans, and almost 20 years later, we have not solved this dilemma. SLPs tend to use traditional service delivery of individual and/or small group pullout therapy, but we need to make efforts to make these interventions more supportive of the curriculum and written language needs of students, as well as participating in alternative service delivery models (e.g., working directly with children and teachers in the classroom). With 20 years of research showing that students with speech and language delays are at high risk of literacy

The authors thank Phyllis Butler for her assistance as a liaison between the university and public schools. Special thanks to various teachers, SLPs, and school administrators who have helped the authors explore CBLIs in their schools. Correspondence concerning this article should be addressed to Ashley Bourque Meaux, Southeastern Louisiana University, Department of Health and Human Sciences, Box 10879, Hammond, LA 70402. Email: [email protected]

References American Speech-Language-Hearing Association. (1993). Guidelines for caseload size and speech-language service delivery in the schools. Asha, 35(Suppl. 10), 33–39. American Speech-Language-Hearing Association. (2010). Roles and responsibilities of speech-language pathologists in schools [Professional issues statement]. Retrieved from http://www. asha.org/policy. https://doi.org/10.1044/policy.PI2010-00317 American Speech-Language-Hearing Association. (2016). 2016 Schools Survey Report. Retrieved from http://www.asha.org/ Research/memberdata/SchoolsSurvey/ American Speech-Language-Hearing Association. (n.d.). Evidencebased practice. Retrieved from https://www.asha.org/research/ebp/ Arwood, E. L. (1983). Pragmaticism: Theory and application. Philadelphia, PA: Lippincott, Williams & Wilkins. Bird, J., Bishop, D. V. M., & Freeman, N. H. (1995). Phonological awareness and literacy development in children with expressive phonological impairments. Journal of Speech and Hearing Research, 38, 446–462. Bowyer-Crane, C., Snowling, M. J., Duff, F. J., Fieldsend, E., Carroll, J. M., Miles, J., . . . Hulme, C. (2008). Improving early language and literacy skills: Differential effects of an oral language versus a phonology with reading intervention. The Journal of Child Psychology and Psychiatry, 49, 422–432. https://doi.org/10.1111/j.1469-7610.2007.01849.x Catts, H. W. (1993). The relationship between speech-language impairments and reading disabilities. Journal of Speech and Hearing Research, 36, 948–958. https://doi.org/10.1044/jshr.3605.948 Catts, H. W. (1997). The early identification of language-based reading disabilities. Language, Speech, and Hearing Services in Schools, 28, 86–89. https://doi.org/10.1044/0161-1461.2801.86 Catts, H. W., & Kamhi, A. G. (Eds.). (2005). The connections between language and reading disabilities. London, England: Psychology Press. Cirrin, F. M., Schooling, T. L., Nelson, N. W., Diehl, S. F., Flynn, P. F., Staskowski, M., . . . Adamczyk, D. F. (2010). Evidencebased systematic review: Effects of different service delivery models on communication outcomes for elementary school-aged children. Language, Speech, and Hearing Services in Schools, 41, 233–264. https://doi.org/10.1044/0161-1461(2009/08-0128) Common Core. (2010). National Center for Education Statistics. Retrieved from https://nces.ed.gov/ccd/ Conti-Ramsden, G., Botting, N., & Faragher, B. (2001). Psycholinguistic markers for specific language impairment (SLI).

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Downloaded From: https://lshss.pubs.asha.org/ by a ReadCube User on 04/06/2018 Terms of Use: https://pubs.asha.org/ss/rights_and_permissions.aspx

