AAC Narrative Intervention

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Intro

Kate Grandbois: Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy 

Amy Wonkka: Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each 

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Kate Grandbois: Hello, everyone. Welcome to SLP Nerdcast. We are here today welcoming a guest that we've had on the show multiple times before, but we were, before we hit the record button, kind of flabbergasted by the fact that we haven't seen you since 2001. [00:02:00] No, no. That was way too long ago. We haven't seen you since 2021, which was years and years ago.

Uh, we're very excited to welcome you back to the show. We are here with Dr. Trina Spencer to talk about narrative language intervention and AAC, which is a topic we don't get to talk much about. Welcome back to the Nerdcast. Oh, thank you so much. Nice to be here. 

Amy Wonkka: Yeah, it's you guys. It's really nice to see you.

I'm glad we got in the time machine and got to see one another again. Um, no, it's good. Time does fly. The older you get, the faster time goes. That's a real thing. I swear. Um, Trina, you're here to discuss this time, um, to discuss AAC and story champs. But before we get started, can you just tell us a little bit about yourself?

Trina Spencer: Yeah, sure. Um, I don't know. Currently, I'm the director of Juniper Gardens Children's Project, which is a 60 year old [00:03:00] community based, community engaged research center as part of University of Kansas and Like, I'm really proud to be affiliated with Juniper Gardens Children's Project because in the 90s when I was just a, uh, you know, like a hopeful researcher, I read a lot of cool stuff out of here, and now I'm here.

It's like, really, really amazing. Um, yeah. And that's what I do now. I am, let's say, originally, I was trained as a behavior analyst. Um, I am also a school psychologist, and I worked as a preschool teacher and a special education teacher. And when I was done doing all those things, I decided to study language.

And yeah, that's language and communication. And I don't know, I, I consider myself an intervention scientist and an intervention designer. So like I design interventions and I, and of course I have to develop a lot of assessment [00:04:00] tools when you're doing that kind of work because oftentimes you develop things in spaces where there's no good assessment tools.

So I do those things too. 

Kate Grandbois: One of the things I love about your background is that you bring so many different perspectives and expertise to the work that you do, having experience as a school psychologist, a classroom teacher. a researcher, a behavior analyst. You've also, a lot of the other episodes you've done with us, um, were with Dr.

Doug Peterson, who is a speech pathologist, researcher, and the two of you have collaborated across multiple, um, projects producing the cubed assessment, the pearl assessment, Uh, let's see a story chance, which is the non AEC version of what we're going to talk about today. So I'm very excited to kind of unpack all of this with you from your many, many lenses and areas of expertise, which is really exciting.

Before we get into the really fun stuff, we do need to read aloud our learning objectives and disclosures. I will try to get through that as quickly as I can. [00:05:00] Learning objective number one, describe the benefits of narrative intervention for AAC users. And learning objective number two, describe the active ingredients of story champs that leads to generative repertoires.

Disclosures. Dr. Trina Spencer's financial disclosures. Trina is the author of Story Champs AAC and is entitled to financial benefits related to its sale. Trina is also the director of the Juniper Gardens Children's Project at the University of Kansas. Trina has no non financial relationships to disclose.

Kate, that's me. I am the owner and founder of Grand Voie Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12 and serve on the AAC Advisory Group for Massachusetts Advocates for Children. I'm also a member of the Berkshire Association for Behavior Analysis and Therapy.

Amy Wonkka: Amy, that's me. My financial disclosures are that I am an employee of a public school system and co founder of SLP Nerdcast, and my non [00:06:00] financial disclosures are that I'm a member of ASHA, Special Interest Group 12, which is AAC, um, and I participate in the AAC advisory group for Massachusetts Advocates for Children.

All right. Now, Trina, before we hit record, we were talking a little bit about AAC and how, you know, we've had, I mean, Kate and I both work as quote unquote AAC specialists. Uh, we've had a number of episodes in this podcast and we talk, I feel like we've focused a lot on kind of earlier communicators or like those early communication skills in AAC.

So I'm super excited to talk more about narrative intervention. Um, You just tell us a little bit about that first learning objective. What, what are the components of narrative intervention? Why is it so important? All of those good bits. 

Trina Spencer: All right. I've, I should first say I am not an AAC expert. Okay. You guys are the experts, right?

I'm an instructional designer who designs with colleagues and partners and community people who tell me what they need and want. Right. Okay. [00:07:00] So, but that way I'm going to tell you a narrative intervention. Is, I mean, it's been defined differently in the, in the research, but, um, in 2021, Doug and I published a paper, Narrative Intervention Principles to Practice, and we kind of just like, okay, this is how we're going to define it because it was kind of getting out of control, like people defining it however they wanted to.

So the way we defined it was the, the active ingredient or the definitional feature was the use of storytelling. As the key teaching procedure, so storytelling, so the children or the recipients of the therapy, of the intervention, the instruction are either telling or retelling stories. And they can do that using speech, gestures, AAC, written, you know, spoken, all sorts of modalities.

But there are some form of storytelling and retelling as the key. Active ingredient. So that's a narrative [00:08:00] intervention. Um, now there are other kinds of interventions that use narratives as the base for teaching language and those are closely related. It just depends on whether or not they're actually doing some sort of active storytelling within the intervention or not.

Um, 

Kate Grandbois: and I have to assume that working on narrative intervention is important for language development. I mean, this is a dumb question. I know the answer to this question, but I'm asking it anyway because I'm halfway through and I'm going to double down. Working on narrative intervention is important for all language learners.

I know we're here talking about AAC, but to kind of Set the, set the stage and talk about, can you tell us a little bit about why this is important for all language learners? Yes. 

Trina Spencer: Okay. It's okay that we talk a little bit about verbal behavior, right? 

Kate Grandbois: I don't think I'm gonna get a rash. Amy, are you gonna get a rash if we talk about verbal behavior?

Amy Wonkka: I am a rashy person, but I have a cream for that.[00:09:00] 

Kate Grandbois: This is so good. It's gonna be so good. Science and humor, right? This is why we're 

Trina Spencer: here. And why not? Exactly, exactly. So I guess I, I can answer that question because I understand that there are kind of like, there's a spectrum of complexity of skills, right? In, in terms of communication and language. And oftentimes when we're like SLPs or in communication therapies of some sort, we're looking at things at the level of a word or an utterance.

