A Model for Reading Assessment and Intervention in the RMIT Bundoora Psychology Clinic

Originally published: Hempenstall, K. (1996). A model for reading assessment and intervention in the RMIT Bundoora Psychology Clinic. Australian Journal of Learning Disabilities, 1(2), 18-27. 10.1080/19404159609546506
Updated: July 2025

This section contains the original publication. You can find new content below. 

The use of a Direct Instruction reading program to tutor an adult with a moderate intellectual disability
or
A model for reading assessment and intervention in the RMIT Bundoora Psychology Clinic

The RMIT Psychology Clinic has a dual function: that of a teaching clinic offering clinical experience to post-graduate psychology students, and that of providing a low cost psychology service to the community. At present, the post-graduate courses are directed towards child psychology, and the clinic treats a range of children’s problems, in particular: educational problems, behaviour problems, enuresis and encopresis, fears and phobias. In recent times, the percentage of referrals for educational problems has increased markedly: from 10% of the total in 1991 to 57% in 1994. This has paralleled a decline in psychology services available to schools in the government system, and perhaps also reflects an increased community and school awareness of the Clinic’s service. The rationale for the educational psychology component of the course should also find expression in the practice of the Clinic, and for this reason a model guiding clinical practice in the Educational Psychology Division was developed.

Paralleling the course philosophy that empiricism should drive practice, the clinic model takes as its theme for assessment and intervention, practices that have sound theoretical and empirical support, with the added requirement that they be feasible in the real world. Masters students are provided with a scaffold that can guide them in their clinical work from initial interview to follow-up. All their sessions with clients are video-recorded, and supervisors provide feedback to students based on the viewing of the tapes. At times, particularly during the students’ first semester, supervisors provide direct service to the client in the Clinic, but in most cases a particular client-clinician interaction (e.g., demonstrating a teaching procedure to a parent) can be satisfactorily simulated in the supervision session.

1. INITIAL INTERVIEW:

(a) information: The clinician obtains relevant developmental and medical history, and any recent school or psychological reports. These will have been requested at the time of telephone contact, and assist in the direction taken during this interview.

(b) The clinician discusses the Clinic’s role and limitations in the areas of assessment and intervention.

(c) The clinician obtains clear agreement about the possible outcomes of the referral, being wary of unrealistic expectations, either the clinician’s or those of clients.

(d) If there is to be an intervention phase following the assessment, the clinician raises the issue of who is to provide it: School teacher or aide, parent, tutor, volunteer, outside agency, or some combination? It is important that this decision is not delayed until the feedback session, particularly if the results present a “crunch” time for parents, as they sometimes do. If parents anticipate that some concerted action will follow, they are more likely to accept the sometimes dismal news about their child’s current attainment. The parents’ sense of hopelessness that sometimes follows such revelations may prevent them from participating in constructive planning at this time, so having an already-existing commitment to action is a decided advantage.

2. INTELLECTUAL ASSESSMENT:

Such assessment is not very useful for instructional decisions, but provides an opportunity for psychologists-in-training to obtain practice – a legitimate objective for a teaching clinic, particularly when fee-for-service is low due to subsidies provided by the University department. Intellectual assessment has the potential for a destructive consequence if a school uses low measured intellectual ability as an excuse for its failure to teach the child effectively, and as a rationale for future inaction. Any report to schools that comments (however obliquely) about a child’s intellectual ability, should also include some reference to the admirable assertion of Marilyn Jager Adams.

The bottom line is that the role of mental age is not one of limiting what a child can learn but of limiting the ways in which they can be effectively taught. (Adams, 1990) 

It is sometimes argued that intellectual assessment can uncover the bright non-reader – those who should be reading well, because they can do most other things well. What is often misunderstood is that reading and intelligence do not have such a strong correlation. Above a threshold, one is as likely to find low I.Q. good readers as high I.Q poor readers. Stanovich (1991, 1993a) concludes that measured intelligence is a poor predictor of reading potential. Further, it is not useful in predicting which children with reading problems are most likely to make good progress (Goyen, 1992).

Despite the lack of value in assessing global I.Q. for instructional decisions, there are psychologists who consider that IQ sub-test analysis can inform practice. Prominent commentators have long warned about the dearth of evidence for such analysis. Examples are Anastasi (1990), “Several decades of research on these various forms of pattern analysis with the Wechsler scales have provided little support for their diagnostic value” (p. 481), and Sattler (1992), “Once one goes beyond the confines of the IQ’s provided by the full, verbal, and performance scales, however, the ground becomes loose and wobbly” (p. 182). Miller and Walker (1981) suggested that such practitioners are perpetuating a myth because of the unremitting pressure on them to make classification decisions. There have been many papers written on this topic, but none has satisfactorily demonstrated any link between such subtest analysis and improvement in decisions about reading intervention (Goyen, 1992; Stanovich, 1993a, Swanson, 1993).

