
Creating a Functional Therapy Plan: Therapy Goals & SOAP Note Documentation

Recently I did a series of lectures for a graduate speech language pathology program regarding how to create the most effective therapy plan following the client’s assessment. The learning objectives for the presentation were as follows:
In the past several years, I wrote a series of posts on the topic of improving clinical practices in speech-language pathology. Some of these posts were based on my clinical experience as backed by research, while others summarized key point from articles written by prominent colleagues in our field such as Dr. Alan Kamhi, Dr. David DeBonnis, Dr. Andrew Vermiglio, etc.
In the past, I have highlighted several articles from the 2014 LSHSS clinical forum entitled: Improving Clinical Practice. Today I would like to explicitly summarize another relevant article written by Dr. Wallach in 2014, entitled “Improving Clinical Practice: A School-Age and School-Based Perspective“, which discusses how to change the “persistence of traditional practices” in order to make our language interventions more functional and meaningful for students with language learning difficulties. Continue reading Do Our Therapy Goals Make Sense or How to Create Functional Language Intervention Targets
Critical thinking are a set of skills children need to make good independent decisions. Critical thinking abilities involve children analyzing, synthesizing and evaluating information in order to recognize patterns, distinguish right from wrong, offer opinions, anticipate reactions to their actions, compare scenarios to choose favorable outcomes, as well as consider a variety of solutions to the same problem.
Even for typically developing children critical thinking can at times be a bit of a challenge and needs to be nurtured and encouraged through a variety of ways. However, for language impaired children, critical thinking skills hierarchy needs to be explicitly addressed in therapy sessions in order to improve these children’s independent decision-making abilities.
Teaching critical thinking skills to language impaired students is no easy feat especially considering the “seriousness” of the subject matter. One fun way I like to address critical thinking skills is through picture books utilizing the framework outlined in Bloom’s Taxonomy: Cognitive Domain which encompasses the following categories: knowledge, comprehension, application, analysis, synthesis, and evaluation.
Prior to story reading ask the children to flip through the pictures and ask them questions regarding what the story might be about and what could be some potential story problems based on provided pictures.
During story reading actively question the child to ensure that they are not just passive story listeners (e.g., “Why do you think…?). Begin with basic story recall of characters, events, and outcomes (knowledge). Here asking simple -wh- questions will do the trick. Then move on to checking on what the child has done with the knowledge by asking him/her to identify main ideas of the stories as well as associate, compare, contrast and classify information (comprehension).
As you are reading the story as students to compare and contrast different characters as well as different story situations. Children can also critically compare different (satirical) story versions of popular tales like Cinderella, Little Red Riding Hood, Jack and the Beanstalk, etc.
Involve children in active story discussion and analysis by asking questions the answers to which are not directly found in the story (e.g., Who else do you know who also…?; Why do you think the ___did that?) Ask the student to identify each characters motives. When looking at a particular problem in the story ask the student how they would solve a similar real-life problem (application).
Have them weigh in pros and cons of the characters choices. Make a ridiculous statement about a story or character and have the students argue with you and explain constructively why they disagree with it. It will teach them how to find weaknesses in someone else’s reasoning. Ask the children to synthesize the presented story by generalizing it to relate to another story or an episode from their daily life.
Consider covering up story ending to have the students create their own creative alternate story conclusions. Do a shared story reading in group therapy sessions and then have a debate (e.g, Who is your favorite character and why?) in which each child has to provide appropriate rationale in order to successfully defend their point of view.
Teaching children critical thinking skills is an integral part of therapy since children need to use their language skills effectively in order to make informed decisions and function appropriately in social and academic settings.
Looking for suggestions on the hierarchy of addressing analogical problem skills then grab this one page FREEBIE I created entitled “Teaching Hierarchy of Problem Solving Skills to Children with Learning Disabilities” from my online store HERE.
So how are you teaching critical thinking skills in therapy?
Helpful Resources:
Recently I got the opportunity to take a look at the “Speech Therapy for Apraxia – NACD Home Speech Therapist” by Blue Whale Apps.
According to the developer the app is applicable to
• SLPs with individuals with apraxia (both children and adults)
• Parents working with children with apraxia
• Traditional articulation practice (drills)
Developed by the National Association for Child Development (NACD) by an SLP, the Apraxia app provides choices of different phonemes to target and gradually increases the levels of difficulty to improve motor planning for speech. Continue reading App Review and Giveaway: Speech Therapy for Apraxia – NACD Home Speech Therapist
So you’ve completed a thorough evaluation of your student’s speech and language abilities and are in the process of creating goals and objectives to target in sessions. The problem is that many of the students on our caseloads present with pervasive deficits in many areas of language.