Right? But narratives are discourse level. And, and so, when you're doing things at a word level, you can do something like, I'm making a request. Right? Or I make, I'm labeling this item. Okay, I'm expressively identifying it. Um, you can also answer WH questions. Those are like common early language and early communication kind of things.

But you often don't get [00:10:00] spontaneous. Fully generative, meaning like not practiced, but they are able to combine and recombine things that they've learned at the word and utterance level into a larger sentence or discourse level, right? So it's like a higher order in terms of the size of the unit, a narrative or a story.

Right, that requires, at the discourse level, you require sentences, and sentences have utterances or clauses, and utterances and clauses have words, and words have morphemes, or, you know, components, um. So, in doing narrative intervention, you get all this other stuff. Do you see that's like nested communication within that and with you, if you can, if you can work at that fire level, you actually get a lot of that other stuff for free.

So it's not like you have to start with the word and build another word into it and build a, a, a, An increased MLU [00:11:00] before you can do a sentence, before you can do a story. Now, to some degree, there's some logic in that, but it's not always necessary. And so I am always, after. As an instructional designer, I would say I'm always after the most efficient means of producing functional, like not, not, I'm gonna say that word again.

I'm gonna use a different word. 'cause that has many, many means, like purposeful, meaningful, generative communication. Right, not something that's been rote memorized, not something that's been like trained over and over, like what's the answer to this question, right? That's not what I'm talking about. I'm talking about how do we get real generative language and communication.

And the narrative, because of its higher order size, the unit of that analysis, you get a lot of stuff for free. 

Kate Grandbois: Well, with that as a backdrop, I'm already looking back at my own clinical decisions with regret, that, you know, narratives. Possibly should have been a larger target in even my more emergent [00:12:00] communicators.

Um, I have, I would love to hear how we're connecting this to fundamentals for why narrative intervention for AAC users is a specific area of need. Yeah. 

Trina Spencer: Okay. So kind of with that same theme, um, when I, okay, there's, there's a lot of starts to this story, so I'm just going to plug in at different places.

All right. But in this one, when I would look at the AAC literature, so often they're talking about like vocabulary and I would go, yeah, but vocabulary for what? Like, like, do they know this word when they need to request it or do they need it to label a preferred item? Um, Or a person or to to ask a question or for social interaction for protest and you see what I mean all of a sudden you go of word or a symbol that doesn't mean that they know how to use it for all of the the Functional, um, you know, [00:13:00] verbal purposes, the communicative functions, right?

And so, and oftentimes, the literature wouldn't really explain very carefully what function they were actually teaching. And in fact, they are always teaching a particular purpose or communicative function. They just don't describe it that way. And so, oftentimes, you can't pull them apart. Okay, so we, we would say that these communicative functions, speaking to an SLP audience, are actually functionally independent.

Meaning if you teach somebody to label something, they don't automatically request that thing when they want it. Or if you're, if you're teaching requests, they don't automatically then be able to like, label it or answer a question about it. You have to actually teach them. somewhat separately. Now, our typical language learners are going to cross those communicative functions quite easily.

They generalize quickly. Um, they don't need much kind of, um, programming to be able to make that, those, uh, cross between those communicative functions. [00:14:00] But in AAC, we're talking about children who have much more complex communication needs and maybe have more difficulty generalizing, especially because it's so pictorial based.

Or iconic base, like it's not as, um, they're symbolic, but you don't have the same variety as you might in a, in a word or an utterance or whatnot. So you get kind of like, I don't know, what am I trying to say guys? I'm trying to say something that it's like a 

Kate Grandbois: more more discreet. 

Trina Spencer: Yeah, so often it is and we start really simple You know, and I'm not saying that Starting simple is bad, you know, like there is like pre symbolic, you know phases symbolic phases and whatnot but even one of the surprises that came up is that We thought that the StoryChamps AAC would be for kids who were already proficient with their devices in these other [00:15:00] communicative functions.

We actually did not find that to be true. As a matter of fact, the kids who learned the most were the ones who had least proficiency with their devices. So that puts you thinking, Oh my gosh, it's not just for those people who are already proficient in their AAC, right? And then you think, what else can you do with this?

So what, what stories don't do is teach requesting, but the majority of the research, something like 60 to 80 percent of the AAC interventions reported in, um, In research are to teach requesting 

Amy Wonkka: and and not to minimize the importance of requesting right like I we all want to get what we want when we want it as much as possible, right?

And like, that is an important piece. But I do, you know, as you were speaking, I was just thinking about how Often narrative comes into play with those more social exchanges with [00:16:00] people, right? I mean, just thinking about, we hadn't seen one, we got on the zoom call, we haven't seen each other for years. And what are we doing?

We're sharing personal stories. It's been a 

Kate Grandbois: really long time, 

Amy Wonkka: so long stories 

Kate Grandbois: to tell, 

Amy Wonkka: but we're all sharing, you know, these bits of like our personal narrative or other things that we've seen. So I think that this narrative piece also has a really Um, it's, it, there's like so much utility beyond just, you know, as somebody who's school based, I'm thinking about curriculum access.

And yes, of course, that's important. And we're asking people to like read a narrative, retell a story and all of these other components that like tie in with the curriculum access. Uh, but it's also, there's such a huge social component there too. 

Trina Spencer: 100%. And like, I also don't want to minimize requesting because if a child can't get their wants and needs met or an individual, not just a child, if they cannot get their wants and needs met.

Like we should not be working on like, let's talk about some stuff, you know, like, we've got to get that but As soon [00:17:00] as the, the basic skill of like, hey, I do this to get something I want or need once that's established, oftentimes our, our AAC users aren't moved on because we go, I don't know what else to do.

How do I link them to this social stuff? I want to build, I want this kid to be able to interact with their friends. I want them to be able to do, you know, like, uh, curriculum related content. The whole reason why I started in the narrative space was because of their utility, right? They're academically relevant.

Narrative language abilities is one of the best predictors of academic achievement, especially around reading comprehension and writing, which is where Doug and I spend a lot of our time, right? Um, But they're also socially important. Like you said, we talk about stories all the time. Well, so, what's to stop us from using this incredibly meaningful, you know, academically relevant, socially important context for teaching [00:18:00] better, or teaching AAC use?

Right. 

