Child Observation Essay

Question 1 (15 points 1 ½ -2 pages)

A 3 year 7 month old boy, JL, is referred to you by his pediatrician for his unintelligible speech. He has a repaired bilateral cleft of the lip and palate (BCLP). He has a restricted sound inventory of /m, n, j, h and ʔ/and has no oral high pressure consonants. His receptive language abilities are WNL. He is struggling in the kindergarten due to his unintelligible speech. According to the teacher he has few friends and often gets excluded from group activities by other children .

Plan and describe a treatment plan for JL and his parents by:

- Explaining the framework you would use

I would plan to assess JL using the ICF-CY framework. Starting with Body structure and function, I would perform an oral mechanism and a hearing screening, then assess for resonance and nasal air emission, as well as expressive language. It might be a good idea to do an oral mechanism on this new client due to his history of BCLP. This will ensure no other abnormalities exist or fistulas. It is also important to perform a hearing screening due to children with CLP having otitis media and/or a hearing loss.

Next, I would look at activities and participation; therefore I would give the Vineland II and the FOCUS. Since JL’s teacher is

concerned his interaction with peers, the FOCUS will be a vital component to the SLP (Creech, Culbertson, Jamison, & Keeton, 2016). Next, I would look at environmental and personal factors by administering the Ages and Stages Questionnaires: Social Emotional- 2nd Edition (ASQ: SE-2). The ASQ: SE-2 will assess communication, compliance, autonomy, affect, interactions with people, self-regulation, and adaptive behaviors to determine if deficits are present and needed to be targeted in intervention (Creech, Culbertson, Jamison, & Keeton, 2016).
- Formulating the long term and short term goals of treatment
Long-Term Goal
1. JL will increase his speech intelligibility.
Rationale (ST and LT): By increasing his speech intelligibility, more people and his peers will better understand him, allowing for more interactions and participation.
Short-Term Goals
1. JL will produce 20 puffs of air with sound elicitation at the end out of 30 trials given moderate cueing (visual and tactile) within 3 out of 4 sessions in a structured setting.
2. JL will produce consonants slides (i.e. m→ b) with 75% accuracy given moderate cueing (visual and tactile) within 3 out of 4 sessions in a structured setting.
3. JL will produce high-pressure consonants p, t, and b with 75% accuracy given moderate cueing (visual and tactile) within 3 out of 4 sessions in a structured setting.
- Select two of the short term goals formulated and describe and justify the activities you would select for each
To begin therapy with JL, I would target short-term goals 1 and 2.
For goal one: I would need visual materials (streamers, tissues, tissue paper). I would instruct JL to inhale and hold like a puffer fish (puffer fish toy) and on the exhale (the clinician holds a mobile visual in front of his mouth, like a tissue) JL will let out the puff of air while trying to elicit one of the high-pressure consonants. My personal judgment on this exercise is that it is no an oral motor exercise due to sound/speech elicitation being incorporated and instructed upon.
For goal two: I would use a tactile and visual method to teach a “consonant slide.” The two materials I would use to complete this activity are a slide (Barbie size) and a little boy figurine (i.e. JL). “JL” starts at the top of the slide eliciting: m while sliding. As JL approaches the end of the slide, out pops the: b sound!
- Explaining how you could involve the teacher and his peers in JL’s treatment.
I would like for the parents to attend one out of the three total sessions a week, so they can learn how to help JL at home. I would also develop an at home program for JL and his parents to use. One session I would like to spend in JL’s classroom. This time can be spent on helping JL communicate better with his peers and educating the teacher on ways to help JL interact better with his peers, as well as proper verbal feedback for JL’s speech in the classroom.

Question 2 (15 points 1 ½ -2 pages)
LB is 15 months old with a repaired unilateral cleft lip and palate. Palotoplasty was performed at 13 months. She babbles using /m, w, j, h /, a glottal stop and grunting sound (possibly a pharyngeal fricative) .She does not produce any anterior stop consonants. She produces some CV and CVCV syllables with the above consonants and has a limited vocabulary (e.g. mamma, no)

Describe the intervention approach that you would follow with LB and her parents. Specify:
i. How you would involve the parents
ii. The goals of treatment
iii. Examples of activities for each goals
iv. Resources that you would use
I would use a Prelinguistic approach due to her age, history, and current sound inventory.

Parental education will be key with LB’s intervention. This intervention approach and parental education will involve face-to-face interaction, natural vocalization times, and imitation (Scherer & Chapman, 2014). The intervention should take place in the clinic and at home with clinician and parents. During sessions in the clinic and at home, the clinician should educate the parents on when and how to imitate vocalization, perform recasts, turn-take, allow for communicative opportunities, and utilize responsive interaction strategies, wait time, and environmental arrangement (Scherer & Chapman,