Intellectual assessment is occasionally of paramount importance when the referral involves consideration for integration assistance, that is, a classification decision must be made about whether a student is eligible for a specific funded program for students with an intellectual disability.

3. ASSESSMENT OF READING:

Is the student a beginner (Year P-2) or an older student referred for remedial assistance?

(a) If the child is a beginner:

Early reading delay is sometimes viewed as indicative of a slow starter who will catch up later; however, this is a dangerous assumption. Juel (1988) reports a probability of 0.88 that a student classified as a poor reader at the beginning of Year One would remain so when retested at Year Four. Hence, early identification and intervention should be paramount issues for the sake of those children who are at present needlessly exposed to crippling, extended failure.

If there are concerns regarding potential reading failure prior to school commencement (family history, disability etc.) there are a number of useful screening subtests in the Brigance  Comprehensive Inventory  of Basic Skills  under the heading of Readiness. If intellectual disability is suspected, or if the child is very young, the Brigance Inventory of Early Development-Revised may provide the educational assessment information at a more appropriate level. Among these tests letter-name knowledge is acknowledged as one of the best predictors of reading progress among beginning readers (Chall, 1967).

There is near-complete consensus among researchers that phonemic awareness is the best single predictor of future reading progress, markedly better than is intelligence (Stanovich, 1991). As this awareness is also the major causal factor in early reading progress (Adams, 1990), assessment of current levels allows both a prediction of a child’s likely progress in the absence of appropriate intervention, and a direction for any intervention to take.

Phonological(or phonemic) awareness is an auditory skill enabling the recognition that the spoken word consists of individual sounds. It follows a developmental sequence: from simple (Do cat and comb begin with the same sound?) to complex (blending, and then segmenting). In a huge study (Hoien, Lundberg, Stanovich, & Bjaarlid, 1995), initial-phoneme and final-phoneme matching tasks (such as assessed by the TOPA: Test of Phonological Awareness) were by far the most potent predictors of early reading acquisition. There are a number of screening tests available, but few with norms as yet; the TOPA is one that is used in the Clinic and has an age range is 5.0 – 8.11yrs). Another advantage of this test is its facility for group-testing.

Another test is the Phonological Awareness Screening Test (Henty, 1993) developed in Tasmania for which the author is attempting to obtain normative data. The Sutherland Phonological Awareness Test (Neilson, 1995) has norms (Australian) for Years P-3.

The Lindamood Auditory Conceptualization Test has norms for Years P-12, while informal un-normed tests are available in A Sound Way (Love & Reilly, 1995), Sound Linkage (Hatcher, 1994), Phonemic Awareness Checklist (Lewkowicz, 1980), among others. The Yopp-Singer Test of Phoneme Segmentation (Yopp, 1995a) is a brief test for Prep/Year 1 students, designed for early screening purposes.

Phonemic awareness becomes important when beginners are faced with the challenge of making sense of the English alphabetic system of writing. The degree to which students are able to use their developing phonemic awareness can be assessed with the Word Attack subtest, Woodcock Reading Mastery Tests-Revised, 1987. The decoding of non-words is considered the most appropriate measure of phonological recoding (Hoover & Gough, 1990; Siegel, 1993; Wood & Felton, 1994). It provides an indication of the capacity to transfer the auditory skill of phonological awareness to the task of decoding print. There are other phonological skills besides phonemic awareness, and they are beginning to assume importance in the research literature because of their capacity to add discrimination power to screening batteries (Badian, 1994; Cornwall, 1992; Felton, 1992; Hurford, Darrow, Edwards, Howerton, Mote, Schauf, & Coffey, 1993; Hurford, Schauf, Bunce, Blaich, & Moore, 1994; Spector, 1992).

Some of these studies have demonstrated excellent results through including phonological tests in a battery to predict problems in reading acquisition. Hurford, Schauf, Bunce, Blaich, and Moore (1994) assessed 170 school beginners, and predicted with 100% accuracy which students would be diagnosed with a reading disability two years later. They used phoneme deletion, phonological discrimination, IQ, and pseudo-words. Badian (1994) assessed 118 pre-schoolers mid-year and successfully predicted 91% would be good or poor readers 2 years later. She used phonological awareness, naming speed, and an orthographic matching task.