Amy Wonkka: So talk to us a little bit about, about story champs. Cause I think as, as some, I haven't used story champs, I'm excited to learn more about story champs. Um, one thing that I'm trying to conceptualize as you're talking to us right now is like, what, what do the activities look like? Like, what are we, are we working on personal narrative?

Am I telling the student a story? Are we looking at a book together? Like what, what does, what, what components are involved in this intervention? 

Trina Spencer: Right. So, Doug and I have been working on StoryChamp's research for now, I think, 15, 16 years, and I'm going to say what it is today. I would say it is more than just a curriculum, just more than just an intervention.

It's a whole approach, and it has three key ingredients. Okay. One is that we have carefully constructed stories. It is not storybook reading. And I love storybook reading. I'm not saying don't do that. I'm saying it is [00:19:00] not for, um, intensive effects of an intervention, right? It's like casual, low dose, low intensity kind of thing.

You want real intervention, you got to construct the story. So our stories are carefully constructed. Number two, we use strategic visual materials. So that we can teach properly and get generalization independence. Um, and we do that through the fading of, the intentional fading of visual materials. So we have illustrations and icons that we use in all of our programs.

So, and all StoryChamps has those kind of visual supports. And the third piece is very explicit. Um, teaching procedures that come from a very large research base and there are some teaching procedures that are really key and one of them is multiple exemplar training. So we've talked about this whole like generative repertoire just a little bit, but I want to talk more about it because especially with you, like, [00:20:00] uh, kiddos or individuals or clients that seem to have, you know, um, intellectual, Considerations and challenges with generalization.

We often do a lot of rote teaching until they say exactly what we tell them to say in response to the stimulus that we taught them to respond to. And that is not generative, right? But we want to build a generative repertoire. We just don't know how to do that with such with learners with such complex needs and high support needs.

Right? And so, um, if we approach it, not as like, Okay. Um, drill or like intent like you might see an intensive teaching session session. Um, you know, I'm a behavior analyst. So we we see a lot of discrete trial teaching. And that is not what I'm talking about. I'm talking about the opposite of that. All right.

So I in when you're talking about communication and language, some other types of really strong teaching procedures are better suited and multiple exemplar training [00:21:00] requires that you have multiple examples involved. Of the construct you're trying to teach or the concept you're trying to teach and a single story is not the goal, right?

We do not want kids to retell this story or to memorize this story. We want them to have the language to be able to retell or generate their own story. That they have never, like a story they've never heard before, generatively, right, putting words together that they may have heard, but in some sort of different sequence, in different things, or maybe using synonyms instead.

It's about meaning, and it's about constructing something unique, spontaneous, and expressionable, not wrote. Right, and that really requires multiple exemplars of stories, right, and, and a controlled exemplars. That's the reason why we write the stories ourselves is because storybooks, they're great, but they don't have all the patterns that we're looking for.

And by the way, patterns are a big thing too. [00:22:00] So I would argue, and people who hear me talk, I'm doing a lot of this, um, that we're actually teaching the patterns of language. And if we teach the patterns of language in Also, to our AAC users, we're going to get generative repertoires. But when you teach patterns, you can't repeat the same thing over and over again.

Because otherwise, you're just teaching content. But if you teach patterns, and you do that through exposing them to multiple stories over time, And it to your question, sorry, I'm like rambling, but I'm getting getting there like in in every intervention session, a new story is presented and we practice retelling the story, but tomorrow or next week, you get a totally different story.

So, the memory of that content is gone, but guess what stays. It's the patterns of the story and the patterns of the language used to tell that story. So I, I started with this like word, uh, word parts, words, utterances, sentences, and discourse because each one of those have patterns [00:23:00] and that is what grammar and syntax is.

And that's also the reason why stories are, uh, stories at the discourse level are analyzed by story grammar. It's the rules. and um, rules and I don't know, organization of how to put the pieces together so that you can have a generative repertoire. That's what grammar does for you. 

Kate Grandbois: Okay, this, this all makes a lot of sense.

This all makes, I feel like I'm, I've entered the stadium, I see the ballpark, I see the relationship between narrative intervention, why it's important for all language learners, all of the, everything you said about multiple exemplars, not teaching in a silo, right? Not teaching the, the rote scripts. We, we know this.

We, we know that that's bad practice, it's not how you teach language. You mentioned earlier that. The research that you've done shows that individuals who don't have AAC proficiency are the [00:24:00] ones who are learning the most. What, tell me, tell us about this research. What does, so now that we know that this is really important theoretically, what does, what does the science so far tell us about this as an intervention strategy?

Trina Spencer: Well, I'm going to just clarify and caveat here that this wasn't our research question, but we didn't know what the inclusion criteria were because we hadn't, you know, we didn't have any experience with it. We assumed that the inclusion criteria to be able to do Story Champs AAC would be that they had, you know, like a tact repertoire, or they could label quite a bit, like that they could say, you know, cop, you know, book, whatever.

We thought that that was a need. Uh, a prerequisite, would you mind you? Okay, but we had difficulties actually recruiting and, you know, in the chaos of all of, you know, moving and whatever. I'm building new community partnerships. And so we were like, okay, well, we got these 3 kiddos, but these 2 

they only [00:25:00] know about 4. Preferred items on their and I can't even remember the lamp or, you know, some sort of anyway, it doesn't really matter. That's that's actually another question. Like, it doesn't matter what, what kind of device or system that they're using. Um, and. We were nervous , but the one kid that had pretty good, like he would, he was able to like request proficiently and was able to label like maybe 30 or 40 items using his device.

It took him the longest to make progress and the other kids were like, Oh my gosh, it's a whole new world. They were just like super exposed to lots and lots of different symbols and the way to navigate their device in a very intensive. Supportive 30 minutes 30 minutes a day, and they only got 9 and 10 sessions something like that 9 to 12 sessions That's it.

We saw generative growth quite rapidly with those [00:26:00] kids who didn't have like a large Proficiency with their AAC device before so now though in the next research that's become a research question. What is Like what exactly, we need to unpack this a lot more, like what are these predictor variables, like at baseline, do any of these variables at baseline predict their growth in the intervention, right?

That's a research question we don't have the answer to. But we were surprised that amongst these three kids, that didn't seem to be the, the case. That we hypothesized. 

