The Moderate/Severe Population: Structuring Therapy Sessions

Over the years, I've realized that when working with students in my Mod/Severe classes, my sessions are most successful when they include several parts that we can "check-off" on an agenda, visual schedule, etc. This is most necessary for my students with behaviors who have limited attention and need to constantly be looking towards the next activity. For example, here's a re-usable visual schedule I use with a student who has particular difficulty attending to tasks for more than a minute or two.

Thus, the clinical question I realized I needed to answer was this: what activities can I do with my Mod/Severe students to break-up an otherwise long, single activity?

What Do My Mod/Severe Sessions Look Like?

My Rules ~ 1 - 2 minutes
As I mentioned in my very first post about working with this population, I always start out by quickly going over the "rules" to get everyone in the mindset of participating and focusing on their good speech strategies. You can find my rule sheet here, although I have recently been contemplating updating it to include an AAC rule since I have several new AAC users this year.

Warm-Up ~ 3 - 7 minutes
I like to do some sort of quick activity to get my students talking and ready to engage in the main activity for the day.
- For my lowest-functioning class, I use the free "Touch and Say" app and open different pages for different students: the "silly" page for students working on imitation, "feel" page to quickly target some emotions, or "color" to work on some basic functions. It may look juvenile with the little mouse-looking creature, but on the actual pages there is no mouse, just a solid color with a "Nick Jr."-esque face. It ends up being much more neutral than some of my students other preferred interests (e.g. Thomas the Train, Dora, etc.).

- For my higher functioning classes, I created the "Conversation Balls." Essentially, it's two dollar store balls (one big, one small) that I hot-glued a long string between to connect. The game is played by selecting a student who gets the big ball and a target prompt (e.g. "What did you do over the weekend?" or "What's your favorite food?"). The student then throws the small ball to a peer and asks them them target question. The string connects the two balls, serving as a good reminder for students to use eye contact and face their conversational partner. After the student with the big ball makes a comment, the student who had the small ball selects someone else to be their partner and then they receive the big ball. I prompt as needed for the students to make comments, ask/answer questions, etc as the balls get passed around the room between all the students.

**For some groups, the conversation ball can be so time consuming that it can take up an entire session; it really depends on how well your students can ask and answer questions**

- If an exciting topic has recently happened, such as Christmas or summer vacation, I may just ask the students to go around and each share one thing that's on their minds. They get to practice their language skills (because most of their day is spent in total silence!) and I get to learn more about their lives! It's a win-win.

Main Activity ~ 15 min - 25 min
You can check out some of my "main activities" that I have posted about in the past here and here. You can also check out my blog post here where I describe some of my favorite "off-the-shelf" materials, some of which I have used with my higher-functioning Mod/Severe students as "main activities." There's many other activities that will one day make it into a blog post, such as using themed surveys to ask and answer questions, re-telling short animated clips, using News 2 You, and modifying traditional games like bingo and go fish to target functional communication and intelligibility. Stay tuned for more ideas for working with this population in the future!

Wrap-Up/Reward/Transition ~ 1 - 5 minutes
With my higher-functioning classes, we always do a quick wrap-up to discuss what we were targeting that day - such as new vocabulary, explanation skills, good speech skills, social skills, etc. This is an important part of any session, but I actually forgot to implement a wrap-up with my Mod/Severe students until this year... whoops! They need the reminder of what they were working on as well!

You may also have some students/classes that need to be working for a reward. I typically implement a short, funny video as the reward since it can target an entire class and be over within 60 seconds or less. Popular google searches for appropriate and enjoyable videos include "dog dancing," "funny cats," and other animal-related videos. I also try to schedule my sessions at the end of a class period so that when my session ends, the students are ready to transition to their next classroom or activity. I feel like this gets some teacher buy-in as well, because the students are completely finished with an activity and are generally willing to transition with little difficulty.

I think the key take-away in planning sessions for the Mod/Severe population is to always try to plan for any crazy thing that may happen and to then have some sort of back-up in mind! Behavior issues? Have that visual schedule, Class Dojo, or reward system ready to go. Session not going well? I keep the students' favorite Matt and Molly stories in my Mod/Severe therapy bag just to whip out in case things go south.

What are your favorite ideas to keep your Mod/Severe sessions running smoothly? How do you handle behavior issues or keep your students focused on your activity? Please share your ideas in the comment section!!

As always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP