Is it worth trying? Evaluating a technique's potential effectiveness

I (Alaina) recently wrote about the Three-Period Lesson, which is a Montessori activity that may be a useful technique for the Speech & Language Pathologist, or other professional, to use to nurture the development of someone's vocabulary knowledge.

After reading about the three-period lesson, you might be asking yourself a few questions: How does the three-period lesson align with your current methods of meeting the goal of vocabulary development?  Is the three-period lesson likely to be more or less effective than your current methods? Could the three-period lesson be an effective therapy tool for any of the individuals with whom you work?

While learning about and thinking about the three-period lesson, I have been asking myself these same questions.  They are go-to questions for any potential therapy technique that I consider implementing.

But coming up with the answers to these questions takes some thinking.  SLPs are called upon to make evidence-based decisions, but there is rarely sure evidence for the effectiveness of any specific therapeutic technique.  So, I find it helpful to organize my thoughts by considering the characteristics of a technique.  There is often evidence for at least the theoretical efficacy¹ of the characteristics that underlie different techniques.

Below I share an example of my thought process, when I am considering the characteristics of a technique to evaluate its potential effectiveness.  Please keep in mind that I'm not taking any position regarding whether or not the three-period lesson should be used.  Rather, I hope you find the questions below to be helpful as you make your own decision.  Therapeutic decision-making is a task best undertaken by someone who can integrate their knowledge with the learner's specific situation. 

Using characteristics of the Three-Period Lesson to evaluate its potential effectiveness:
 
I would characterize the three-period lesson as highly structured.  When do you find it more effective to present words in a highly structured format, such as by drilling flash cards or object words? In contrast, when do you find it more effective to present words in a loosely structured format, such as focusing on certain words in play or in conversation?  Related reading: Shriberg & Kwiatkowski (1982), and Cogher (1999).

In conjunction with its high structure, I would characterize the three-period lesson as adult directed. When do you find it more effective to present words in an adult-directed manner, such as by choosing the objects you want to teach and leading the child to listen to you, copy you, follow your directions, and answer your questions? In contrast, when do you find it more effective to present words in a child-directed manner, such as by watching the child and giving words for the objects/actions/concepts that the child chooses to engage with?  Related reading: Yoder, et al. (1993).

I would characterize the adult's directions in the three-period lesson as both instructive and evaluative. When do you find it more effective to present words in an instructive manner, such as by using the names of objects/actions/concepts? When do you find it more effective to present words in an evaluative manner, such as by giving a direction to "point to _____" or asking, "What is this?"  Related reading: Sohlberg, Ehlhardt, & Kennedy (2005).
 
The adult's choice about when to be instructive and when to be evaluative during the three-period lesson can be characterized as responsive to the child's current level of understanding. When do you find it more effective to present words responsively, such as by using the child's cues to inform your method or level of support? When do you find it more effective to present words in a predetermined way, such as by following a script or a standardized format?

Finally, I would characterize the Three-Period Lesson as linguistically consistent.  The examples and explanations that I have seen use simple sentence frames such as "This is _____," and "Show me _____" to deliver each vocabulary word to the child. When do you find it more effective to present words in linguistically consistent sentences? When do you find it more effective to present words with linguistic variation, such as by using the new word in a variety of different sentence structures? Related reading: Onnis, et al. (2004).

Conclusion:

It's up to you! Does the three-period lesson sound potentially effective in any of your specific situations?

Footnote:
1. What is the difference between efficacy and effectiveness?  Efficacy is how well a treatment works under experimental controls and effectiveness is how well a treatment works under real world conditions.  A year ago Hannah and I spent a month using the technique of spaced retrieval to commit this to memory and it's stuck ever since :)

Modeling Clinical Skills in the Classroom

In our ‘About Us’ section, Alaina and I mention that we practice privately in the East Metro area of the Twin Cities.  A detail that we did not include in this section is that I am starting the PhD program at the University of Minnesota, Twin Cities, starting this spring.   As I applied to the PhD program, and now, as I embark on the next few years as a doctoral student, I have been thinking about the intersection of classroom knowledge and clinical skills.