Kate Grandbois: Tell us a little bit about what this intervention looks like. Is it parallel exactly to StoryChamps without the AAC piece? Is it, for those, if anyone's listening and they're familiar with StoryChamps, but not yet familiar with StoryChamps AAC, or maybe someone's listening and they have an AAC user and they're excited to try this approach, like me.

Thinking back to all of the mistakes that I've made, that's what happens every single time I get [00:27:00] in, get in these recordings, is I learn all the things I've done terribly. What, what does this look like? What are some of the things that happen in an intervention session? 

Trina Spencer: Okay, so StoryChamps AAC is the same as StoryChamps, and that was three key ingredients.

Carefully crafted stories, Right? Engaging visual materials and explicit teaching procedures. Very intentional. How they're different is the stories are crafted and simplified specifically for AAC symbols. Now, it, it, I don't think it can accommodate, and it doesn't accommodate everybody, right, and all AAC users, but let's say school aged children, okay, who use AAC, so we crafted stories, and we crafted them slightly differently, we, these stories have, like, the five main elements, they have a character, like, a setting, which kind of goes with the character, um, a problem, a feeling, an action, and an ending, You know, some sort of resolution.

Um, so it has those basic story grammar, but the [00:28:00] sentences themselves are not super complex like we would have in StoryChamps, and some of the versions of the stories are really like complex sentences with multiple subordinate clauses. These don't have that because in an AAC, when we're talking about these emerging AAC users, they're using simple sentences.

Okay, like maybe two or three, um, you know, symbols to say one thing. Um, okay, and each, what we did to create the stories is I reviewed several different software vocabulary lists and kind of put together a list that was very common. And I, I don't remember, 102, 108, I don't know, words. And I have a verb. Um, I have a noun, a verb, and an adjective, or a modifier, in every story.

So, I clustered the words, wrote a story using those words. So, we, in the StoryChamps AAC, there is some vocabulary learning, [00:29:00] but what we're trying to do is expose them to the symbols on their device. That, if they don't have that particular one, then one that's very close, and it's easy to like swap out symbols and stuff like that.

So, it's not a big deal if they don't have that exact thing. Um, So there is some intentionality around teaching this vocabulary, but we don't repeat that story so that they memorize that thing, right? The next session, they would get a new story and new set of words. So, in the Story Champs AAC, we only have two master lesson plans right now because that's all I think the research is telling us we can do, you know, I, I, I tread lightly, and the beauty of being involved with the, with commercialization is that I only can step two steps.

Like, I can, I can gauge how far out of the research we can go. Um, and in this case, we have a, a lesson plan. It's very similar to the StoryChamp's regular lesson plans. And then we start with a retell. So the, [00:30:00] the steps are like this. We name the story grammar, sorry, name the story grammar parts. We display the illustrations that I forgot to mention.

Sorry, let me go back to the illustrations. This is my, one of my favorite parts about the illustrations is the kids in our illustrations. Use AAC and have disabilities, and they're a very diverse group. So the representation is better. There's 36 stories too. Regular Story Champs has fewer. If you think about it, kids with high support needs, they actually need more exemplars, not fewer.

And if you go fewer, they're going to likely repeat them or cycle around and then they're memorizing. So if listeners have used Story Champs, With kids with high support needs who are speakers. This is one of their complaints is that there's not enough stories 

Amy Wonkka: well You that sorry to interrupt you just really quickly though If you are like how firm are the boundaries if i'm somebody who has used story champs?

Like the original story champs and I have a student who's not an AAC user But they're just a high [00:31:00] support needs learner and they need a lot of repetition and they use their oral speech like would it be appropriate for me to use some of the AAC materials with my Student who's using their oral speech instead of AAC?

Trina Spencer: The answer is yes, but I feel like I should like finish the answer to those other things and come back. Don't do it. I jumped in. I got hasty. I got hasty. It's okay. It's okay. I know you're going to remember the, the, the. I'll bring us back. The word is expansion pack. Okay. All right. I'll bring it 

Announcer: back. 

Trina Spencer: We're going to come back to that.

Like, how do we expand regular story champs using the AAC stories? Okay. We'll come back to that. But in terms of like the, the, the way it's different. Yeah. Okay. So the stories are crafted differently. The illustrations feature, feature AAC users and the teaching procedures are actually drawn from the AAC intervention literature.

Okay. And that's important because you teach AAC [00:32:00] communication slightly different. You know, the things that work are going to be different than what they do for speakers, and so that was a very important step, which is also the reason why it took me so long. I've actually been working on Story Champs AAC for probably, like, Seven years, seriously, seriously.

Kate Grandbois: That's impressive. 

Trina Spencer: I, uh, yeah, there's phases in how you like go through, like, you got to do like a research dive, you know what I mean? And when I first started this dive, there was so much debate about like core and fringe words. I was like, I cannot start a story unless I understand this. Right. And it required, it required a bit of, uh, time, you know, I don't know if you know this, but this was actually the reason why I went to South Africa.

I applied to South Africa for my Fulbright scholarship to work at the Center for AAC. This is exactly the reason. It's because I was not getting enough time in my regular job in the U. S. to devote to [00:33:00] studying what needed to be done. I needed to dive into that research fully to understand what the teaching procedures were.

You see, and I didn't, I had to clear my plate, so I went to South Africa and did that. I want to, I just want to point out, I had some really great, um, colleagues, um, in South Africa who were my AAC mentors, and I, you know, I was able to teach them a little bit more about those communicative functions and why it matters in terms of teaching stuff.

So, great, and we actually have a systematic review on AAC interventions to teach commenting. Which is a precursor to this, right? I had to do that systematic review to find out, because commenting is a, is a precursor to storytelling. 

Kate Grandbois: That makes a lot of sense. When does that systematic review come out? Do you know yet?

Well, 

Trina Spencer: I just resubmitted it. We got some feedback. So 

Kate Grandbois: 2025. 

Trina Spencer: Yeah. Yeah. I think that's what I'm hoping for. 2025. Yeah. [00:34:00] For sure. Excellent. Probably by the time this, uh, this podcast gets released. Yeah, that's what I was going to say. So if it's, 

Kate Grandbois: if it's available, we'll link it in the show notes. We'll link all of the research that you're reviewing in the show notes.

