Issue 23, Page 18-19: Ask a Therapist: Intervention tips

QUESTION: “My speech and language intervention isn’t going as well as I expected. What should I try?”

ANSWER: With the best of intentions, we often can’t predict how our speech and language interventions will pan out. We try to ensure success by planning our sessions meticulously so that they are packed with fun activities that will capture our pupils’ imaginations. However, no matter our skill or experience, things just go wrong sometimes, and it’s not always about the toys you brought along for motivation. This brings me to my first and most fundamental piece of advice for when speech and language therapy isn’t quite going your way: the secret to good interventions is not perfect planning. The real secret is to reflect, adapt, and be resilient.

There are all sorts of things that might be a barrier to the success of your intervention. Keep in mind that while these barriers might not all be under your control, you can often make more changes than you think. Consider these three key variables:

Setting

The setting of your speech and language intervention is easily overlooked or even dismissed as something that is outside of your control, however it is worthy of consideration as context can certainly have an impact (positive or negative) on the outcome of your intervention. There are a number of factors to assess, including the room or location you are working in, the time of day, length of session, frequency of your sessions, and, if you’re working with a group, the size of that group and the mix of individuals. Try to notice any patterns that align with when your intervention sessions are more or less successful. For example, are you taking pupils out of their favourite lesson? If so, try to change the time of your intervention, or find an opportunity for them to catch up on what has been missed. Do your pupils find it hard to focus on an intervention after break time? Perhaps pupils could benefit from a transition activity. Do you find that pupils struggle to maintain their attention for the duration of your session? Consider a shorter session length, a movement break, or switching up the activities in your session to help pupils to refocus.

Groups of pupils can be especially difficult to manage. Remember that the purpose of an intervention session is to provide students with lots of opportunities to practice their target skill. If your group is too large, each pupil will have fewer turns at each activity, which may make the intervention less effective. Time spent waiting for their turn can also lead some pupils to disengage. It might be more efficient to work with smaller groups if those groups are more effective.

Targets

The goals you set for your intervention may or may not have been your choice but remember that they are the result of somebody’s decision making. Goals are not self-evident – we have to choose what is important for a child to work on right now, and what the appropriate next step would be for that child. If you find that, after a few weeks of work, your intervention isn’t going well, it might be appropriate to think about whether the target was the right choice. For your intervention to be successful it will be essential that the pupil has the pre-requisite skills in place so that they are ready for this step-up. You should feel confident that the child has mastered the foundation of attention and listening skills that they need to participate in your session and that they have met the developmental steps that lead up to what you are asking of them. You can look at developmental milestones to help you make this decision (Speech and Language Link subscribers can find this information within their packages). If you feel your pupil is skipping a few steps, it’s a good idea to shift your focus and make sure that you are building on secure foundations.

Level

It’s not always necessary to change your overall target. That might be an overreaction! If you are satisfied that you’re on the right track, and the target is an appropriate next step for that child, you might simply need to ‘fine-tune’ your activities. For pupils to make progress, you need to pitch your intervention activities at just the right level. Too easy and they won’t extend their skills – there will be little or no change. Too hard and the child won’t be successful, which can be really damaging for their motivation and engagement, not to mention self-confidence. To make sure that the activities that you are carrying out, and the support you are providing, are always well matched to each pupil’s individual needs, you will need to make small adjustments to activities throughout the session. In fact, to maximise effectiveness, you should look to make slight tweaks to differentiate for each pupil. It sounds simple, but this requires some skill and lots of practice. I recommend planning out your step-up and step-down for each activity in advance of your session, which will give you more confidence to make those changes seamlessly and purposefully.

With all of the above to consider, and plenty more on your plate, it can seem overwhelming to evaluate your own interventions and make changes. However, my final piece of advice is to call on support. There are lots of people who will be able to help you to unpick the situation, so do reach out to colleagues who may have similar experience or work with the same pupils, specialists such as your local NHS Speech and Language Therapy service, and even ask pupils and/or their parents to gain insight into what is or isn’t working.

Speech Link and Language Link subscribers can also access unlimited support from our Speech and Language Help Desk, helping you to problem-solve your interventions and find a way forward!