Phonological recoding in lexical access. Humans store the internal representations of words in sound form known as phonological segments. These representations need to be clearly distinguishable from other stored sound segments, or else the wrong word may be selected when, for example, one is asked to name an object presented in a picture, or a written number, or letter.

Not only must the representations be distinct, but they must be quickly and accurately accessible. Students classified as dyslexic often display speed and accuracy problems even prior to experience with print. Naming speed for pictures or objects is slow, as is, subsequently, naming of (known) numbers and letters. A number of researchers have noted the predictive power of naming-speed tasks, using pictures, numbers, and letters. Both naming speed and sight word reading depend on rapid, automatic symbol retrieval. Bowers (1995) argues that slow naming speed is specific to reading disability, and not common to children with either garden-variety  reading problems, or Attention-Deficit  Hyperactivity Disorder.

Tests:RAN: Rapid Automatized Naming (Denckla & Rudel, 1974). BNT: Boston Naming Test (Kaplan, Goodglass & Weintraub, 1983). SNS: Symbol Naming Speed (Swanson, 1989). For children with automatic letter-sound recognition a letter-naming test may be the best predictor, being conceptually closer to reading.

Phonological recoding in working memory. The beginning reader is required to decode a series of graphemes, and temporarily order them to allow the cognitively expensive task of blending to occur. This skill has been found to be an important determinant of early reading success. It is assessed by digit span (oral & visual) and sentence memory tasks.

Tests: Wechsler Intelligence Scale for Children: Third Edition (WISC III): Digit Span subtest; Wechsler Pre-school and Primary Scale of Intelligence- Revised (WPPSI-R): Sentences; Stanford-Binet: Fourth Edition (SB-FE) Memory subtests; Brigance: Sentence Memory.

There do not yet appear to be published test batteries of the type discussed earlier that have demonstrated such excellent predictive power. At this stage, judgements concerning at-risk status are made through an examination of individual test results rather than through a score cluster. In the not too distant future, it is possible that accurate early identification will become a normal part of a school’s literacy program.

(b) If the child has been referred as a remedial reader the major questions are:

How delayed is this child’s reading development?

The answer will provide an idea of the length of time it could take for the child to achieve a reasonable level of reading skill (i.e., to be able to adequately comprehend grade-level textbooks as a minimum outcome) given a good program, regularly and competently presented to a motivated student. Normed reading tests may be used for this purpose, bearing in mind the various problems they have in specifying absolute grade levels. In the Clinic, the most commonly used tests are the Woodcock Reading Mastery Tests (Revised, 1987), the Neale Analysis of Reading Ability  (Revised, 1989), and various subtests of the Brigance Comprehensive Inventory Of Basic Skills (1992). The Woodcock has a significant advantage over the Neale because of its Word Attack subtest which indicates the degree to which the student can apply his phonemic awareness to the task of reading (sometimes called phonological recoding). The Neale  allows for testing of reading rate, an important element in a student’s progress, reflecting the level of automaticity or fluency achieved. Rate also provides information about the attentional capacity a reader has available to commit to the task of reading comprehension.

Does this child have only a decoding problem, or is his decoding ability actually commensurate with his other language skills?

Stanovich (1988b) describes the dyslexic child as one with a severe phonological problem, but (initially at least) no other language difficulties. He contrasts this child with the garden variety reading-problem student, who shares the phonological problem (though perhaps to a lesser extent) with his dyslexic colleague, but who also has other language difficulties, such as language comprehension, vocabulary, short-term memory, or attentional problems. The rationale for making such a discrimination revolves around the instructional decisions that need to be made consequent upon the assessment. For the dyslexic child, there is considerable consensus in the research community that the deficit lies in the area of phonological processing (Elbro, Nielsen, & Petersen, 1994; Yap & Van Der Leij, 1993), and that the intervention focus needs to be at the level of word decoding. Consistent with research findings (Adams, 1990), best Clinic results have come from reading programs that have a strong phonic emphasis and involve explicit instruction (Foorman, 1995; Perfetti, 1992) – such as the Corrective Reading Program – Decoding strand. The garden variety reading problem is also addressable by the same program, at least at the decoding level. This is a valuable intervention to introduce, as the increased facility for decoding reduces the attentional requirements needed at the level of print-decoding, thus freeing up valuable attentional capacity for the task of comprehension. However, this group of students may also need assistance with the comprehension of what they decoded, and additional intervention should be considered simultaneously with, or perhaps after, the decoding program. The Corrective Reading Program – Comprehension strand is a program that has been successfully used in primary and secondary settings and by parents (Clunies-Ross, 1990; Noon & Maggs, 1980) for this purpose.