Trina Spencer: Yeah. Okay. So where was I? In terms of like the T, so those were the three major differences between Story Chams Classic and Blitz. With Story Champs AAC, um, which I think are appropriate. Yeah, it took me a long time, but it's not that it really took that long time, because by the what's really funny is Doug is constantly going, How did you make Story Champs AAC so fast?

And I said, I didn't. It's just the part you saw didn't take much time. I mean, seriously, think about seven years of reading research, uh, working with community, you know, partners, SLPs all over the country who were using regular Story Champs, To teach with their AAC users. And as a matter of fact, a long time ago, I was invited into the Chicago area [00:35:00] and some really great SLPs there.

I want to say shout out to Bobby, Eileen, and Sue from the Chicago area, from the LaGrange, um, um, school district there, because they were showing me how they were using StoryChamps with their AAC users, like seven, I don't know, maybe even more than that, I didn't count properly, but anyway, and I was like, oh my gosh, sweetie, I could do that better for you, because I didn't write those stories using the symbols that are likely to be on those devices, and I didn't design those teaching procedures based on the literature for AAC interventions, so I had to do it right.

So that's what got me going and like, listen, this clearly is a need they're like, but we love it. The kids love it. You know, we need more stories, though, because we're talking about high support needs. So anyway, 

Kate Grandbois: This is great. And I just want to point out one thing that I appreciate so much, which is, you know, the, the SLP.

product landscape is wide, right? I'm not going to get on my soapbox about this, I swear. But there are many, many, many products [00:36:00] and services available to us as clinicians to, to purchase, to use in our, in our therapy rooms. Um, not all of those products that are available for purchase are science based. or rooted in evidence.

And I just want to take a second to point out and appreciate that what you're talking about is putting science first and moving and creating products and services that are following the science instead of creating something that sells really well and then asking somebody to research it to see if it works.

And so I say that because I think it's a very important and very under discussed distinction, um, everywhere in medicine and intervention. And, but. particularly in our field. That's all I will say about it. I just want to point it out that anybody listening who's getting excited is because this is bound.

This is backed by evident by by research, which is great. 

Trina Spencer: Okay. But I have to say something too . 

Kate Grandbois: I knew I was gonna, did I, [00:37:00] did I open Pandora's box so much? 

Trina Spencer: So much? Oh, no. No. What did I, I'm gonna be quick. I'm gonna be, I'm gonna be quick because I, I am right there with you. Okay? Like I am a clinician at heart.

I'm an interventionist a heart. I see kids who could communicate better, and I wanna teach 'em. That's what I wanna do, but. As a researcher, my audience, my users are the SLPs and teachers who are teaching these kids. And I don't start with, here's the science, I'm going to do this for you. I start with, what do you guys need?

What do you want? What's going to be useful in your context? And I design based on what they tell me they want and need and what's going to be good for their kids. And it's, so it's not just based on science, it's based on community, um, identified Problems of practice and, um, I did say this at the beginning.

Juniper Gardens is a community based community engaged research center. And this idea of doing this kind of [00:38:00] work is it. First of all, it's very difficult. To do takes a long time and a lot of scientists don't do it because it's so much easier to just go to their university clinic or this lab school or, you know, whatever, but to actually be in the trenches with these people, like, it's so satisfying.

So, so satisfying. And I'm going to be talking about the community partners that helped me along the way. So, so Bobby, Eileen, and Sue were the original ones that said, hey, this is what good idea. I picked Bobby's brain several more times after that. Well, how would you do it? How do you, you know, how would you do this?

I mean, here's some of these things going, having these conversations, right? And then when, when I had a prototype, I had some more colleagues in, or partners, I don't know, There are SLPs in schools, um, in the Michigan area, Oakland County schools in Michigan, who piloted, field tested, gave real feedback, right?

Real feedback. [00:39:00] So, yes, I applied to science, but it wouldn't be nearly as good as it is, and it would not be, it would not be what it needs to be to solve the clinical problems if the clinicians weren't the ones telling me this is what you need. Or, this is how to do it. And you see this, you know, I'm not the ones out there trying it out.

They are. 

Amy Wonkka: I mean, we've talked so many times on this podcast too, just about, I mean, I think there's, there's all the things at play, right? So, it is, when we can find the sweet spot as something that's actually an evidence based intervention that you could then use as a curriculum in your session is like, ah, like that's wonderful.

There's also this crazy research to practice practice gap. Um, and I feel like in, I don't know if it's because we do this podcast, so I get to talk to all of these smart people who are doing the research or because it's like a bigger, I mean, I would like to think it's a bigger shift in the field too, but the idea that there are more of these researcher and clinician partnerships is just.

So exciting as somebody who is not in the research world at all other [00:40:00] than like reading it and trying to be like, well, I don't know what that means exactly, but I'll try. Um, so I think, you know, all of those pieces intersect and are really exciting for people who are practicing clinicians. Um, I want to, I want to, I want to weasel us back toward the story champ, because I have specific questions.

I know, and they're selfish. We get on the tangent. I'll get to it. No, it's good. 

Trina Spencer: That tangent was my 

Kate Grandbois: fault. I take full responsibility. 

Trina Spencer: It's okay. It's alright. But that is clearly something I care a lot about, is finding that sweet spot. You know what I mean? Like that's how you get real impact and I'm always promoting the interlocking relationships between practitioners and researchers, right?

It's so 

Amy Wonkka: important. It's, it's really like, because in fact, like you can have something that's like a really tight, great clinical intervention in a lab, but that is, Impossible most of the time to translate, um, exactly into a school [00:41:00] environment. So, and I think for people who are practicing in schools, we're used to curriculum, like I've had so many conversations with special education teachers about, you know, just the, the difference between, we, we never expect like third grade teachers to share curriculum, right?

Like we just buy them curriculum, like we being the schools, I don't actually buy anybody curriculum. Um, But just, you know, I think that part of that is because there's not as much curriculum available for special education. And again, like that is changing. Um, for my higher support need learners who are using AAC as like all are part of their communication system.

What are, like, can you walk us through like what a story champs? Um, what do you think the next intervention might look like? Like, like, am I reading this story to them? Am I modeling on their system? And like, what, what does that look 

Trina Spencer: like? I started on those steps, but I didn't get very far. So let me pick up.

