Synergic Therapy
Social | Executive Functioning | Behavior | Speech-Language
Types of Professional Services
Screenings, Assessments, Evaluations
Synergic Therapy offers screenings, assessments, and evaluations. The differences in these 3 types of procedures lie in the intention of their use.
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Is your child achieving expected Cogmental milestones based on a standard set of neurological and developmental markers?
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A screening is a process that determines whether your child is exhibiting red flags indicating skill and performance deficits within the Cogmental™ (cognitive-developmental) Domains. The purpose of a screening is to identify the need for further evaluation. Screenings are not used to solely
diagnose disorders, but rather to compare your child’s current development to standard developmental norms to determine if he/she is acquiring skills as typically expected for their age.
Evaluations involve making an informed professional judgment determining whether your child's challenges and differences equate to a disorder or disability diagnosis. Evaluations can diagnose (disorders), determine (eligibility, level of progress), and dismiss (from programs and services). Evaluations are the outcome of assessing.
Assessments collect data in the form of scores, frequency, duration, and intensity of behaviors, and levels of proficiency to determine your child's strengths, deficits, and challenges. These markers are then used to guide appropriate interventions. Assessments are an integral part of an evaluation. Assessments can be ongoing to keep a consistent measure of present levels in skills and the development of behavior (progress or lack thereof) and identify strengths and challenges as frequently as needed.
A comprehensive evaluation can assess any areas of development you should choose. Along with my expert recommendations, we can plan the evaluation together.
Sample Evaluation Content Sheets
A Comprehensive: Communications Evaluation
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Functional and contextual communication with others
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Functional analysis of speech and language skills to inform treatment-identifying causal variable in addition to response topographies
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Understanding language
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Related executive functioning skills-organization and sequencing of expressive language
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Related social and emotional competencies-social and situational awareness
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Related behavior skills-response inhibition, attention
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Play skills
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Articulation
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Oral motor functioning
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Related neurological skills
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Parameters of voice
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Fluency​
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Rules of conversation
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Strategy use to learn and generalize
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A Comprehensive: Executive Functioning Skills
Evaluation
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Working memory
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Related behavior skills
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Related social and emotional competencies
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Organization
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Initiation and persistence
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Self-knowledge
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Planning, prioritizing
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Related neurological skills
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Related speech and language skills
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Functional analysis of speech and language skills to inform treatment-identifying causal variable in addition to response topographies
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Written expression
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Time management
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Theory of mind/perspective thinking
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Pivotal thinking skills
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Visual-spatial skills
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Strategy used to learn and generalize
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Longterm memory/recall
A Comprehensive: Speech and Language Evaluation
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Oral motor structure and function
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Functional analysis of speech and language skills to inform treatment-identifying causal variable in addition to response topographies
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Auditory discrimination
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Related eating and drinking skills
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Grammar
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Semantics
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Pragmatic language
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Language processing
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Reading skills
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Related social and emotional competencies
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Listening comprehension
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Reading comprehension
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Narrative discourse
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Perspective thinking
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Voice
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Auditory memory
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Fluency
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Word finding
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Play skills
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Related executive functioning skills-WM, organizing language
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Functional and contextual communication
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Related neurological skills
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Strategy use to learn and generalize
A Comprehensive: Being Social-Social and Emotional Competencies Evaluation
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Oral motor structure and function
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Functional analysis of speech and language skills to inform treatment-identifying causal variable in addition to response topographies
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Social thought processing
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Perspective thinking
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Social and situational awareness
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Sharing space
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Self-knowledge skills
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Related executive functioning skills-cognitive flexibility
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Related speech and language skills
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Identifying, understanding, and using feelings and emotions
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Empathy
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Related behavior skills
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Related neurological skills-language processing
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Strategy use to learn and generalize
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Central coherence
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Written expression
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Friendship skills
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Listener skills
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Social reciprocity
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Pivotal thinking skills
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The rules of conversations
The Evaluation Process
1. Review of records
2. Observations and interviews
3. Assessing: tests, questionaires, discussions, other direct interactions
4. Scoring, interpreting, analyzing results
5. Comprehensive written report
6. Share the results, discussion, collaboration/consultation
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Individual variations may apply
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A domain-specific evaluation covers 1 or 2 of the Cogmental areas in depth. Evaluations usually take place over several sessions, and optimally, data is collected across at least two different environments in which the student participates on a regular basis such as school, home, daycare, after-school care, etc. The evaluation includes the process of assessing, describing, and interpreting a wide range of skills, processes, and behaviors.
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Parents may come to Synergic Therapy with an idea of the type of evaluation they are seeking in which case we may have established a starting point. After an initial consultation which may or may not include a screening, observation, a short interview, and/or review of records, I can also recommend the areas to target for the evaluation.
A combination of standardized testing, dynamic assessment principles, behavior checklists, observations, interviews, and a case history review will be used to assess and diagnose. Standardized measures are selected based on their validity and ability to capture the areas of need. Considering culture, home language, students' and family sensitivities are of utmost priority when determining what tests to use. Dynamic testing provides more in-depth information on how the student responds to actively being taught and then observing how learning, thinking, and problem-solving takes place.