While it’s perfectly acceptable to target just a few goals per session in order to collect good data, both research and clinical experience indicate that addressing goals comprehensively and thematically (the whole system or multiple goals at once from the areas of content, form, and use) via contextual language intervention vs. in isolation (small parts such as prepositions, pronouns, etc.) will bring about the quickest change and more permanent results.
So how can that be done? Well, for significantly language impaired students it’s very important to integrate semantic language components as well as verbal reasoning tasks into sessions no matter what type of language activity you are working on (such as listening comprehension, auditory processing, social inferencing and so on). The important part is to make sure that the complexity of the task is commensurate with the student’s level of abilities.
Let’s say you are working on a fall themed lesson plans which include topics such as apples and pumpkins. As you are working on targeting different language goals, just throw in a few extra components to the session and ask the child to make, produce, explain, list, describe, identify, or interpret:
Ask ‘why’ and ‘how’ questions in order to start teaching the student how to justify, rationalize, evaluate, and make judgments regarding presented information (“Why do you think we plant pumpkins in the spring and not in the fall?”)
Don’t forget the inferencing and predicting questions in order to further develop the client’s verbal reasoning abilities (“What do you think will happen if no one picks up the apples from the ground?)
If possible attempt to integrate components of social language into the session such as ask client to relate to a character in a story, interpret the character’s feelings (“How do you think the girl felt when her sisters made fun of her pumpkin?”), ideas and thoughts, or just read nonverbal social cues such as body language or facial expressions of characters in pictures.
Select materials which are both multipurpose and reusable as well as applicable to a variety of therapy goals. For example, let’s take a simple seasonal word wall such as the (free) Fall Word Wall from TPT by Pocketful of Centers. Print it out in color, cut out the word strips and note how many therapy activities you can target for articulation, language, fluency, literacy and phonological awareness, etc.
Language:
Practice Categorization skills via convergent and divergent naming activities: Name Fall words, Name Halloween/Thanksgiving Words, How many trees whose leaves change color can you name?, how many vegetables and fruits do we harvest in the fall? etc.
Practice naming Associations: what goes with a witch (broom), what goes with a squirrel (acorn), etc
Practice providing Attributes via naming category, function, location, parts, size, shape, color, composition, as well as accessory/necessity. For example, (I see a pumpkin. It’s a fruit/vegetable that you can plant, grow and eat. You find it on a farm. It’s round and orange and is the size of a ball. Inside the pumpkin are seeds. You can carve it and make a jack o lantern out of it).
Practice providing Definitions: Tell me what a skeleton is. Tell me what a scarecrow is.
Practice naming Similarities and Differences among semantically related items: How are pumpkin and apple alike? How are they different?
Practice explaining Multiple Meaning words: What are some meanings of the word bat, witch, clown, etc?
Practice Complex Sentence Formulation: what happens in the fall? Make up a sentence with the words scarecrow and unless, make up a sentence with the words skeleton and however, etc
Phonological Awareness:
Practice Rhyming words (you can do discrimination and production activities): cat/bat/ trick/leaf/ rake/moon
Practice Syllable and Phoneme Segmentation (I am going to say a word (e.g., leaf, corn, scarecrow, etc) and I want you to clap one time for each syllable or sound I say)
Practice Isolation of initial, medial, and final phonemes in words ( e.g., What is the beginning/final sound in apple, hay, pumpkin etc?) What is the middle sound in rake etc?
Practice Initial and Final Syllable and Phoneme Deletion in Words (Say spider! Now say it without the der, what do you have left? Say witch, now say it without the /ch/ what is left; say corn, now say it without the /n/, what is left?)
Articulation/Fluency:
Practice production of select sounds/consonant clusters that you are working on or just production at word or sentence levels with those clients who just need a little bit more work in therapy increasing their intelligibility or sentence fluency.
So next time you are targeting your goals, see how you can integrate some of these suggestions into your data collection and let me know whether or not you’ve felt that it has enhanced your therapy sessions.
Happy Speeching!
Helpful Resources:
Those of you who follow my blog know that in my primary job as an SLP working for a psychiatric hospital, I assess and treat language and literacy impaired students with significant emotional and behavioral disturbances. I often do so via the aid of picture books (click HERE for my previous posts on this topic) dealing with a variety of social communication topics. Continue reading Using Picture Books to Teach Children That It’s OK to Make Mistakes and Take Risks