I think it's because I [00:42:00] interrupted you. Step one. So illustrations, some visual materials. Um, they're just like five panels. And then there's icons for character problem, filling action, ending that correspond to each of those panels of illustrations. Um, we model a story. And in Story Champs AAC, there are actually two versions of the story.

One is what you might hear in a Story Champs regular, so it has the more complex language. Not super complex, right? But some. It's more complex than what they likely are doing in, you know, some beginner AAC use. Um, so we can textualize it. So they're hearing the story. All right. And then, then the next step, the, um, the interventionist is using an aided modeling with the child's device and using a simplified story.

Okay, and the simplified story importantly, it's not telegraphic [00:43:00] speech. So they're still voicing it. as complex like, you know, um, the boy was at home, right? But that might not be what the kid is doing on their device. It might be like boy home, right? So there's a simplified story, a regular story, a simplified story.

Um, there is a little bit of Instruction on the parts of the story like character problem filling action ending, which is in the original and it's mostly because we want to make the pattern salient. Okay. And, um, then after there's been an aided model of that story there, then the child. Or the individual retells that story using their device and there is a, uh, customized least to most prompt hierarchy that gets used.

And so we have some guidance about how to go about selecting. The, the levels in the prompt [00:44:00] hierarchy and some cautions against things like physical touch and using things like questions when many of our kids with high support needs don't answer questions readily. It's not really a prompt. So like these kinds of things.

Um, so there's a customized least to most prompting. And so they are getting support in Retelling that story using their own device, and then it's faded again, they get another trial with just the icons so that they move from maybe relying more on the pictures, the illustrations, which provide more content information, and the icons only tell you kind of like the category of what you're supposed to be talking about here.

Okay, 

Amy Wonkka: meaning like character 

Trina Spencer: or like selling exactly. It only gives you information like describe the character. And now you have to like, rely on the previous steps of them going. Okay. It was the boy was at home. Right? Um, so, I mean, that's pretty much it. That takes about 30 minutes. And they're just [00:45:00] practicing with their device and remember the next day or the next intervention session the story changes And so those three target words were planted, but they get a lot more than just those three target words Online we have this really cool like I don't know.

I think it's really cool I like anything that's pretty and like helpful, but it's basically a list of words that The stories were designed around, and it's not just those three, like a noun, verb, and adjective, but there's also a variety of people. So I'm looking at the list. There's like mother, family, teacher, grandpa, dad, mom, sister, tutor, kid, lunch lady, aunt, brother, cousin, you see, grandma, like, We've intentionally made sure that kids are getting exposed to any kind of family member they might have on their device.

And what's really, I mentioned this kind of before, if like there's a story but the child doesn't have like a grandma on their device, it doesn't matter, you make it another female character, [00:46:00] you know, that they do have. And then there's also settings, so you have like home, kitchen, school, house, classroom, park, gym, class, closet, study hall.

You know, all sorts of different locations that would also be on their devices. And then we use a variety of emotions as well. So there's a lot of emotion training in kind of the stories. And these are kind of incidental. So they might not have been the words that we. Well, we did. We identified words that we constructed stories about, around, I guess, so that there would be lots of variety, but they're in these kind of like categorical bins.

And there's lots of actions, like, everything is an action, like, the attempt to solve the problem is always some sort of action. Um, things like, Eat, draw, help, carry, fix, drive, run, forget, you know, these are kind of words that you would see in, um, vocabulary lists on devices. So, there's a [00:47:00] lot of practicing of getting to a category for a certain bin in the pattern, right?

Are you guys following me there? So like, if there's a character problem, filling, action, ending, they kind of know what categories they have to go to in order to talk about that, but they're not memorizing the specific. Symbols or words. 

Amy Wonkka: And I feel like when you're talking about the patterns repeating, it is not so explicit as like book one is the boy was at home.

He lost his book. And book two is not the horse was at home. He lost his frog. Right? Like, so pattern in the sense, in the sense that it's like pattern in 

Trina Spencer: the, in the structure, not in the content. 

Amy Wonkka: Right. And I think that that is also, as somebody who's worked in a lot of programs that do a lot of repetitive instruction and practice, I think that that's a helpful distinction to make too, that it's not, it's not a, just a tiny shift.

[00:48:00] It's like a, it's like a fundamental, you're not showing like almost the exact same picture every day. You're showing like completely different things that like have a similar. 

Trina Spencer: Yeah, and the teaching procedures that are, like, in there, I already talked about multiple exemplar training, but we also train loosely.

This is kind of a tricky one. People go, wait, what? Yeah, 

Kate Grandbois: I was going to say, explain this. Yeah. 

Trina Spencer: Okay, so,

I don't know how or why, but somehow there's this idea that if we've got a kid with high support needs, we need to be more rigid in our instruction. That just isn't true. It's the opposite. We actually have to be more intentional about variety. Otherwise, we build rigidity and rote learning. Okay, so the strategy here is to not train too tight, not train too mastery.

Uh, by the way, a lot of people, I might even be criticized for this sometimes, but that's okay. Um, I'm old and I've been doing this a long time and it works really well. The criticism is that I [00:49:00] will not use a mastery criterion before I make a change. I will not, because it is the antithesis to generalization and generative language repertoires.

We're here. So, I won't do it. But, that is the, what's the right word? That's the, that there's this some sort of like, I don't know, unspoken agreement that we all have to go, like, This prompt then made a mastery criteria and then we go to this thing and meet some other mastery criterion and then we go to this thing, right?

Well, I did that once and it backfired and it sent me on a rabbit's hole to figure out why I came out of that rabbit's hole. So in love with SLP and behavior analysts who works, SLPs and behavior analysts that work together to create spontaneous language. And that, that's what I learned is you've got to train these things loosely so that the kids will learn, will use the current stimulus conditions and [00:50:00] environment to choose the right words when they need it.

And let me give you an example for this. And remember I talked about you don't really get a lot of transfer without intentionally teaching it well. So in the study that we did, um, and I should also mention my doctoral student, Nora Amnubark, she was the lead, um, investigator on this, and she just had a baby, um, she lives in Saudi Arabia, she's amazing, 

Kate Grandbois: congratulations, 

Trina Spencer: yeah, so, so good, and let me tell you how many times she freaked out that she was not going to finish her dissertation, I said, no, no, we got this, she's like, but I got no participants, recruitment is so hard, I said, don't worry about it, this is going to happen.