In addition to school-based evaluations, I conduct Independent Educational Evaluations (IEE) for the Cogmental Domains of; speech and language, executive functioning skills, emotional and social competencies, and behavior skills. This does include Functional Behavior Assessments, Behavior Support Plans, and Fidelity of Intervention Implementation Reports.
An IEE is a type of assessment conducted by a licensed speech pathologist that is not an employee of the school district. Parents, advocates, attorneys, school administrators, and hearing officers can initiate the IEE process. I am listed by the Santa Clara County Office of Education as a preferred provider to conduct IEE's in Santa Clara County and neighboring counties.
Finally, private evaluations are also provided to resolve disputes, gain further insight into specialized areas, and provide an alternate perspective.
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The evaluation is recorded in a formal report. If you are interested in a meeting to review the report, one can be scheduled. An IEP meeting can also be scheduled to discuss the report and the individualized treatment plan, including C.O.R.R.E.C.T. goals.
The Evaluation Report
1. Pertinent History
2. Current Function Status
3. Parent/Caregiver Input
4. Behavioral Observations
5. Assessment Results
6. Analysis of Diagnostic Findings
7. Prognosis
8. Treatment Recommendations
9. Treatment Plan including C.O.R.R.E.C.T. Goals-analyzed and prioritized
10. Additional Recommendations to explore
11. School/educational Accomodations and modifications
Individual variations may apply
Treatment
Based on the results of the evaluation process an individualized treatment plan is developed and shared. As part of the collaborative care model, parents are encouraged to add their feedback, upon which the treatment plan is finalized. Treatment is provided in the office setting, community-based, school-based services, and TeleTherapy (remote learning). Services are provided individually, in a pair, and in small groups (3-5 students).
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When using a synergic approach to treat a variety of evidence-based interventions are considered based on the child’s needs, and their situation. Core Cogmental Skills are considered first. What are the underlying executive functioning skills and fundamental neurological skills that need to be developed or strengthened?
These processes drive and support the treatment targets.
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What do evidence-based teaching and intervention strategies mean?
Evidence-based refers ideally to methods that have been proven effective, to some degree, through the use of experiments conducted using randomized controlled trials. The studies should be repeatedly replicable and provide similar results each time. Research-based teaching methods, such as shaping procedures, direct instruction, repetitive practice, and consistent data collection, are important components of most programs. C.O.R.R.E.C.T. treatment goals are created as a result of the assessment process. Task-analysis procedures are used to identify the competencies or prerequisite skills that need to be met to gain the goals successfully.
A dynamic and multi-modal approach to treatment is utilized at Synergic Therapy. Combining methods to teach concepts, maintain motivation, and ensure understanding and later use of the information learned. Guided practice and independent practice are 2 strategies used to develop understanding and fluency. The use of background knowledge, visualization, colorful visuals, and cognitive training are examples that support a rich and dynamic brain-based treatment approach to learning and understanding. Learning styles are also considered every step of the way (visual, aural, kinesthetic, read/write). Cognitive learning exercises-brain-based methods are a highly effective practice for learning. It's the active process of adapting and stimulating cognitive processes and improving neuronal functions and behavioral responses to attain skill mastery more effectively. Numerous studies have found that some brain functions can be significantly improved with practice.
The therapist delivered hands-on approach to cognitive training exercises has shown to be more effective than the independent use of computerized learning games. The advantages of a therapist-delivered training program allow for more controlling of variables that support success. Immediate feedback in the form of encouragement, modeling, positive reinforcement, and behavior management strategies can be utilized at any moment. The application and monitoring of strategies to accomplish the tasks, maintaining an appropriate pace, controlling for distractions are yet a few more advantages. Developing self-awareness based on the types of skills trained also occurs during the therapist-student interactions. Multiple cognitive competencies can be trained simultaneously, such as executive functions, behavior, and cognitive learning capacities
A multi-modal approach promotes learning to understand as opposed to memorizing for the moment. Learning to understand aids fluency and the transfer of skills to different environments, people,
materials, and situations. Specific research-based published interventions are also used with students. I have completed the mentor training with Michelle Garcia Winner for her language-based Social Thinking Programs. Other language-based interventions include Lindamood Bell reading and comprehension programs, Visualize and Verbalize, Seeing Stars, Talkies, and Lindamood Phonemic Sequencing. The Kaufman Speech to Language program has been utilized very successfully with Apraxia, speech sound disorders, and other expressive language disorders.
Progress is communicated using data collection and data analysis methods, meaning gathering factual information about the behaviors and/or skills and then interpreting it. Information regarding treatment proficiency helps make informed decisions about the effectiveness of interventions and instructional strategies. These methods include frequency, duration, latency, time sampling recordings, permanent product, and ABC analysis. Baseline data is gathered using testing information and present levels from treatment to determine the extent of change that has occurred. Progress on treatment goals is measured objectively using observations. Data is graphed to depict trends in the data visually. These measures track progress on current goals, pre-requisite skills, and maintenance skills.