The deceptively simple way to discriminate between these two (dyslexic and garden variety) groups of students is to compare their attainment on a reading comprehension task to that on a listening comprehension task. The Brigance Comprehensive Inventory Of Basic Skills has the capacity to provide such a comparison, with its reading comprehension and listening comprehension subtests (up to Year 9). This technique is now considered by many researchers as the most appropriate method of discriminating these two groups since the discrepancy-defined dyslexia model has fallen from favour in recent times. In this previous approach, dyslexia was assessed by the presence of a discrepancy between a child’s intelligence and his reading attainment. However, it is now increasingly recognized that intelligence is far from perfectly correlated with reading. Stanovich (1992) calculated a median correlation of 0.34 across 14 studies involving 26 measures whose correlations ranged from 0.10 to 0.66. The range of correlations relate to the choice of intellectual and reading tests. The lower figures are more likely when the reading measure has a strong word-decoding emphasis, and the higher figures when comprehension is the major focus. Given this only moderate correlation, any discrepancy may be more reasonably considered a normal statistical variation than a specific neurological deficit. More recently, the Spadafore Diagnostic Reading Test (1983) has been employed in the Clinic, as it is normed to Year 12.

Further, it is noted that the development of literacy is closely intertwined with the development of intelligence (Stanovich, 1993b). That is, the continued normal development of intelligence may rely on an adequate volume of reading. This assertion may be difficult to accept, but vocabulary development and higher-order comprehension skills are best advanced through reading (Nagy & Anderson, 1984) once the beginning stages are passed. Thus, as children with reading difficulties grow older, their lack of reading could be expected to reduce the initial gap between intelligence and attainment. That is, over time, dyslexic students measured intelligence may come to more closely resemble that of their garden-variety colleagues, as problems additional to the phonological core develop (Stanovich, 1988a). Sadly, the intelligent under-achiever may appear to become less intelligent because of our educational system’s failure to adequately address his needs at the critical early stage.

The other major problem with discrepancy-defined dyslexia is that a different group (between 2%-35% of the population) is described by different intelligence tests, and through different subtest-analysis. For example, there has been debate over whether verbal or performance (or both) scales should be used – the use of one over the other certainly defines a different group as dyslexic. There is also disagreement over how large a discrepancy (eg 1, 1.66, or 2 SD) is needed for a diagnosis of dyslexia; over the minimum intelligence level needed for a dyslexia classification; and, over the type of reading test chosen to define the reading deficit. Given the slippery nature of such assessment choices, it is unsurprising that such a model is falling from favour, although it still has currency in some educational circles.

Comparing the results of listening comprehension to reading comprehension also makes intuitive sense, because listening comprehension tasks are much more closely related to reading than are the more global tasks involved in intellectual assessment. It offers the capacity to define those children who have a major problem only at the level of print. They will perform well on the listening comprehension tasks, using their impressive general language skills to answer questions about a story read to them. On the reading comprehension task however, they will do relatively poorly as their under-developed decoding skills prevent them bringing into play their well-developed general language skills. When required to decode a passage unassisted, they struggle, as did their garden-variety  peers. On the other hand, the garden-variety students would be expected to perform similarly on both tasks. Their reading problems are general rather than specific, and they may not have any particular reading subskill restricting their development. Their decoding skill is commensurate with their other language skills, such that if they know the meaning of a word (or phrase, or sentence), they can comprehend it whether it is presented orally or in print. The consequence for the high LC (listening comprehension)-low RC (reading comprehension) child should be intensive assistance at the decoding level. For the low LC-Low RC child, intensive assistance at both the decoding and comprehension levels is indicated.

Other possible outcomes are high LC-high RC, a result predictable from an all-round good reader; and low LC-high RC, a rare result, possibly from a student with acute attentional, hearing, or short-term memory problems. In this case, the permanence of text would allow the student to use his intact language comprehension skills, whereas the ephemeral nature of the spoken story precludes such access. Hyperlexic students (a rare sub-group with excellent word recognition, but poor reading comprehension) would not be detected by this discrepancy analysis, because their listening comprehension parallels their reading comprehension (Sparks, 1995).

This LC-RC discrepancy represents an alternative definition of the group known as dyslexic; however, as with the IQ discrepancy-defined dyslexic, an issue is how great a discrepancy should be considered significant. Some (including the Clinic) have considered two years to be very significant (Anderson, 1991) given the extent of commonality of the tasks; although this is clearly an arbitrary figure, its significance being higher the younger the age of the child. As the term dyslexia is unlikely to disappear (at least in the short term), and parents almost always ask questions about it, the Clinic policy is to make use of the listening comprehension-reading comprehension discrepancy in discussions with parents. This is its major value since the techniques employed include systematic phonics whether the difficulty is described as dyslexic or garden-variety. The dyslexic classification does, however sensitize clinicians to the possibility that dyslexic students may be more treatment-resistant (Berninger & Abbott, 1994) than garden-variety students, and may also require additional direct phonemic awareness instruction

Why are so many students referred from about Year Four?