Literally she started her study the next week and had all those three participants. So anyway things work out. But anyway, what was I saying? Oh, yes. I'm gonna give you some examples about how the train loosely works. Okay, so we only had one story On I think the story is about somebody who got food from mom or something and it was cold [00:51:00] and they wanted their food to be warm, so warm food.

I can't remember what the other target word of the story was, but warm and food are very important to this, right? So, one story, one session about these words, okay? And remember, it's more like commenting and discourse level talking about something, not requesting we parents. Had written down, they kept a log of what the kids were saying and doing outside of our sessions and two parents recorded that their kids had asked for, or clarified, or described food and the word warm in the same multi symbol utterance spontaneously without anybody prompting them to do it.

One of the kids said, said, um, um, I want warm food. So, there you go. You got, you, we just got like a four symbol request and we taught a story about how the kid wanted to warm up his food, [00:52:00] right? So, that's what I mean by the stimulus environment that's immediate. That's going to help control what words, what symbols those kids need, when they need it, if you trained loose enough.

for the correct stimulus condition to take over. 

Amy Wonkka: And when you say, sorry, Kate, you're unmuted. No, I've, I've got words in my 

Kate Grandbois: brain, but I can hold onto them. 

Amy Wonkka: Okay. I'm, I'm trying to clarify the trained loosely. So it was trained loosely about also in that moment, what you're accepting from the learner as like a correct response.

Yes. Some of that. So it's some of that. It's also some of like, I'm not reading this story a hundred times. We're not like focusing on the warm food story. We're just focusing on like the components of stories. This one's about incorporate some warm food. Is there anything else in that that that would make you say, ah, that's training loosely?

Was there anything else that you're [00:53:00] doing or in the way that you're teaching or responding or like what your criteria is for your learner? I mean, yeah, 

Trina Spencer: kind of like all of those things, right? We, we shuffle stories, we, we change stories quickly, right? So we don't over teach anything. Um, and then we accept and model, like, we will keep modeling those three target words, but if they, if it was warm and he said hot instead of warm, we'd be like, Great.

Let it go. We're going to reinforce the independence and the spontaneity of the variety, right? Like it's a, it's a recombinative, um, utterance. That's more important than correcting him and saying, no, no, it's warm food. Like who 

Kate Grandbois: the 

Trina Spencer: hell cares? I 

Kate Grandbois: can't communicate. I, I want to say this back to you as another point of clarification for Amy.

But that like what Amy said, um, when I think of training loosely, the word variety really comes to mind. So variety of [00:54:00] materials, variety of people teaching in a variety of places. Um, I see a lot of, you know, when we're talking about complex learners, I see a lot of teaching at the desk, teaching at the desk, teaching at the desk, using Mayor Johnson symbols, using Mayor Johnson symbols, you know, a lot of repetition of the same flavor, not a lot of variety.

And is, would you agree? Yeah, 

Trina Spencer: yeah, 100%. But variety should be intentional and strategic and systematic. And when I first got into this field and I worked with some SLPs, one of the things that I, I, you know, I was a behavior analyst, I was probably too much on the rigid side. And I would be like, okay, so what were you trying to teach there?

And the SLP would be like, I don't know, just playing. I'm like, oh. You see what I mean? I don't mean that. I don't mean just like going in there without a plan, without any idea what you're going to do, because the more intentional you are about that variety, the better outcome and the faster it's going to happen, right?

So [00:55:00] there is a balance between that, you know, and that's why it's so important to understand the different communicative functions, okay? Now, I want to tell you about one, another kid. Um, one of the kids that was not, never really used his AAC device in our study, okay, remember he only got like 9 or 10 sessions, 30 minute sessions, and remember there are 36 stories, we only got through 10 with this kid.

Um, we did these, um, intervention sessions at home, um, it was like easier than to go into their schools. Anyway, but of course, the kids were using their AAC device so much more just a result of the exposure that we were giving them. And this one day. The SLP at school says to the mom when he, when she came to pick him up from, uh, from school, she said, Hey, did you guys ride a bus and go to a swimming pool over the weekend?

And, um, the mom says, yeah, we did. [00:56:00] And she goes, okay, he just told me a story about that using his device. Oh my God. I know. That's so cool. A personal story with multi syllable utterances about something that actually happened to him that was real, right? Using words that we had not taught him for more than one exposure.

That's amazing. Yeah. And personal stories, by the way, are really the ultimate goal, right? We want them to be able to talk about things that are important to their lives. We teach in the retail format primarily to start the exposure to the layers of their device, the navigation, and the, the breadth of vocabulary and categories.

But what, as we're doing that, those become useful in their everyday. Which is the reason why we were tracking with the parents and, you know, we had really good details from two out of the three parents and that's the kind of thing that showed up and we're talking about kids who would never use their device before, hardly even to make [00:57:00] requests.

So the second type of Master lesson plan is a version of a personal story because we want to be able to, like, build the retell transferred over to personal generation. Now, I, that we did not use in our, in our study this, this 1, but I know it from the clinicians that helped me design that. And I, there are some other studies of generating personal stories using photos of real events.

So, basically, once you teach patterns and the. Variety of symbols that they got at their disposal, transferring it over to a personal story is, I think, easier than we think it is. That's 

Kate Grandbois: amazing. I, I want to make a comment just to anybody listening who's, I don't know, feeling excited about this, the outcomes that you're seeing, the early phases of this research and, and all of the, all of the positive patient outcomes that you're describing.

But also looking at their professional workplace [00:58:00] and thinking, you know, how can I make this change? I, and I say that because when you talk about the rigidity of instruction and some phenomenon that happens when we have someone who's a complex learner and something happens where we get very rigid and we, we need to like do things in steps.

I, my opinion here is I feel like that is very much a professional culture. And I think that it also in a lot of instances stems from workplace culture, or this is just the way we do things here, or how people are trained and expected to kind of go about their jobs. 

Trina Spencer: I think the origin was accountability.

Kate Grandbois: That too. I wonder if you could tell us a little bit about How to, if someone is experiencing those thoughts or thinking about how to shake things up and bring training loosely in and bringing multiple exemplars into their current intervention, what are some strategies that they can employ to [00:59:00] move that needle and kind of break some of that rigidity?

Yeah. 