Clearly, there is a certain amount of knowledge that is critical as one begins her career as an SLP.   But there is also a great deal of experience that drives one’s knowledge and intuition as a clinician. This is not to say that we intuit an interpretation of standardized test scores (as an example). 

However, therapy designed to improve communication abilities should have genuine and humane characteristics.  Perhaps we may be more successful at cultivating these components through empathy and thoughtful reflection.  It seems reasonable that the connection we are able to establish with individual clients can be considered a powerful clinical tool, influential in our practice and our ability to help them achieve goals and learn new skills.  

I did not learn that as a master’s student, and I wonder, is it possible to model that value to students as they prepare to become clinicians?  I recently read an article (Everyone’s Developmentally Delayed, Starting with Us) about how faculty members who teach at the college/university level should have better knowledge about reaching all different types of students who are at varying developmental stages (to help more students be more successful academically and to increase student retention).   In the article, Tom Bissonette discusses the idea of being ‘vigilant lifeguards for (our) students.’  Given, Bissonette discusses different areas of development (e.g. social, intellectual, emotional) within college students (particularly when they first begin post-secondary study), and I have posited the question of modeling clinical skills (to master’s students studying to become SLPs) within their graduate-level courses.    Nevertheless, I am interested in the idea of modeling clinical skills while providing explicit instruction during knowledge based classes.

I have found my most successful moments as an SLP to be those in which I am most flexible and dynamic in my teaching methods.   I have observed the individuals with whom I have worked to experience the greatest amount of success toward reaching their objectives when our communication (what they are working on) is grown out of an authentic connection.  Sure, articulation cards are helpful tools.  But, in my experience, they don’t get individuals to work particularly hard.

I wonder how as a professor (someday. . .) I may model the importance of developing authentic connections from which communication can be grown.    I don’t mean to say that the professor-student relationship is a therapeutic one, but as therapists we are in the business of teaching new skills. Graduate students are meant to learn knowledge, but they are also expected to learn clinical skills.  I have to believe that at least some of these skills could be cross-trained (read: modeled) in the classroom.

The Three-Period Lesson for Vocabulary Development

Speech & Language Pathologists (SLPs) are called upon to nurture the development of vocabulary knowledge. There are many ways to present words and their meanings to children and adults, and each way works to varying degrees, for different people.

Today I (Alaina) describe one method that I have been thinking about recently: the "Three-Period Lesson." Please keep in mind that I'm not taking any position regarding whether or not the three-period lesson should be used.

The three-period lesson is a popular method in Montessori education. Montessori teachers use the three-period lesson to teach their students new words for objects and basic concepts. I will give you a short summary below, but many people have written fuller explanations with examples. Most helpful for me were Kroenke's article, Irinyi's article, and Jackson's (2011) highly readable dissertation, "The Montessori Method's Use of Seguin's Three-Period Lesson and Its Impact on the Book Choices and Word Learning of Students Who Are Deaf or Hard of Hearing."

Here is a quick summary of the three-period lesson. The teacher lays out 2-3 objects on a mat. In part one, the teacher picks up each object slowly and deliberately and tells the child what it is, and as the child picks each object up, the teacher tells the child what it is again. The teacher continues with part one over minutes or across days, until there are signs that the child is ready for part two. In part two, the teacher gives the child many action+object directions related to each object, like, "Pick up the ____." The teacher continues with part two over minutes or across days, until there are signs that the child is ready for part three. In part three, the teacher shows each object to the child and asks the child what it is.

From all of the above explanations, I would characterize the three-period lesson as:

• highly structured
• adult directed
• instructive and evaluative
• responsive
• linguistically consistent (...and I will explain all of these terms in an upcoming post)

Many SLPs make use of activities having these same six characteristics, and appearing very much like the three-period lesson. However, my recent search of ASHA journals (http://journals.asha.org/) and google searches for ["three period" SLP] and ["three period" speech language] didn't show any relevant results, so it seems that many SLPs are likely to be unaware of this overlap between their methods and this particular Montessori method.

I hope this was interesting for you!  In an upcoming post, I'll be exploring how we can go about evaluating the effectiveness of different therapy techniques, using the three-period lesson as an example.