Elements of a goal (no set sequence…but this is general order of approach)

  • Given(context)
  • XX will demonstrate improved/increased(functional domain change)
  • By (doing what specific behavior? )
  • with(%) accuracy; in (9/10 instances); for increasing durations (30s, 45s)
  • in the presence of(high to low) cues
  • across (2-3) consecutive sessions
  • in(acad, functional, community) settings
  • as measured by (clin, obs, tchr)

Examples:______

1a. Formal goal:

Given a student-selected topic, XX will demonstrate improved functional knowledge of story grammar by using cognitive organizersto successfully tell 3 of 4 personally relevant story elements three times dailyto peers and adults in academic settings, in the presence of diminishing multisensory cues,as measured by clinician dataacross three consecutive sessions.

1b. Family friendly version:

Given a student selected topic,XX will use an organizer to tell 3 of 4 personally relevant story elements three times daily to her classroom peers and/or teacherswith diminishing adult assistanceacross three consecutive sessions.

1c. Another version of family friendly:

After selecting her own story to tell, XX will use an organizer to tell 3 of 4 relevant story components three times daily to her classroom peers and/or adults with minimal adult assistanceover three consecutive days.

______

2a. Formal goal:

Given an adult-selected expository passage,XX will demonstrate improved receptive comprehension by independently using note-taking organizersto successfully identify 80% of the main content points in academic settings with diminishing adult cues as measured by classroom data across three consecutive probes.

2b. Family friendly version: (create based on above example)

______

Possible hierarchies we clinicians might constantly manipulate in our treatment plans:

  • Cueing (max to min)
  • Linguistic (sound difficulty, utterance length, syntax complexity)
  • Contexts (structured, unstructured)
  • Modalities, speaking tasks (reading, comment, monologue, conversation, joke)
  • Settings (clinic room, outside, café, home)
  • People (familiar, unfamiliar, family, friends, teachers, peers)
  • Frequency (consecutive, sessions/term)
  • Diverse data collection (qualitative, self-report, observation, quantitative, event, interval, duration)
  • Must fit client’s behavioral goals…must fit what you will actually observe them DOing

So…obviously, every client might require goals/objectives structured differently depending on how they respond to treatment plans, strategies, and generalization.

Treatment goal examples mapped onto WHO-International Classification of Functioning, Disability and Health (ICF) framework (guided by the organization of integrated treatment suggested by Yaruss, Pelczarski, & Quesal, 2010)

  1. Impairment Level: addressed timing & tension of speech by integrating fluency shaping & stuttering modification strategies to change stuttering behaviors to be less disruptive
  2. Given diminishing support, CLIENT will demonstrate increased speech controlby using fluency shaping (prolonged speech [ERA2], single stretch) and stuttering modification (cancellation, pullout with stretch, pullout with easy bounce) strategieswith 90% accuracyin structured speaking tasks of increasing interestover two sessionsin the clinic.
  3. CLIENT will demonstrate increased “controlled fluency”1 by using prolonged speech strategyin 9 of 10 utterances/intervals of increasing linguistic length/complexity (e.g., 3-4 word carrier phrases, comments, narrated stories).
  4. CLIENT will demonstrate increase “controlled fluency”1 by using initial-word stretch strategyon 9 out of 10 target words (picture card cues) within increasing linguistic hierarchy (e.g., 3-4 word carrier phrases, picture description, silly stories).
  5. CLIENT will demonstrate increasedresponsivity by using stuttering modification strategies4 (e.g., cancellation, pullout-stretch, pullout-easy bounce) in 9 of 10 real stuttering instances within increasing linguistic hierarchy (e.g., carrier phrases, question, comment, memory story).
  6. CLIENT will demonstrate increased knowledgeof 8 targeted strategies3, 4 by describing and demonstrating each strategy in pseudo and real stuttering instances during structured speaking tasks across two sessions in clinic and home.
  7. CLIENT will demonstrate increased knowledge for 3 fluency shaping strategies3 by describing and demonstrating each strategy during structured tasks in clinic and home.
  8. CLIENT will demonstrate increased knowledge for 5 stuttering modification strategies4 by describing and demonstrating each strategy in pseudo and real stuttering instances during structured tasks in clinic and home.
  1. Participation/Activity Limitation: addressed education, self-advocacy and generalization via collaboration with school and active multi-media home program.
  2. CLIENT will demonstrate increased knowledge of stuttering (the total disorder) by performing related activities (see below) at targeted accuracy within the short-term objectives that span settings.
  3. To increase self-knowledge about typical and atypical speech production, CLIENT will independently identify 5 of 6 “speech helpers” (parts of speech mechanism) on an anatomical chart over two sessions in clinic and in home.
  4. To improve self-advocacy and confidence with sharing information about stuttering, CLIENT will independently conduct at least 3 educational interviews with adults and/or peers (familiar, unfamiliar) this term in clinic and in home settings.
  5. To increase his knowledge about how stuttering changes for many people who stutter, CLIENT will describe at least 5 (of possible 10) universal fluency enhancing conditions to adults (familiar, unfamiliar) with a cognitive organizer three times in each setting (clinic, home).
  1. Personal Contextual Factors: minimized client’s negative reactions, beliefs and attitudes with desensitization and cognitive restructuring activities.
  2. CLIENT will demonstrate improved cognitive-emotional responses to fluency (e.g., decreased fear reaction/response; increased positive communication attitude) by scoring lower on OASES subtests and total full test (pre to post duration: 3-months).
  3. CLIENT will demonstrate improved emotional responses to stuttering by reporting a rating value of “2” or less for 6 of 9 highest scoring items on OASES within 4 months.
  4. CLIENT will demonstrate improved cognitive-emotional responses to fluency across functional environments (i.e., school, S/L class, home) as measured by perceptions of classroom teacher, school SLP, and parents on appropriate surveys.
  5. CLIENT will demonstrate improved emotional responses to stuttering as measured by decreased parent, school SLP and teacher report of frustration on the TOCS behavioral rating scale within 4 months.
  1. Environmental Contextual Factors: provided family with education and coaching related to questions, concerns and negative feelings.
  2. CLIENT will demonstrate increased comfort with stuttering and strategy-use in home settings by participating in 15-20 minutes of structured fluency tasks at least three times weekly as measured by parent data (using clinician-created tool surveying dosage, fluency rating, child’s fluency rating) over three consecutive weeks.
  3. Given high levels of reported fluency (parent & child rated; rate 1-2 of 10 for 3 consecutive weeks), home practice sessions will target lower interest topics/activities and lower linguistic demands.
  4. Given high levels of reported fluency (parent & child rated; rate 1-2 of 10 for 3 consecutive weeks), home practice sessions will target increased linguistic demands within higher interest topics.

Hierarchies to consider when working with all clients—especially fluency clients:

1.

2.

3.

4.

5.

6.

7.

You will probably manage
4-5 hierarchies with every activity you introduce! Make sure you are mindful of each one and collecting data appropriately for those you choose. Remember to consider the type of data you collect in order to have a well-rounded data collection plan in place!