Trina Spencer: Oh, I, I, those, those are really good questions, ones I'm not necessarily, you know, prepared for, but I would happy to talk about them. 

Kate Grandbois: Just, you know, throwing you right under the, you know, in the hot seat, right at the end here. And totally, 

Trina Spencer: and totally fine, right? Because that is ultimately what I want. I don't, I don't necessarily want, like, a million, you know, Story Champs users.

I want the, the technologies that we have been able to, to document their effects, I want them to be used. I want, to be honest, there's not a lot of literature that's going to tell you to train loosely. The literature that's out there is these stupid prompt hierarchies that say you got to do this and have a mastery criterion and da da da.

And every single time I want to roll my eyes and go, Yeah, give me that, give me, give me those people, give me those people, I'll show you. We can do this better, faster, and have better impact, and no one's going to hate our services because we're so rigid if we just do it with some [01:00:00] intentionality. So, how to get there, sorry.

So, I would plan on what's your ultimate goal, right? Is it to teach this phrase or is it to teach generative communication, right? And be, be thoughtful about what are the components. All right, the component skills and the patterns needed to be able to generate the, the language needed for something and, and I would argue it really is about patterns and we, uh, this is one of the things that SLPs are so much better at than behavior analysts because they're, they often focus on structure and all the behavior analysts are over here focused on function and think somehow that that's superior.

Guess what? We need both. That's structure. Okay. is the pattern of language and we don't really understand how to teach that. So the way you teach that is give, once you've identified that's your generalizable strategy or your big idea that you're after, the pattern of something, right, you need to inventory a set of patterns that you're [01:01:00] teaching because you don't want to just teach one because otherwise you get like I want cookie, I want a cup, I want Choose you see you don't want that right you got to create a list of all the patterns that you want to teach and then Make sure that you're designing the instruction so that they're getting multiple opportunities to practice each of those But not in consecutive trials, right?

So you have to like mix it up in a very Thoughtful, almost random way. It appears random, but it's not random, right? It's strategic variety. Um, so they're getting lots of exposures to them and you have to be very, very careful about your prompting. So you have to be able to fade your prompting. These are the key components of good instruction.

Exemplars of the thing you're teaching. Strategic, intentional exposures to those in, in meaningful context. If Doug was here, he would have been, trih, contextualize, contextualize, contextualize. Meaningful context, right? Don't do it in, um, [01:02:00] sitting need a need a kids intensive. There's no need to drill. I have not drilled in 20 years.

Right have not and the kids are learning how to talk. So, you know, you don't need it You don't need it and often the structure that's in place It's because we as the clinicians or the teachers we need it more and then there's accountability to it Okay, so so Identify your big ideas. I list all the different patterns and things that you're trying to teach in order to get to that big ideas.

Uh, create some sort of structure or system to make sure you get that variety that's random but not random. It looks random but not random. And then, um, teach with intentionality to fade your prompts. Um, make sure you're identifying good prompts for that learner because A full physical prompt is not the best prompt for everybody and I would argue for very few people.

Um, so we have to be very selective about how we customize prompts and then we have to have a [01:03:00] plan for fading and the fading needs to happen a lot more rapidly than you think it does and do not rely on mastery criteria. Right? And you have lots and lots of setting changes, context changes, you know, curriculum differences to practice all of those new patterns and generative repertoires in meaningful 

Kate Grandbois: contexts.

Is that enough? That was beautiful. And now again, I'm just thinking about all of the things that I've done wrong, uh, in terms of, in terms of previously using mastery criteria and all kinds of things. I love the entire landscape that you've painted for us. And I'm wondering in our last couple minutes, if there are really important takeaways or other themes that you want to leave our audience with.

Trina Spencer: I want to make sure that I answer Amy's question about the expansion. Do you mind if I go there? You get so many [01:04:00] points for remembering my interrupting tangent. Good call. No, it's, it's important because we, we kind of were like. Well, is this a new Story Champs? What is this exactly? You know what I mean? We, we struggled with how you, how we can conceptualize this and how we communicate it with our, with the, you know, the clinicians out there using it.

And we really want to say it's an expansion, right? And we call it an expansion pack. Kind of because it builds off of what we already know and do, especially the research. We already have a good, a very solid base of research. So we're expanding from that, um, expanding from the other research and the other clinical experiences that contribute to it, but also it adds more stories.

Now, if you have high support learners who are speakers, even if they're just doing two word speaking, you know, spoken word utterances, the regular StoryChamps lesson plans would be [01:05:00] appropriate, but you can use these stories. Okay, the teaching procedures are really for AAC. Users specifically. So if you have a speaker, you can use these stories, but use the other story champs, story, uh, story champs, master lesson plans.

Okay, because those are written with the research for the teaching procedures for speakers. And these are written, which is only, there's only two right now, but we believe that there's additional expansion coming. We got more research to do. So, yes, expansion, it works. And actually, Story Champs AAC is quite affordable, too.

Like, that's another piece that we kind of, we want people to be able to be like, Oh, I have regular Story Champs and now I'm going to start collecting these expansions for different versions. 

Kate Grandbois: I love it. Thank you so much for sharing all of this. We're going to have all the research that you mentioned in the show notes, a link to [01:06:00] Story Champs for people to check it out.

I so appreciate, I don't know, everything that you talked about from rigidity of instruction to, you know, how we need to think more, more robustly about the power of teaching narratives. It was, I, like I said, I have a lot of regrets, but that means that I learned a ton. Uh, so, you know. Glass half full and thank you so much for being here.

This was awesome. 

Trina Spencer: Well, thanks for having me. I definitely think that narratives are underutilized and we could be a more efficient workforce with the people we serve. If we. Like, integrated some of these instructional design principles. Yeah, 

Amy Wonkka: this was awesome. Thank you. Trina. Thanks. Trina. 

Kate Grandbois: You're the best.

Trina Spencer: I just enjoyed it. It's fine. I'm sure you probably we have more problems, more clinicians and more teachers are like, okay, this is what we need. So I got other [01:07:00] things to work on now. 

Kate Grandbois: Excellent. Well, we'll be following along closely. And of course, we'll, we'll just beg you to come back. That's right. 

Trina Spencer: I appreciate you letting me come on and talk about it.

It was, it was good fun. Thanks again. Yeah, you guys are awesome.

Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.

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