What should I expect for a treatment plan for a child?
PROMPT is concerned with all areas of the child’s development and how he/she uses all domains (Physical, Mental and Social) to interact verbally with significant others. In Assessment all sensory modalities e.g. auditory, visual and tactile-kinesthetic are considered as well as speech sub-system development.
In treatment planning for children, all information is structured to enable the child to make the most of their physical and speech sub-system developmental levels. If appropriate the creation of a lexicon, (vocabulary), that will enable the child to functionally practice and use the new or rebalanced motor actions is created. This lexicon is developed with the family and school team members.
Other questions that will be addressed during the consultation and assessment are:
How the family/care givers, child and school environment interact and the expectations of each.
How intact or limited are the child’s physical, mental, emotional and environmental resources, and how this information can be used to best enable functional communication and interaction to occur.
What strategies should the Speech-Language Clinician or school staff use to help the child integrate the areas of attention, processing and concept formation with behavioral regulation, structure, routine, interaction.
What types of auditory, visual or tactile-kinesthetic facilitation are needed to help the child form links between speech-motor systems and the development of language or literacy skills?
Finally, what type of PROMPTing is needed to achieve the most functional verbal communication?
After evaluating how the child functions overall, e.g. how they have developed and are currently using communication strategies and the speech-motor system; treatment suggestions will be developed. These suggestions will be primarily for the Speech-Language Clinician directly treating the child but will include carry-over activities for the family and caregivers.
What happens in the treatment sessions?
In the instance of a minimally verbal child or adult, PROMPT first structures sessions so that the patient is required to focus or give as much attention to the task of interaction as possible. It also requires the patient, at a minimum; begin to use a (vowel) sound in response to a request, interaction or question. For example, “Do you want the toy/book etc.?”
As part of the structure the clinician may initially slow down their rate of speech and lengthen the response time (or production time), required from the patient and use an imitative model. The production of the patient’s utterance is supported through integrated auditory and tactile (with visual as a secondary source) feedback and gradually, as the patient is able, the basic structure of the movement(s) required for more accurate speech production, are required.
Sessions also require, that the patient, through focus of attention, “be present” in the interactions. If the patient is having difficulty with attention, focus, eye contact, repetitive behaviors or uninhibited behaviors etc., the therapist will organize strategies that help the patient “be present” for learning.
Once the patient is focused and begins to imitate or initiate a vowel-like production for appropriate communication interaction, PROMPT then begins to help shape that production by use of tactile-kinesthetic information directed to the jaw, face, lips or tongue. These PROMPTs, which are all provided externally, facilitate jaw/facial control and amount of movement required. The PROMPTing is dynamic and may be used to create and organize a single sound, word, phrase, or sentence.
As some understanding and proficiency is mastered, different types of PROMPTing will be used. Usually within a session, the structure moves from focus and attention combined with motor-sound practice to learning/using interactive, functional routines or activities that incorporate turn-taking and use syllables or short phrases.
All goals are developed with the parents, spouses or care-givers so that the immediate sounds, words or phrases facilitated are important, necessary, provide interaction for requesting, emotional support or help. If the patient has the capacity to expand these words or phrases, more complex motor speech and language is developed. However, the immediate goal is always functional interaction and use. Every patient is considered individually.
Finally, PROMPT recognizes that depending on the underlying reason for the patient’s overall ability levels and communication disorder, he/she may be able to achieve more or less normalized vocal communication (with more or less precision). Ultimately, the goal is always interaction and communication, by all or any means (vocal, gestural, pictorial etc.).