At about Year Four, there is a marked increase in the number of children referred for reading assistance to the Psychology Clinic. This may represents the dawning of recognition for a teacher that the maturational-delay hypothesis can no longer be used to explain the lack of reading progress. More salient perhaps is the generally unacknowledged explosion of new words in textbooks at about that time (Carnine, 1982). Many students who have relied upon whole-word memory recognition as their mode for storage and retrieval find the strategy collapses in Year Four. Whereas a word recognition capacity of 400 words is adequate for coping with text up to this time (and many children’s visual memory can manage such a load), the demand increases dramatically to about 4000 words around that year (Carnine, 1982), and up to 7000 words by Year Six, what Share (1995) describes as an “orthographic avalanche”. For the student who relies primarily on word shape, the task is similar to that required in visually memorizing 7000 telephone numbers. Students who cannot access the phonological route to identify these words do obviously struggle and progress grinds to a halt. In truth, they had difficulties before this time, but perhaps managed to disguise them in classrooms where careful continuous assessment of word attack skills was unavailable. Unfortunately, this appears to be even more likely for girls, as their rate of referral for assistance (about 1 in every 4 referrals) does not match the prevalence (about equal with males) of reading problems among females in our society (Alexander, Gray, & Lyon, 1993).

A low Woodcock: Word Attack score suggests this scenario in students at (or beyond) Year Four. For younger students it is predictive of their reading future. Inability to decode pseudo-words is indicative of the need for an intensive, carefully designed program that provides at least a reasonable opportunity for the accelerated progress needed if a student is to make headway against his peers. If a student is two years behind his peers he must develop in reading at a rate twice as fast as they do, if he is to catch them by the end of primary school (as they will improve by at least two years over that period). While this conception of reading progress is rather crude it does give the flavour of just how immense a task it is. It also helps explain the chilling finding from a Melbourne University study (Hill, 1995), that for most students in this position there is no discernible improvement in reading between Year Four and Year Ten. Most students do not have access to intervention, and their prognosis is grim. For those students who do receive help it is incumbent upon us to provide the best and most efficient intervention available at the time. This implies that the most salient content must be delivered to students in the most effective manner possible.

The use of a well-constructed, direct instruction phonics program should be the first line of attack for most students. There is ample evidence to support this emphasis (Felton, 1993), although there is no reason why it could not be introduced alongside a whole language program (Adams & Bruck, 1993). The principles of effective teaching, such as task analysis, appropriate initial placement, mastery learning, demonstration-practice-feedback as a major teaching strategy, rapid pacing, well-defined correction procedures, attention to academic learning time, adequate massed and spaced practice, and high rate of success – are variables associated with rapid progress independent of learner characteristics (Rosenshine, 1986). Both the content and delivery principles outlined above are exemplified in Direct Instruction programs, which also have excellent empirical support in addition to their strong theoretical base (Adams & Engelmann, 1996; Gable & Warren, 1993; White, 1988). Even with well-designed and regularly presented reading instruction, the reader with delayed development rarely makes miraculous progress. It has taken some years for the student to reach this invidious position, and it may well take some years of intensive assistance for him to develop age-appropriate reading facility (Felton, 1993). Quick-fix cures usually occur only in the realm of tabloid television. The road back is fraught with pitfalls, and the difficulty of the task should not be minimized when discussing an intervention with parents.

4. REPORTING BACK

Reporting back usually involves the preparation of a written report, and discussion of this report and its ramifications with parents, and possibly with the student’s school. This can occasionally be a difficult experience for all concerned, though planning can alleviate unnecessary distress. First, the issue of intervention (and who is to implement it) should have been addressed from the beginning. Thus, the impact of a report that is potentially distressing is attenuated because the possible need for intervention has already been discussed and planned for. The parent is not left solely with sad news, but with a strategy for addressing the problem. Second, the report is usually sent to parents prior to their interview to allow time to comprehend the contents and any ramifications, and to prepare any questions. Preliminary discussion of the findings usually occurs progressively over the assessment period (several one-hour sessions), hence there are unlikely to be any complete surprises within the report. This procedure also provides time for any initial upset to dissipate, and for parents to re-orient themselves toward addressing the future. If the parents have no information prior to the report’s presentation at the interview it is possible for them to be quite perturbed and less able to comprehend or remember either the content or any subsequent discussion or decisions. Alternatively, they may not have enough time to fully understand the report, and the goals of the session regarding feedback and clarification are unmet. At the very least, parents should be left alone for 10-15 minutes to give them some opportunity to read the report prior to discussion. A common response to feedback about a child’s lack of attainment is anger, and asking pointed questions as to how this problem could have been either undiagnosed or ignored for so long. In most cases, it is prudent to focus on the future, and work towards harnessing energy for the long haul, rather than feeding acrimony towards schools or the Education system. In some cases however, anger may preclude productive action initially, and time needs be spent in assisting parents to come to terms with the future and the past.

