Speech Sound Carryover Across Settings
Back when I worked primarily in junior high schools, I wrote a post on Articulation Carryover. It included carryover tasks that I did within that setting. However, since that time, I've worked in outpatient pediatric (18 months to 18 years), private practice (accent modification), and university (English as a Second Language) settings. I realized that some of the carryover tasks I listed in that post no longer fit, but there are other things that I've been doing the whole time which were not included in the original post. That made it clear, it's time for a carryover update.
Here's how I plant the seeds of carryover with kids and adults across settings:
1. Carryover starts with Listening
Long before a student even gets to the carryover level, it's important to establish a solid foundation of auditory discrimination. The client needs to be able to distinguish for themselves when a production meets the target and when it does not. Otherwise, they are just going through the motions (literally) with no internal mechanism to troubleshoot or correct productions outside of the therapy environment. In this way, carryover starts before shaping and drilling even begin. The skill can later be reinforced at various stages, but it starts before practice production ever does.
(e.g., "hut" vs. "hurt" when targeting vocalic /r/ sounds)
A few options for auditory discrimination tasks are:
Present the client with pictures of two minimal pair words, say one of them, and have the client point to which word you said. Remember to vary the order of presentation.
Tell your client their target sound, then tell them you will read a pair of similar sonding words with and without the target. They are to let you know if their target sound was in the first word you said or the second one (strategy from Compton PESL Accent Modification method). Continue to vary the order of presentation.
You read or speak accurately while student listens out for the target sound, indicating when they hear it.
You read or speak a sentence or longer passage and have student identify whether you use the target sound accurately or inaccurately each time you attempt it.
Have client listen for their sound in another person's speech (such as how many times do you hear your sound in the first five minutes of a show, video, song, etc.)?
(Some people seem to benefit from a little amplification of the sounds during the very beginning of auditory discrimination, but it is not necessary for all).
2. Listener Facial Expressions
Throughout the early stages of therapy, I pair my verbal feedback with my facial expressions, eventually fading to facial expressions only as a natural form of feedback. I start with very exaggerated facial expressions and then fade to more subtle changes. This is to promote carryover. Non-speech-language pathologists wouldn't (and probably shouldn't in most contexts) give direct verbal feedback on someone's pronunciation. Instead, if people are confused or surprised by how something was said they might naturally exhibit a fleeting look of confusion (helpful non-verbal feedback). When people understand something clearly, they tend to smile and nod (natural positive reinforcement). I train my clients to catch these non-verbal signals and react to them by proceeding or re-stating more clearly depending on the feedback they received. This primes them to do this with other listeners, aiding the carryover process.
3. Articulation Hierarchy
This part is consistent with what I said in my original carryover post. I introduce the articulation hierarchy at some point (not when we're still working on shaping a sound in isolation or syllables, but after they've gotten a little success at some level. I show them the visual that I made so that they and their families understand that just because they can do the sound in words or sentences, does not mean we can expect it in their conversational speech yet. I reinforce that "just talking" does not count as practice if that is not the level that the speech-language pathologist (SLP) asked them to work on at home, reinforcing that they should practice at the level assigned. (This can even help keep some colleagues on track. I've seen some SLPs expect students to jump from the sentence level to conversation, which will not be reasonable for all students). Using the checkbox format of this visual really helps people see their progress, visualizing how far they've come and what is still left to go.
4. Data with Visual Tokens
I take data using the cups (shown at the top of the post) or something similar. For young children, I use the green and red cups from "cups and bears" counting manipulatives, dropping a token (bear) of any color into the green cup when they produce a sound correctly and the red cup when they produce it incorrectly (often with the additional visual of a smiley face drawn on the green cup and an "X" drawn on the red one). For older kids, teens and adults, I'll still use color coded or labeled cups but with a more age appropriate manipulative (like poker chips, magnetic tokens, buttons, or even paper clips). The idea is that Green = Good (keep going with your speech) and Red = Stop (and fix that production).
This promotes carryover, as I tell the client that if they correct their speech sound before I can get the token into the red cup, I will put it in the green cup instead. This gets them in the mindset of making self-corrections - which is the skill they need to have their progress carryover outside of the therapy room. I reinforce that all people misspeak at one point or another and repairing that communication error is natural; some never even noticed that other people do that. Instead they strive for an unrealistic expectation of perfect speech and fail to notice or correct themselves when they mispronounce something.
For some learners, I also introduce a yellow cup for sounds that were distorted and are hard to judge as clearly right or wrong. This helps them to see how speech is really on a continuum and may explain why sounds they previously judged as correct, may be judged as incorrect to listeners.
5. Students Take Their Own Data
Have students take their own data either using the token in a cup method shown above or using tally marks (a method I also use to take data, even during conversation). The students have seen me do this. I don't hide data from them, so they usually know how to do it. Even children as young as 4 or 5 can take data. Of course, I don't use their data in my official records. I still take my own, but it helps them to get into the habit of monitoring themselves. I often even tell them that they need to learn to be the judge because I will not follow them around all day correcting them, and they probably wouldn't want me to anyway. After they take the data, we tabulate the results and I tell them their percentage of accuracy. Sometimes we compare it to my data. Sometimes we talk about that 80% that we strive for, sometimes we look at where they now fall on the articulation hierarchy (above). At other times, I simply give verbal praise, encouragement, or tips for further improvement, like discussing which words were incorrect and having them re-try those at an earlier level on the articulation hierarchy.
6. Monitored Outside Practice
To more explicitly start working on carryover to other settings, I do activities similar to the carryover tasks you might see in fluency therapy. I have the client make a phone call to a store or library with me (topics are pre-selected/discussed to include target sounds) or go talk to a receptionist (usually one who I've coached ahead of time to try to keep the conversation going for a while). This is where I might also ask for teacher's feedback in a school setting (see previous carryover post). Just knowing that a family member, instructor, or any other person is also listening to how their speech sounds can help with carryover.
7. Brief Periods of Self-Monitoring outside of Therapy
Pick a time, any time, and do tell me what it is! I encourage clients/families to pick a very short chunk of time (like 5 minutes) in which they are going to be cognizant of their target sound and whether they produced it accurately or not. It's too much to ask someone to monitor HOW they produced their speech sounds all day every day when they also have to think about WHAT they are actually saying. (This also helps get some parents out of the habit on harping on their child for their speech all day rather than listening to the content of their messages - avoiding an annoying and unproductive pattern for all). Instead I encourage short bursts of monitoring. For young clients, I may ask families to pick a time, such as the first 5 minutes of snack after school or the first 5 minutes of the drive to school. For adults, I encourage them to choose a time that they think will be most beneficial, like the first 5 minutes of every phone call at work or every time they speak to a barista.
YOUR Carryover Takeaway: No matter which carryover tasks you choose, it's important to have a carryover conversation with your client, letting them know that practicing in therapy alone is not enough and they will need to make it their responsibility to monitor their own speech outside of the treatment room.