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Journal of Child Psychology and Psychiatry and Allied Disciplines, 42, 741–748. Creaghead, N. (1992). Collaborations as a service delivery model. In ASHA Transcript Series. Focus on school issues: Classroom integration and collaborative consultation as service delivery models (pp. 6–19). Rockville, MD: American Speech-LanguageHearing Association. Durand, V. N., Loe, I. M., Yeatman, J. D., & Feldman, H. M. (2013). Effects of early language, speech, and cognition on later reading: A mediation analysis. Frontiers in Psychology, 4, 586. https:// doi.org/10.3389/fpsyq.2013.00586 Ehren, B. J. (2006). Partnerships to support reading comprehension for students with language impairments. Topics in Language Disorders, 26(1), 42–54. Ehren, B. J. (2009). Looking through an adolescent literacy lens at the narrow view of reading. Language, Speech, and Hearing Services in Schools, 40, 192–295. https://doi.org/10.1044/01611461(2009/08-0036) Every Student Succeeds Act of 2015, Pub. L. No. 114-95, § 114 Stat. 1177. (2015). Farber, J. G., & Klein, E. R. (1999). Classroom-based assessment of a collaborative intervention program with kindergarten and first-grade students. Language, Speech, and Hearing Services in Schools, 30, 83–91. https://doi.org/10.1044/0161-1461. 3001.83 Good, R. H., & Kaminski, R. A. (2002). Dynamic Indicators of Basic Early Literacy Skills. Austin, TX: Pro-Ed. Gosse, C. S., Hoffman, L. M., & Invernizzi, M. A. (2012). Overlap in speech-language and reading services for kindergartners and first graders. Language, Speech, and Hearing Services in Schools, 43, 66–80. https://doi.org/10.1044/0161-1461(2011/10-0056) Green, C. W., Kopel, L., & Roesser, S. (2006). Georgia school-based SLPs: Providing language intervention in the general education classroom using the curriculum at the American Speech-LanguageHearing Association Convention, Miami, FL. Hadley, P. A., Simmerman, A., Long, M., & Luna, M. (2000). Facilitating language development for inner-city children: Experimental evaluation of a collaborative, classroom-based intervention. Language, Speech, and Hearing Services in Schools, 31, 280–295. https://doi.org/10.1044/0161-1461.3103.280 Hammill, D. D., & Newcomer, P. L. (2008). Test of Language Development–Intermediate: Fourth Edition (TOLD-I:4). Austin, TX: ProEd. Hoffman, L. M., Ireland, M., Hall-Mills, S., & Flynn, P. (2013). Evidence-based speech-language pathology practices in schools: Findings from a national survey. Language, Speech, and Hearing Services in Schools, 44, 266–280. https://doi.org/10.1044/ 0161-1461(2013/12-0041) Idol, L., Paolucci-Whitcomb, P., & Nevin, A. (1986). Collaborative consultation. Rockville, MD: Aspen Publishers. Justice, L. M. (2006). Evidence-based practice, response to intervention, and the prevention of reading difficulties. Language, Speech, and Hearing Services in Schools, 37, 284–297. https:// doi.org/10.1044/0161-1461(2006/033) Kottmeyer, W. (1970). Teacher’s guide for remedial reading: Second grade diagnostic spelling. New York, NY: McGraw-Hill. Larrivee, L. S., & Catts, H. W. (1999). Early reading achievement in children with expressive phonological disorders. American Journal of Speech-Language Pathology, 8, 118–128. https://doi. org/10.1044/1058-0360.0802.118 Leitao, S., & Fletcher, J. (2004). Literacy outcomes for students with speech impairment: Long-term follow-up. International Journal of Language & Communication Disorders, 39, 245–256.

174

Lewis, B. A., & Freebairn, L. (1992). Residual effects on preschool phonology disorders in grade school, adolescence, and adulthood. Journal of Speech and Hearing Research, 35, 819–831. https://doi.org/10.1044/jshr.3504.819 Magnotta, O. H. (1991). Looking beyond tradition. Language, Speech, and Hearing Services in Schools, 22, 150–151. https:// doi.org/10.1044/0161-1461.2203.150 Markwardt, F. C. (1998). Peabody Individual Achievement Test– Revised (PIAT-R). Circle Pines, MN: AGS. Miller, L. (1989). Classroom-based language intervention. Language, Speech, and Hearing Services in Schools, 20(2), 153–169. https://doi.org/10.1044/0161-1461.2002.153 Monroe, M. (1951). Growing into reading: How readiness for reading develops at home and school. New York, NY: Scott Foresman. Moore-Brown, B. J. (1991). Moving in the direction of change: Thoughts for administration and speech-language pathologists. Language, Speech, and Hearing Services in Schools, 22, 148–149. https://doi.org/10.1044/0161-1461.2203.148 Nation, K., Adams, J. W., Bowyer-Crane, C. A., & Snowling, M. J. (1999). Working memory deficits in poor comprehenders reflect underlying language impairments. Journal of Experimental Child Psychology, 73(2), 139–158. Nelson, N. W. (1989). Curriculum-based language assessment and intervention. Language, Speech, and Hearing Services in Schools, 20(2), 170–184. https://doi.org/10.1044/0161-1461. 2002.170 Nelson, N. W. (2010). Language and literacy disorders: Infancy through adolescence. Boston, MA: Pearson Education, Inc. No Child Left Behind Act. Pub. Law. No. 107-110, § 115 Stat. 1425. (2001). Norris, J. A. (1991). From frog to prince: Using written language as a context for language learning. Topics in Language Disorders, 12(1), 1–6. Norris, J. A. (1998). I could read if I just had a little help: Facilitating reading in whole language contexts. In C. Weaver (Ed.), Practicing what we know: Informed reading instruction (pp. 513–553). Urbana, Illinois: NCTE Press. Norris, J. A. (2010). Four leaf luck. Baton Rouge, LA: Elementory. Norris, J. A., & Hoffman, P. R. (1993). Whole language intervention for school age children. San Diego, CA: Singular. Overby, M. S., Trainin, G., Bosma Smit, A., Bernthal, J. E., & Nelson, R. (2012). Preliteracy speech sound production skill and later literacy outcomes: A study using the Templin Archive. Language, Speech, and Hearing Services in Schools, 43, 97–115. https://doi.org/10.1044/0161-1461(2011/10-0064) Powell, R. K. (2018). Unique contributors to the curriculum: From research to practice for speech-language pathologist in schools. Language, Speech, and Hearing Services in Schools, 49, 140–147. Rudebusch, J. (2008). The source for RTI. Austin, TX: Linguisystems. Russell, S., & Kaderavek, J. (1993). Alternative models for collaboration. Language, Speech, and Hearing Services in Schools, 24, 76–78. https://doi.org/10.1044/0161-1461.2402.76 Scheule, C. M., & Ehren, T. C. (2016). No more flippin’ cards: Linking speech sound intervention to curriculum for preschoolers & school-age children at the American Speech-Language-Hearing Association Convention, Philadelphia, PA. Semel, E., Wiig, E. H., & Secord, W. (2004). The Clinical Evaluation of Language Fundamentals–Fourth Edition. San Antonio, TX: The Psychological Corporation. Snowling, M., Bishop, D. V. M., & Stothard, S. E. (2000). Is preschool language impairment a risk factor for dyslexia in adolescence? The Journal of Child Psychology and Psychiatry, 41, 587–600.

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Starling, J., Munro, N., Togher, L., & Arciuli, J. (2012). Training secondary school teachers in instructional language modification techniques to support adolescents with language impairment: A randomized controlled trial. Language, Speech, and Hearing Services in Schools, 43, 474–495. https://doi.org/10.1044/01611461(2012/11-0066) Stothard, S. E., Snowling, M. J., Bishop, D. V. M., Chipchase, B. B., & Kaplan, C. A. (1998). Language impaired preschoolers: A follow-up into adolescence. Journal of Speech, Language, and Hearing Research, 41, 407–418.

Tucker, J. A. (1985). Curriculum-based assessment: An introduction. Exceptional Children, 52, 199–204. Wilkinson, L. C., & Silliman, E. R. (2000). Classroom language and literacy learning. Handbook of Reading Research, 3, 337–360. Zucker, T. A., Justice, L. M., & Piasta, S. B. (2009). Prekindergarten teachers’ verbal references to print during classroombased, large-group shared reading. Language, Speech, and Hearing Services in Schools, 40, 376–392. https://doi.org/ 10.1044/0161-1461(2009/08-0059)

Appendix Example of an Articulation-Phonics Worksheet

This appendix appears courtesy of the authors. Copyright © 2018 The Authors.

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