5. READING INTERVENTION

A Clinic intervention usually includes recommending a relevant program, lending it to the client, teaching the responsible person how to use it, monitoring its use, and finally, evaluating the outcome. The Direct Instruction programs, recommended because of their history of success, have an additional advantage in their high level of structure. Program presenters do require administrative skills, commitment and endurance, but the content and presentation script provided in the programs remove the need for presenters to be expert in teaching reading. While this may appear to over-simplify the issue of who can or should teach reading, it is ultimately an empirical question, and the experience in the Clinic supports the success of the model. It is fortunate that this approach can be successful as many parents find there are few resources in the schools or wider community to alter the likely outcome for their children. Interestingly, there has been a marked increase in the number of schools requesting information about the programs used by the parents. They often express surprise at the progress made by formerly intractable students (that is, students with whom the schools have failed). In a number of cases, schools have subsequently sought assistance to commence the implementation of the Corrective Reading program in their own school.

The Beginning Reader:

In the Clinic, success has been achieved with the Teach Your Child To Read In 100 Easy Lessons  program (Engelmann, Haddox &  Bruner, 1983). This program is written for parents, and is based on the teacher-directed programs, Reading Mastery 1 & 2 (Engelmann & Bruner, 1969, 1984, 1995). In the Clinic, and at schools, training has been provided to parents, volunteers, and teachers to successfully implement either of these programs in an individual or group format. Apart from initial training, the Clinic provides monitoring of the presenters’ skills, on-going support, and a variety of pre- and post-test evaluation strategies. The success of the program is heavily dependent upon treatment fidelity; thus the necessity of continued support. This overseeing role has an important secondary effect of enhancing the endurance necessary to achieve success. Experience has suggested that without this continued Clinic role, programs are often discontinued prematurely, or are altered to the extent that success is jeopardised. In addition, parents are sometimes pressured by schools not to implement such a program because it is not consistent with the school’s existing language policy. Whilst there is no valid reason why the approaches need be seen as incompatible, contact with the school regarding the programs may be advisable to allay any of their concerns.

The approach to training involves the following sequence: the clinician provides information about the program; the clinician demonstrates the program while the parent initially acts as the student. This is followed by a role-reversal, in which the parent teaches the clinician (who provides feedback). Then the clinician teaches the student, and, finally the parent teaches the student (with clinician feedback). This process of demonstration-practice-feedback continues until the clinician is satisfied that the parent is able to correctly present the program. Usually two complete sessions are devoted to this sequence, and often another session (one week later) is scheduled before the parent is asked to commence the 5 times per week program implementation at home. During the intervening week, the parent (or preferably, parents) practise the various tasks in the first couple of lessons with someone other than the student. The training of two parents is advantageous because it reduces the load on one parent, reduces the problems of possible student reluctance, and allows for supportive collaboration – all of which enhance program endurance and fidelity.

Follow-up sessions are (typically) weekly for the first two weeks, fading to fortnightly for two subsequent visits, then monthly until the program is completed. The amount of support that parents require varies from case to case, depending upon their rate of progress in presentation facility. Parents who are well-organised and able to be assertive and task-focussed with their children typically make rapid progress. Parents are asked to tape-record the first, 50th and 100th lesson, as such recordings can provide a more dramatic indication of progress than the standardised pre- and post-test results. One major difference between the above-mentioned programs is the increased opportunity in Reading Mastery for practice with stories. This practice can be added to the 100 Lessons program by including use of the Distar Library series. A sheet has been developed that indicates the stories from Distar Library appropriate to any given lesson in the teaching program.

Although the Teach Your Child To Read In 100 Easy Lessons program has a strong emphasis on the phonological skills of blending and segmenting, some students may make better progress if first directly taught an oral phonemic awareness program either prior to, or in conjunction with the reading program (Juel, 1993). A number of such programs have been published in recent times. Those currently in the Clinic are:

A Sound Way: Phonological Awareness: Activities for Early Literacy, Love & Reilly, 1995;

Auditory Discrimination in Depth, Lindamood & Lindamood, 1975;

Metalinguistic Awareness Program, Department of Education, Queensland, 1990;

Phonemic awareness in young children , Adams, Foorman, Lundberg, & Beeler, 1998.

