Before The First Session

• Carefully read the previous therapy/evaluation reports
• Call parents
• find out child’s interests
• find out what is most concerning to parent regarding child’s communication
• find out parent’s opinion of child’s learning style
• Prepare any materials necessary for the first session (based on what you’ve read in the previous therapy/evaluation reports.

First Session

• Breathe and relax. Get to know the client. Play, read books, have a conversation. Start listening to their speech and language.
• Talk to the parents or client him/herself (as is appropriate). Ask them what they are most interested in working on (What do they want to see change.)  Talk to them about what is most appropriate, what will effect the most improvement in communication.
• Start to take pre-therapy measures (e.g., standardized/nonstandardized procedures administered prior to treatment. This information will go in the Beginning of the Quarter Assessment section of your report:

• Formal measures (e.g., artic test, language test)
• If client is new to the clinic
• If client has not had a formal test in more than 6 months, and
• If you (and your supervisor) believe that this is going to shed some light on the need for or direction of treatment.

• Informal measures
• Language/connected speech sample. Focus both on intervention targets from previous quarters as well as other speech/language errors.
• For artic clients you might also rate intelligibility.
• From information collected in the previous therapy report, be prepared to elicit target behaviors that were not generalized to conversation.
• Take stimulability measures as are appropriate: How far can the client get on a particular behavior without prompts and cues from you. Where they begin to require help from you is the place you start treatment (teaching).
• Use materials that you would use in treatment
• Start taking probe measures if possible (materials not used in treatment to measure progress). This information is going to tell you if the behaviors you are teaching are generalizing to untaught contexts/materials.

• Determine "long term functional goals" (based on samples, parent interview, report recommendations). These will be called "Long term functional goals" in your report. These will help to create consistency across quarters. They are written in general terms.
• Examples:
•  The client will produce age-appropriate phonemes in connected speech.
•  The client will use age-appropriate grammatical markers in conversation.

• Determine target behavior(s) for intervention. These will be called "Quarterly Behavioral Objectives" in your report. Please see the section on formulating behavioral  objectives in:
 
Roth, F.P. and Worthington, C.K. (1996). The essential ingredients of good therapy: basic skills. Treatment Resource Manual for Speech-Language Pathology. San Diego: Singular Publishing Group.  Specifically pages 8 - 11.
 

 
• Prepare untrained exemplars for stimulus generalization measures (measures of the target response that should change with treatment).
• 5 to 10 items (e.g., words with target sound, constructions using different words)
• Example, if you are teaching /s/ - prepare 10 or more pictures/word cards that have /s/ in beginning, middle, ending of word
• set them aside and do not use for treatment.
• Prepare untrained exemplars of items for response generalization measures (measures that are related to treatment targets and would be expected to change).
• 5 to 10 items (e.g., words with the cognate of the target sound, counterpart of a subject pronoun)
• set them aside and do not use for treatment

• Choose 1 or 2 control measures (measures that are unrelated to treatment targets and are not expected to change) these are often the hardest to find.
• for artic- use another error sound that is close developmentally to target sound. For other targets we’ll brainstorm together.

• Think about another type of data you can take (i.e., systemic  which is qualitative but valuable)
• Examples:
•  client’s attitude during sessions
•  parent reports (is client producing treated sounds in speech at home, more than untreated?)

• Take baseline measures (generalization probes) on targets chosen for treatment:
• Stimulus generalization probes
• use untrained exemplars - take for 2 points prior to beginning treatment
• sample connect speech (take 1 time prior to treatment, 3 minutes or so.
•  Response generalization - take for 2 points prior to beginning of treatment
• Control Items - take for 2 points prior to beginning of treatment

• Carry out treatment using training materials.
• Keep treatment data: Take data during treatment and keep track of the amount of prompting use to get success. Treatment data is important because it tells you where you need to go - when to fade or increase prompting, when to increase complexity of the task.
• At the beginning of the session take a moment to see if the client can produce the target behaviors with treatment materials with less cueing than before (e.g., No model - take 5 of your items and say - "What’s this? If they can’t do it increase the cueing (e.g., Delayed model - It’s a        . Now you say it. Or Immediate Model - Say     .)
• Work at the level where the client can have success.
• Embed treatment in fun, game-like activities to help maintain interest (especially for children).
• Provide breaks for young children.

• Every 2 weeks (or more if your client is progressing rapidly) take data on your generalization probes (stimulus, response) and controls.
• For articulation targets, when generalization data on stimulus probes (untreated targets) reached 50% accuracy take a short connected speech sample (i.e., 3 minutes) to see if target has generalized to spontaneous speech.
• Other times to take a connected speech sample:
•  when word probes are not found to be representative of connected speech
•  at the end of the quarter

• Take final probes (stimulus/response and control).
• Write your case summary using generalization probe information. Also include your treatment data - especially for goals that were not achieved. You want to let others (especially subsequent clinicians) where you left off - how much prompting, etc. the client needed to achieve the behavior.

Final Case Conference

• Review goals of quarter. Present information of progress - show beginning of the quarter versus end of quarter status.
• Use visual tools (e.g., graphs).
• Discuss disposition (e.g., terminate, continue).
• Get parent feedback - what do they want to do (e.g., Continue? Stop?); What goals would they be interested in working on for the next quarter.