Intervention Products

The first step in planning intervention is the identification of the communicative behaviors to be acquired in the program. These are drawn from assessment data and are usually called long-term goals. Long-term goals are the relatively broad changes in communicative behavior to be achieved during a course of therapy. The achievement of these goals will be justification for terminating therapy.

Once general long-term goals have been identified, clinicians must decide how to help the client progress toward them. This is accomplished by formulating steps so that progress can be observed and measured and will lead the client toward the long-term goal. To facilitate this, therapy steps are stated in a specific form as behavioral objectives. There are three components of a behavioral objective:

1. The do statement identifies the action that the client is to perform. This statement should contain verbs that name observable actions, such as point, label, repeat, say, match, write, name, ask. Words to avoid in behavioral objectives are those that refer to processes that cannot be observed directly, such as understand, know, learn, remember, comprehend, or discover.
   
   
2. The condition identifies the situation in which the target behavior is to be performed; such as when it will occur, where, in whose presence, and with what materials or cues. Examples of condition statements are:
   
   Following a clinician’s model
   In response to a question
   Given a list of written words
   In response to pictures
   In presence of other therapy group members
   
   
3. The criterion specifies how well the target must be performed for the objective to be achieved. Typically used criteria include:
   
   90% correct
   Eight correct trials of 10
   Fewer than four errors in three consecutive sessions
   Consistently over a 10-minute period

At this point, you might like to try writing a behavioral objective for one of Marlene’s long-term goals. One example follows, to help you get started:

Before beginning a therapy program, the clinician must be sure that the client cannot already perform the target behavior independently. This might seem obvious; but often a diagnosis is made on the basis of standardized tests that include only one item for a particular communication element, and a client may have missed that one item for a variety of reasons. This is an example of why potential therapy targets must undergo a pretest before an intervention program is initiated. The pretest allows a clinician to establish that the client has not already mastered a target behavior. When the clinician observes that the client is achieving target behaviors in most intervention activities, he or she administers a posttest to determine the client’s consistency with target behavior. The pretest and posttest are usually the same; they consist of a set of 10–20 opportunities for the client to produce the target form when presented with minimal cues, prompts, or other supports from the clinician. Suppose one behavioral objective for Darrell was

Before beginning intervention, a pretest (such as the one that follows) would be administered to ensure that a reasonable goal has been set:

If the client failed to attain the criterion on the pretest, intervention on this target would be provided using the techniques that follow. When the client achieves criterion levels of correct production in the intervention situation, a posttest is given to determine whether the objective has been met, using the same stimuli, responses, and criterion that were used in the pretest.

Once long-term and short-term objectives have been established and pretested, it is necessary to determine how to move the client toward achieving these objectives. This process usually involves task analysis. In a task analysis, a larger goal is broken down into small steps that can be followed to achieve it. To accomplish this breakdown, a clinician examines the input and output prerequisites necessary for completing the task. Consider Marlene’s first long-term goal: increasing the intelligibility of speech. The requirements of the goal can be analyzed this way:

• Sensory: She must hear the speech spoken to her
  
  
• Motor: She must be able to make oral articulatory movements
  
  
• Language: She must have some degree of semantic (word meaning) and syntactic (sentence structure) skill
  
  
• Cognitive: She must have some degree of conceptual and problem-solving ability; she must not be inordinately confused or demented

A clinician would then proceed, by means of informal assessment, to determine whether Marlene has the requisite skills. If not, the clinician might revise the goal or work on developing its prerequisites. If Marlene demonstrates the requisite abilities, then the clinician devises a series of steps, or a task sequence, through which Marlene will be guided in order to achieve the goal. The whole process, from establishing task prerequisites to sequencing steps to achieving goals, is what we refer to as task analysis. Figure 6.1 [not available] presents a sequence of difficulty for both verbal and nonverbal behaviors that is typically used in communication intervention. A task analysis encourages the clinician to move from the simplest forms of response to more complex forms in the course of the intervention program. Table 6.1 [not available] gives an example of the sequence of steps a clinician might choose for Marlene to increase her production of intelligible speech. In summary, identifying the products or targets of intervention requires a clinician to

• Establish long-term goals, using pretest probes
  
  
• Identify short-term objectives that build toward the long-term goals
  
  
• Use task analysis to create task sequences through which clients progress toward their goals

Once these steps have been accomplished, the next challenge is to find activities that facilitate this progress. To face this challenge, a clinician has a range of intervention processes.