Phonemic Awareness Training, Solomons, 1992;

Phonological Awareness Training for Reading, Torgesen & Bryant, 1994.

Sound Foundations, Byrne & Fielding-Barnsley, 1991; 

Sound Linkage : An Integrated Programme for Overcoming Reading Difficulties, Hatcher, 1994;

Sounds Abound, Catts & Vartiainen, 1992;

To assist parents who would like to extend such a program to the home, an annotated bibliography of suitable texts to enhance phonemic awareness is to be found in Yopp, 1995b. In fact, there has yet to be a case in the Clinic in which it was found necessary to take the step of temporarily halting the reading program to introduce a dedicated phonemic awareness program.

The Remedial Reader:

For students in Year 3 and above, the program found particularly valuable in the Clinic is the Corrective Reading Program: Decoding Strand. Placement testing determines the appropriate level, and the teaching methods parallel those described earlier. The method of introduction to presenters is also similar to that described above. One difference is the likelihood that years of failure have left the student with at least some degree of resistance to addressing a task long ago solved by the student’s age-peers. This resistance may be active or passive, but can certainly threaten the viability of the program, especially when (as is often the case) the mother alone has the responsibility for motivating the child daily over a significant period of time. There have been cases when it has been more fruitful for two parents to swap children for the purposes of implementing the program. This option may also be considered when parents are unable to present the program to their child without being punitive, but are quite patient with a child other than their own.

A number of parents with resistant children have found it useful to plan an incentive program to address the problem of student resistance. There are a number of options: One can use the motivational points system incorporated in the program, and develop an associated reward menu suited to both the needs of the child and any family constraints; or an individual incentive program can be designed in conjunction with the Clinic, as simple or as complex as the situation requires. As with the 100 Lessons  program, a progress sheet is used as part of the intervention. This sheet fulfils several roles: 1. As a guide for feedback between clinician and parent on progress and problems. 2. As a subtle spur to maintain lesson frequency – the clinician’s interest in this aspect helps parents appreciate the importance of frequency, as it is always discussed in sessions. 3. As a means of increasing the amount of free-reading achieved by the student. Research (Stanovich, 1988; Adams & Bruck, 1993) has demonstrated the importance of increasing the student’s volume of reading. It provides additional opportunity to practise the skills taught in the program (thus supporting generalization), and to learn new words. This is especially important as there are far more opportunities to increase vocabulary through reading than through conversation, or television (Stanovich, 1993).

In some cases it may not be possible to use the Corrective Reading Program, or the 100 Lessons Program as the intervention. Although it is a less effective option, a program that aims solely at increasing the volume of reading achieved may still be a worthwhile compromise. The Clinic offers a parent-monitored Increasing Reading Program using a simply designed record sheet.

6. AVOIDING PITFALLS

An important general consideration in planning interventions is a careful analysis of the situation in which the intervention is to occur. Specifically, one should attempt to predict which aspects of the situation are supportive of the plan, and which aspects threaten the viability of the plan. An assumption implicit in the program rationale described earlier is that the recommended programs will be implemented in their prescribed form. These programs have much theoretical support (Adams, 1990; Hempenstall, 1996; Tunmer & Hoover, 1993; Wood & Felton, 1994), and also empirical support (Adams & Engelmann, 1996; Baker, Kameenui, Simmons, & Stahl, 1994; Bateman, 1991; White, 1988), but have no magical qualities. They are effective probably because of the almost obsessive attention to detail in their construction and field testing, and the same attention to the instructions for the presentation of the program. The old dictum when all else fails, read the instructions certainly applies here. These programs invariably feel odd to novice presenters, being scripted and highly structured. Parents and teachers alike have commented that it may take 20 lessons before a reasonable level of comfort is established. The initial discomfort may cause presenters to alter elements of the program to suit their personal style, usually to the detriment of the program. The most common adjustments are to the frequency of lessons, and to the wording of instructions. Awareness of this possibility enables the clinician to take steps to alleviate, or even preclude the problem by careful explanation prior to the program commencement, and equally careful monitoring during the initial stages. Other common hazards (mentioned earlier) include student resistance, teacher resistance, and parent role-conflict.

Student clinicians are encouraged to examine these important, but often neglected, aspects of an intervention within a wider framework. Attention to these aspects may be considered as the art of being a clinician, as opposed to the science involved in designing and assessing programs. The conceptual framework detailed below attempts to integrate these clinical skills into a hierarchical structure.

