How can we write better goals for our clients?

Hi all! 

I’ve heard a bit through the grapevine about the push to restructure IEP goals in order to focus less on pure percentage of fluent speech produced and instead prioritize the emotional wellbeing of clients — decreasing negative secondary behaviors and working to minimize shame or any other negative emotions that may surround stuttering. 

If you are a school-based SLP, how would you restructure your IEP goals if not limited by legislature in order to better serve your students who stutter? If you are a private practice-based SLP or not otherwise limited by IEP guidelines and the like, how do you structure your goals to be more holistic rather than exclusively focused on minimizing instances of dysfluency? 

Looking forward to hearing from you all!

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Comments

How can we write better goals for our clients? — 3 Comments

  1. Great question – I’ve never actually written an IEP goal focused on fluency. That’s because I don’t target “fluency” in my therapy. Even when I’m teaching strategies, it’s not fluency that I’m targeting but rather easier speaking and communicating.

    Here’s an excerpt from a blog post that I wrote for Stuttering Therapy Resources a while back on this topic… there’s much more in the original post, but this provides a bit of info about why I don’t write goals about fluency:

    Put simply, goals such as “Child will be X% fluent…” are inappropriate. Here are some thoughts about why…

    First, fluency is not what we are teaching in therapy, so it doesn’t make sense to use that as the goal. What we teach in therapy (when we are working on speech aspects) is the technique that the child can use in order to enhance fluency. Therefore, we ought to be writing the goal and measuring the child’s success in using the technique (whatever that technique might be). Thus, a goal like “child will be X% fluent” is not consistent with what we do in therapy because we’re not teaching fluency. Instead, we could write a goal like “child will use X technique” since that’s what we’ve been teaching him to do.

    Second, we are supposed to write goals that relate to our state learning standards. I guarantee you that nowhere in your state learning standards does the word “fluency” appear—except as relates to reading fluency and language fluency. Speech fluency isn’t there. Therefore, we shouldn’t be writing goals on speech because that isn’t consistent with the learning standards.

    Third, the level of fluency that a child exhibits does not reflect the difficulties that he might have in communication. Some children may stutter severely yet experience no negative impact as a result of their stuttering; others may stutter mildly yet be devastated by it. If we focus on fluency in our goals, then we are missing what we are truly supposed to be working on, and that is diminishing the adverse impact associated with the child’s speaking difficulties. Fluency really has little to do with that.

    Think of it this way: which child experiences greater adverse impact on his educational attainment…the child who stutters (even severely) but reads out loud in class and participates fully and interacts with his friends OR the child who doesn’t stutter much because he never talks? Clearly, our job is not just to address the fluency.

    Finally, remember that there is far more to stuttering than just the stuttering behaviors. So, all of this discussion on what types of goals we write for speech behavior should be taken in the context of a broader, more comprehensive approach to addressing stuttering that includes therapy for the child’s reactions to stuttering, the functional communication difficulties the child experiences, and the impact of stuttering on the child’s quality of life. This is where we are actually supposed to be measuring our success anyway: the reduction in the adverse impact of stuttering.

  2. So, what should we write instead? Here’s an excerpt from a free handout from Stuttering Therapy Resources that provides some examples:

    For example, if we have a child who is working on reducing negative reactions to stuttering, we start by thinking about exactly what we do in therapy to help him achieve that goal. For many children, reducing negative reactions involves strategies such as learning more about stuttering, using desensitization exercises such as pseudostuttering to reduce fear, and educating others about stuttering. Our goals for these activities might read something like this:

    The student will demonstrate his knowledge about stuttering by independently teaching 5 key facts of his choosing to his parents, at home, as confirmed by parental report, within 2 weeks.

    The student will demonstrate his ability to stutter with less physical tension by using 10 easy pseudostutters in the therapy room with the other children in his therapy group, as documented by clinician observation, for 2 consecutive sessions.

    The student will demonstrate increased acceptance of stuttering by talking openly about stuttering, with the clinician’s support, with 1 new friend each week, as measured by the student’s report (and the friends’ confirmation).

    The student will demonstrate his increased acceptance of stuttering by pseudostuttering 2 times while reading aloud in class, as measured by the student’s report.

    Likewise, goals for improving functional communication might include:

    The student will demonstrate his reduced avoidance of speaking by independently volunteering to answer questions in class 5 times each week as verified by the teacher’s report.

    The possibilities are endless! Once we recognize that goals can reflect the ways that we work to address the child’s needs in therapy, we find that it is much easier to write comprehensive, measurable, and objective goals that reflect the many ways in which we help children overcome the burden of stuttering.

    (see the original for this post and the prior one at http://www.StutteringTherapyResources.com)

    • Dr. Yaruss,

      Thank you so much for that thoughtful and thorough response! It is such an honor to be in contact with you — I have long admired your work and read many of your papers. Thank you for your immense contribution to this field! I am in complete agreement with everything you mentioned and will be keeping this comment readily accessible to show students as well. Your examples of IEP goals are also extremely informative and I look forward to modeling my own goals after yours one day as a future clinician!

      Thank you so much again. All the best,
      Nicki

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