2014).
1. When LB’s elicits a growl, immediate feedback will be provided to reinforce a a vowel such as “ahhh;” LB will imitate this sound with 60% of all instances given moderate cueing in structured and the home across 4 weeks (Seattle Children’s, 2013).
Activity: This goal does not have an appropriate activity due to the nature of the goal needing to be extinguished; therefore, anytime LB elicits this sound, the clinician and/or the parents will give appropriate feedback.
2. LB will complete 10 verbal turn taking cycles within a 30 minute naturalistic time period of play/meal given minimal cues in structured and at the home across 4 weeks.
Activity: During a snack time, the clinician will use environmental arrangement and sabotage to help elicit verbalizations. The clinician will need plastic containers (a variety of colors, shapes, etc.) and a variety of snack options. Using the containers and snack items, the clinician will model syllable shapes and introduce new vocabulary for LB.
3. LB will produce CV syllables with 75% accuracy given moderate cues in 3 out of 4 sessions.
Using the Kaufmann cards (CV level), the clinician will select a set of 10 that incorporates anterior stop consonants, glides, and liquids. Using naturalistic play and preferred toys of LB the clinician will model each syllable and prompt LB (Chapman & Scherer, 2014; Children’s, 2013).
Resources that I would use for myself the clinician and provide to the parents may consist of: ASHA’S Compendium, Seattle Children’s CLP Patient and Family Guide, Early Assessment and Intervention for Infants and Toddlers, the Guide to Understanding CLP, and refer them to a support group in their area (Bennett, 1997; Chapman & Scherer, 2014; Children’s, 2013). I think its important not to overwhelming the parents with too many resources. Some of the above resources will be sufficient to begin with.

Question 3 ( 10 points 1-1 ½ pages)
Your new client, MG, is 5 year old girl with a repaired palate of the soft palate. Her family recently moved from Colima, Mexico to Johnson City and although her parents speak some English, it is limited. Her Mom takes care of her and her elder sister and her Dad has a position at a local factory. Describe how you would accommodate the family how you would adapt when conducting the initial interview to determine what MG and the family’s needs are re speech therapy services.
Since I do not know Spanish, I believe it would be really important to have an interpreter present during the initial interview. This will help the family feel more comfortable and ensures comprehension on both sides. Due to the family’s background, I will conduct an ethnographic interview that will consist of open-ended questions, restatements, and will be mindful of not asking multiple questions back to back or asking why questions (Louw, 2016). It will be important for me to take an interest in learning about their cultural group. This will allow me to understand more about the family. Also, within the interview identifying the family’s strengths will be important as well (Louw, 2016). Next, I would gather as much information I could about MG’s history.
Since I do not have any experience with a multicultural, CLP, or multilinguistic children, I would refer the family and MG to a bilingual SLP. If a bilingual SLP is not available, I would move forward with an appropriate protocol with collaboration with bilingual support personnel (Louw, 2016).
If the bilingual SLP is not available to see the family, I would conduct the following (see below); however if availability exist I would recommend the following. Next, I would perform a battery of assessments and administer the FOCUS and the ASQ: SE-2. What is key during this initial meeting is taking the parents concerns into consideration. Using all of the information from the interview and assessment portion, I would propose a treatment plan. If parents were in agreement and fully understand the goals, then the intervention can move forward. Depending on how much English MG knows, I would incorporate same age peer models into the treatment sessions. This would help MG feel more comfortable, allow for her to learn English in a more naturalistic setting, and allow for speech therapy to occur in a more naturalistic setting.

Question 4 (5 points, ½- ¾ pages)
Explain the benefits of using the ICF-CY (WHO, 2007) framework for planning and executing assessment and intervention for children with POD.
Using the ICF-CY framework is an absolute must when working with children. Using the framework ensures that the clinician is assessing and treating the whole child in a holistic manner. By the clinician examining the child’s body function, their activities and participation, and contextual factors allows for a more all-inclusive picture to be seen about the child. For an example, cleft lip and palate doesn’t just impact the speech or physical appearance of the child, unfortunately more is at play in these cases most of the time. Fortunately, the ICF-CY framework is a wonderful tool that can help guide SLP’s to look at the full picture of the child, “see more than just the CLP” if you will. The major benefit is that it allows the SLP to guide assessment and intervention in a more tailored holistic manner and because of this; the client wreaks the benefit of receiving quality/ethical care that has no rigid or shallow perspective. I feel fortunate to have been educated on this framework, especially learning about other clinicians who do not know about it. Knowing that I have the framework and the knowledge and education to use it correctly is a great comfort, because I want to be a great clinician and do what is best for them.

Question 5 (5 points, ½- ¾ pages)
Evidence –based decision making was emphasized throughout the course. As a new graduate explain how you would perform EBP when providing services to children with cleft palate and their families. Refer to the resources that you would use

When considering EBP, three factors come into play: current best practice, clinical expertise, and client or patient values. As an SLP, we will always have our clinical expertise or judgment as well as taking our client’s values into account; however, using the current best evidence takes a whole role in itself. An SLP must stay informed of the latest research by reading and educating themselves. Setting aside time to read and complete research helps with EBP. Also, attending conferences or talking with other SLP colleagues are helpful too. Using ASHA’s Compendium of EBP is one of the greatest tools SLPs have for EBP http://www.asha.org/members/ebp/compendium/. Continuing my education through these resources is one way I will stay informed of new topics. One important note for myself, being a new graduate, is that I will have some experience through my education and clinical practicums; however, I’m going to have to do a great deal of learning my first years. I must lean heavily on my clinical judgment and evidence-based practices to ensure quality and ethical services to the children I serve. With my education in this class, I have learned that the TEAM is best when working with children who have cleft lip and palate, its like that old say “one head is better than one.” By referring our clients to a team will help ensure that the child receives a holistic treatment approach.

References

Total: 50
0-0-0
Dr. Brenda Louw