Learn more about treatment
Observations/ Consults
Directly observing students to gather pertinent and essential information regarding their learning is a skill that is developed through knowledge, experience, and training. Knowing what to look for, measuring it, noticing other confounding variables and their impact, and being as conspicuous as possible during an observation requires skill and experience. In-depth knowledge of child development, specific knowledge about the student being observed, and training in applied behavior analysis methods enhance the effectiveness of the observations and thus the recommendations provided.
Further attributes that can improve the effectiveness of the observations and in turn support the development of a carefully designed intervention plan include; developing an objective mind, free of preconceived thoughts that may influence the observation, being able to interpret context-specific discussions the students engage in, and recording context-based information at the moment. Focused behavioral observations are an essential component of therapeutic intervention plans. Observations are also imperative during the evaluation process.
Observation can be more objective for assessment purposes than behavior rating scales that measure perception when conducted by a trained professional. Describing and interpreting observational data is a vital component in all of my evaluations.
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What am I looking for during an observation?
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The answer to this question is dependent on the purpose of the observation. A student's understanding and use of specific skills, strategies, behaviors, and processes, identifying the function of behavior/s, assessing the fidelity of implementing of an intervention program, etc. In addition, I am looking for specific strengths and challenges such as maladaptive behaviors, verbal expressions, mental health, appearance, mood, ability to interact, reactions to medications, demonstration of various cognitive abilities, environmental influences, independence, physical abilities, motivation, monitoring compliance, etc. Essentially, an observation of a student in his natural settings provides objective and quantitative data that can be used to make informed decisions when developing goals and interventions.
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Following the devising of a plan comes the consultation with team members to review the results and intervention plan for child success. There are four critical responsive stages to a consultation.
Responsive Strategies for a Consultation
1. Identifying the challenges and strengths :
It's helpful to start with a summary of the main circumstances that precipitated the observations and consult. Please do not assume that everyone knows why they have been brought together for this meeting.
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2. Analysis of observations and data collection :
I create visuals such as graphs and tables to represent the information. Bullet points can be easier to organize and process than an extended narrative. The style of documentation will vary depending on the reason for the observations. This part includes a description of the behavior/s, frequency, intensity, duration of the behavior/s
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3. The implementation of intervention :
Understanding why these strategies have been chosen, how to use them, and when and where to use them is covered next. I would also review each strategy and answer specific questions.
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4. Treatment evaluation/maintaining treatment integrity is accomplished through data collection procedures. Here a plan needs to be created for how frequently data will be created and who will take the data.
Trainings/ Teaching
Supporting school staff in developing goals and instructional strategies is an important part of any intervention program. Consistency in implementing strategies across all staff in all settings is vital and determines the program's success. Paraeducators need to understand why they need to learn a particular skill in a specific way.
In addition to spoken directions, providing step-by-step written instructions can further support understanding and follow-through by staff members. Role-playing can trigger questions that may not have been answered previously.
Controlled practicing with staff members can also improve understanding and build self-confidence when they are using the skills. Regular ongoing feedback following the training is imperative to address unforeseen challenges quickly and provide continued training and collaborative support.
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Caregiver training is also an important factor in improving appropriate behaviors and skills and reducing students' inappropriate behaviors. Regular parent training can help increase knowledge and skills, build confidence, reduce stress, improve coping and well-being, reduce burnout, and reduce frustration. Perhaps most pertinent to the intervention program, parent training will support transferring skills from one environment to many others.
During a parent training session, I focus on providing a systematic, multi-modal experience to learning. A customized session includes real-life examples of their family dynamics and the student's applicable behaviors. Introducing new behavior management strategies is only one part of a therapeutic session. Knowing how and when to apply the strategies is equally imperative. Providing real-life examples of when and how to implement the strategies has been one of the most successful parent/caregiver training strategies. One of the most common questions I hear is, "What to do if?"
A good amount of time is spent answering this very question by providing If/Then responses to common challenges. During a treatment session, it is essential to discuss the strengths and positive aspects of a situation. Parent participation cannot be emphasized enough. Optimal outcomes are only possible when parents are actively involved in every step of the way. ​Training's for all adults working with the student receiving treatment is vital. Not only will it positively impact your relationship with the student by increasing social connections and general behavior, but it can leave adults feeling satisfied, competent, empowered, and can greatly reduce stress and anxiety.
Some key take-aways from training:
​Some key take-aways from training:
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Consistency and routines are at the forefront of behavior management
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Establishing a positive relationship will yield more learning than establishing a strict authoritarian role.
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Follow through when giving directions is imperative to establish appropriate expectations.
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Reward, reward, reward, reward, functional consequence, reward, reward, reward, reward.
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Students' are not always internally/self-motivated to learn and behave. At times external reinforcement is necessary and can be faded.
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There are key differences between reinforcement and bribery. It's all in how the reinforcement is presented.
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A child's brain learns best when the child is happy, and his brain is calm.
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Choose your battles based on your time and energy because you will need to follow through.
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​Actively and safely ignoring can be as effective as verbally addressing the concern.
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Use different levels of reinforcement. Small reward for small accomplishments, larger rewards for greater accomplishments. The smaller reward for some effort, the greater the reward for full participation.
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Functional consequences can include a lesser reward and not automatically a negative consequence.