11/18/2011
Setting Goals and Making Progress
But we have ONE hour… So, we have made some adjustments;
We are focusing on GOAL WRITING www.stutteringtherapyresources.com
Humiliation, anxiety, nervousness, fear of speaking
(affective/cognitive) – feelings and thoughts Physiological responses – speech disruption / speech
behavior Secondary behaviors – eye blinking, struggle, tension Parent issues – counseling, concerns
Write goals that address the entire disorder…
Acceptance Variability – stuttering is not the same from situation to
situation or time to time or day to day Shame, guilt Self‐esteem Feelings about themselves as a communicator
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Goals: Lots of goals related to
speech fluency (“speak fluently in…”) Lots of goals related to “reducing rate” or “using easy starts” Not sure how to write goals for cognitive and affective features “I have a lot of questions”
Issues:
“Speech‐language pathologists work to
Lots of concern about
improve quality of life by reducing
generalization Lots of concerns about
impairments in body functions and
how to make goals measurable Questions about self‐monitoring Questions about motivation “Never mind…”
structures, activity limitations, participation restrictions, and barriers created by contextual factors…” ‐‐ ASHA (2007) Scope of Practice for Speech‐Language Pathologists 6
‐ Quality of Life
International Classification of Functioning,
‐ Impairments in Body Functions and Structures
Disability, and Health (ICF)
‐ Activity Limitations
World Health Organization (WHO, 2001)
‐ Participation Restrictions
Designed to describe all aspects of human health
‐ Environmental Barriers
experience, not just communication The ICF includes components for describing not only
Where’s “speech fluency” or “stuttering” in that list?!?
what can go wrong with you, but what that means for your life as a whole.
It all comes from the WHO Framework
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Contextual Factors: Other factors that affect how the
Body Function and Body Structure: All of the
person experiences the problem:
structures and functions of the human body
Personal Factors: The person’s coping styles,
Impairment: Something that goes wrong with a
person’s body function or body structure Activities and Participation: All of the things people
might want to do in their lives
history and background, behavior patterns, etc. Often, these are referred to as the person’s
affective, behavioral, and cognitive reactions. Environmental Factors: The way those in
Activity Limitations / Participation Restrictions:
The difficulties people might have in doing those things (impact on the person’s quality of life)
the person’s environment responds to the problem These responses can be supportive or they can pose a barrier that
increases limitations and restrictions.
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Look at the entirety of the impairment Personal Factors / Reactions Affective
Who
Behavioral
Presumed Etiology
Impairment in Body Function
Cognitive
Activity Limitation Participation Restriction
(Observable Stuttering Behaviors)
Environmental Factors
What When Where Why How (documentation)
(adapted from Yaruss, 1998, 2007; Yaruss & Quesal, 2004, 2006)11
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Individual
• IMPAIRMENT
Measurable Functional Attainable within time
TIME FRAME
• REACTION
Do What?
In what context?
With what support?
With whom/when
Objective Aligned with state learning standards No “speech fluency” “Communicate effectively in a variety of settings…”
• ENVIRONMENT
• IMPACT As measured by…
Minimize adverse impact
Supported by Clinician Guided/Child Created
HIERARCHIES
Instead of these…
Try this…
Instead of these…
Student will demonstrate
Child will demonstrate
Child will participate in a Child will demonstrate
fluent speech 85% of the time while speaking in the speech room as measured by clinician charting and observation. Student will use 'tapping it out' in order to increase fluency in the classroom setting.
ability to decrease struggle during moments of stuttering by exhibiting independent use (no clinician prompts) of pull‐ outs, as needed while describing pictures during structured activities in the therapy room.
variety of desensitization activities Child will reduce negative reactions to stuttering. Child will feel better about himself 80% of the time…
Try this… ability to self‐monitor stuttering by catching at least # stutters during expository discourse activities in the therapy setting with no clinician cues.
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Instead of these…
Try this…
Instead of these…
Try this…
Child will minimize
Child will demonstrate
Child will increase
Child will demonstrate
bullying and teasing in the classroom. Child’s parents will participate in therapy. Child’s teacher will understand stuttering.
knowledge of the disorder of stuttering by teaching others about stuttering (facts, types of stutters, famous people who stutter, etc) using speech journal entries as a guide.
classroom participation Child will stop avoiding speaking situations Child will improve scores in class (or tests) Child will complete timed reading tasks.
ability to participate in the classroom discussions by volunteering to answer questions in class # times with support from therapist and teachers.
Some quick thoughts… Our ultimate goals in therapy? Documenting progress does not always mean
“counting stuff” IDEA 2004 clearly outlines the appropriateness of “portfolio documentation” Use expanded views of what constitutes successes in stuttering therapy (along with your creativity) to develop ways to document ALL types of progress in ALL areas of the disorder of stuttering
Minimize the negative impact due to stuttering Ensure that the child can communicate effectively and
say what he wants to say in a variety of real‐world settings
How do YOU assess adverse impact?
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