This structure is relevant to other fields of intervention besides reading. The first level recognizes that clinicians must be able to relate to other people. Basic interpersonal skills are necessary to engage people in conversation, to conduct an interview that successfully obtains client cooperation and relevant information, to gain children’s confidence sufficiently to allow accurate assessment, to liaise with teachers and other professionals, to sensitively handle the assessment feedback session, and to gain and maintain parent cooperation during the intervention phase. Clinicians vary in the degree to which they display the interpersonal skills needed to perform these tasks, and to some degree this variance represents personality differences. These basic skills provide a focus for further development, the necessity more obvious for some than for others. In a humanistic model of counselling, this represents the primary focus of training, as the therapeutic relationship is seen as a more appropriate focus than technique. In the above hierarchy, basic interpersonal skills are necessary, but insufficient.

In the Clinic, it is assumed that interventions chosen will have theoretical and empirical support. It is accepted that approaches which have proved successful over a range of situations, and with many individuals have a greater chance of success than either randomly chosen interventions, or those based on relationship development alone. It is further assumed that there is usually sufficient commonality between people to allow similar interventions to be successful. That is, although it is accepted that people and their environments are unique, nevertheless problem-similarity is the best determiner of intervention type. In the development of the clinician’s knowledge of interventions, the major emphasis is study of the intervention research across the range of problems presenting in the Clinic. The operational sequence involves a careful investigation of the problem type, followed by a matching process in which the optimum intervention strategy is assigned on the basis of it having the best support for its effectiveness in similar situations.

A clinician who is able to relate to clients, and who has developed a good understanding of appropriate strategies would seem to be well placed to be able to skilfully assist people to resolve life problems. Whereas these skills are necessary, there are many occasions when they are insufficient to obtain the sought-after change. This level has been called situational empathy in recognition of the art involved in making an intervention work. The clinician asks the question – What may interfere with the effectiveness of the intervention in this situation? Put more positively – What steps should I take to give this intervention strategy the best possible opportunity to be successful in this situation? In order to list the potential obstacles to success, the clinician figuratively enters the environment of the client through client observation, client questioning, past experience, or through consultation with other experienced clinicians. This skill is a high-order one, and should continue to develop across one’s career. The proviso is that the clinician maintains this mental set, and remains committed to evaluation, otherwise similar mistakes may continue to be made without the clinician ever becoming aware of them. One outcome of this latter scenario is a tendency to blame the intervention content rather than the intervention delivery. Thus one may lose faith in an effective approach when the problem lies in a different domain. An example of this phenomenon is sometimes seen when parent reading programs are introduced without examining the household situation. Some factors that may intrude are previous daily time-commitments, work schedules, parent literacy skills, parent-child relationship, parent assertiveness, student levels of resistance, marital relationship, between-parent support, parent mental health. There are many such potential problems capable of scuttling an otherwise well-researched and presented program. One may be tempted to discard a particular program instead of recognizing the true source of the problem. Even worse is the possibility that blame may be shifted to the client to account for the intervention failure. Whereas the clinician’s acceptance of responsibility for ensuring that interventions are successful does provide an added burden on the clinician, it has a positive side in increased effectiveness, and in a clearer understanding of the complexities of one’s profession. Such a model also allows the recognition of those situations in which no effective interventions are possible given the time and circumstances currently existing. This may appear unnecessarily pessimistic; however, it is preferable for all parties to avoid interventions doomed to failure. Such ventures cause great disappointment to clients who, because of the result, may avoid subsequently seeking assistance at a time when success might have been achievable. In addition, the Clinic’s limited resources could more profitably have been used in assisting other clients.

7. EVALUATION

Evaluation of the intervention involves several issues:

Firstly, was the chosen program appropriate to the objectives negotiated with the family? That is, assuming the program itself was successful, is the outcome what the family expected? Are they satisfied with the outcome?

Secondly, was the program a success? Did the anticipated changes eventuate? These changes may be judged through in-program mastery tests; program behavioural-objectives analysis; pre- and post-test criterion-referenced and standardized assessment; video- and audio-taped reading behaviour.

Thirdly, was the program appropriately implemented? Was treatment fidelity obtained? Without it one cannot be sure that any success was due to the program itself. If there were alterations to the program, are you able to assess their impact? You may gain information useful in future interventions.

Fourthly, were social-validity expectations met? If there have been noticeable changes, do they also occur outside the home or clinic situations? In particular, can it be shown that reading has improved at school? Is there a genuine, easily recognizable change in the reading ability and attitude of the child as a consequence of the intervention?