Does data get you down? Do you find yourself struggling to write easy to measure goals that are still meaningful? Have you ever found you were measuring the wrong thing when it comes to writing progress reports? If any of this sounds familiar, then this podcast is for you! Learn to make data a good servant, instead of a bad master. 

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Other Podcast episodes:
Challenges in Early Intervention – Episode 33
Phonological Awareness Tracking – Episode 11

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Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Denise: So the real question for me is what is the most important area to change now? And how can this change be measured in the most effective and least time consuming way, a way where you aren’t tied to your pencil and paper. Put down your pencil, pay attention to the child.

Welcome to The Mindful SLP, the show that explores simple but powerful therapy techniques for optimal outcomes. I’m Denise Stratton, a pediatric speech language pathologist of 30 years. I’m closer to the end of my career than the beginning. And along the way, I’ve worked long and hard to become a better therapist.

Join me and I’ll do my best to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. Joining me in the conversation is Dan, my technical wizard and office manager.

Dan: Welcome back this week, our topic is going to be, what will you measure? And I have to admit as a guy who loves productivity and has studied it for most of my career, I am really eager to talk about this.

Denise: Today I want to talk about the balancing act between taking data and interaction with your client. Well, I love the story I heard a couple of months ago, the school district where I used to work, the supervisor of the speech therapist told them, put down your pencils, interact with the client.

And I love, love that. So here’s the dilemma we face, interaction with the client. That is how change happens. But it’s also true that what is measured improves. In fact, there’s this famous quote, “that which is measured and reported improves exponentially”. Okay, so there’s that, well tension there between those two seemingly competing ideas.

So we’re going to talk about that more in depth, the second point, who of you out there hasn’t procrastinated writing that progress report because what you ended up measuring in therapy, over several sessions, doesn’t actually match the goals you wrote. That’s a time consuming process, he was trying to meld that into a progress report that looks like you weren’t insane or something.

Dan: Sometimes the data just points in a completely different direction.

Denise: And our time is precious. And the time you sit there trying to think through this, I mean, that’s, that’s time you don’t want to spend. The third issue is, uh, you know, why? Why do we even write these goals? Other than we’ve got this IEP, we have to meet? Well chosen goals lead to being able to document change for the parents. So these reports are for the parents, right? As much as, as there for you, to further explain things we might not have been able to cover in our conversations with them, to help them remember where we’re headed, the steps we need to get to the ultimate goal.

Now, for me as a therapist, they could also help focus me. And what I mean by that is, if I spend sufficient time really thinking about that child as I’m setting my goals, then it helps me stay focused when the going gets tough. And I remember, okay, there were good reasons. There were really valid reasons why I chose these goals.

And if they’re well chosen, I won’t just discard them and try and go a different direction, like squirrel, squirrel. This is too hard just for an example, like in my approach for R therapy, if a child is not stimuable for R I have all these goals I’ve written to get them stimuable for R, to help them develop the muscle movement so they need to say R, and I write a goal for that. It used to be when I had a child who wasn’t a stimuable for R, you would just write, well so-and-so will say R at the word level with 80% accuracy, then we’ll move on. And those goals would be repeated over and over and over again because they still, they still haven’t learned how to say R, well now I know specific things to do now I’ve had so much experience.

I just absolutely know that this approach works for R, but back when I was first starting it, and some clients were really hard, I had to keep remembering my goal. I know this works, I’ve done this before. I know this works. I know this sequence works. Let’s not throw this approach out. That was just my little reminder that yes, this will work.

So stay the course. Now, if you have a bad goal and your data is telling you that that’s another issue.

Dan: We’ll talk about that too. Goals are important things. You’ve spent some time thinking about this as you’re writing your evaluations and forming these goals. And it is a good thing to remember, that that that is the rudder that should guide your therapy over the next X amount of months. And if you don’t go back and review that. Then it’ll get lost.

Denise: Exactly. So the real question for me is what is the most important area to change now. And how can this change be measured in the most effective and least time consuming way, a way where you aren’t tied to your pencil and paper, you can put down your pencil, pay attention to the child.

Dan:‘Cause don’t get so caught up in measuring things that you forget what you’re actually doing.

Denise: So what is the most important area to change now? That could be a whole nother podcast. That could be several podcasts for another day. So today we’ll focus on measuring in the most effective and least time consuming way.

And a lot of it comes down to how well I choose and write my goals.

Dan: Absolutely. That’s critical.

Denise: Have you ever had a super productive day? And then you look at your planner and you couldn’t cross anything off?

Dan: Oh, I do that all the time.

Denise: Isn’t that just so frustrating? So when you don’t have great goals, sometimes you can say, oh, they did this great thing today.

And you go to do your soap notes and you’re like, I never had any of that down. That wasn’t one of my goals. Um, without great goals, you know, at best it’s an irritation or a bit of a slowdown, but at worst you lose track of where you’re headed with your client. So we want to be able to track those great things that happen and have the goals be really easy to measure and track.

Dan: Yeah. Well, goal writing is a very undervalued skill. I call it actually an art to writing good goals because it’s so easy to get wound up in all sorts of different things that you end up spending more time measuring than actually doing. And then the next thing you know, you haven’t really accomplished anything, but you’ve measured it really, really well that you haven’t done anything.

Denise: Well, there’s a few things that crop up that frustrate me about goal writing. If you don’t hit it right on, my goal is too broad or too narrow. So either there’s too much play for that concentrated focus or I’ve boxed myself in by being too narrow. So it is kind of an art. Um, so here’s an example of a goal that is too broad, given a narrative or story or something like that, a client will make inferences. So saying that a client will make inferences. Whoa. I asked myself, well, why aren’t they inferring and work on that? So here’s an example. I have a client with autism, her pat responses. I don’t know, I don’t know, I don’t know. And what I noticed was like, if I was reading the book to her and she said, I don’t know.

I would say put your finger on anything that you see because these books have pictures. Right. And tell me what you notice. That focused her. If she pointed to something, she would look at it with her eyes and she would tell me something she noticed. She didn’t know, but it was just a little bit too hard for her to want to do it without actually pointing.

That was the goal, right. That became the goal. She needs to find a way to say what she notices and when she could tell me what she noticed, then she started to be able to make inferences.

Dan: Yeah, that’s a great change in the goal, yes.

Denise: And also, I also noticed that she couldn’t remember things. Well, you can’t inference things if you don’t remember the clues that lead up to someone making an inference. So that became the goal. So memory and noticing, where what led to her being able to inference. So those were much better goals. Focused at her parents, able to understand, oh yeah, we can work on this. Instead I had a goal like this for her, within three months, she will describe characters, a setting, events, or emotions, which she notices in books.

And then I just say, I’m going to measure that mastery by her noticing a minimum of three things each for three books. Just so I have something specific. That’s just so yes or no, she inferenced one or two or three so much better than a percentage. So if I were trying to do that she noticed a certain percentage of things in a book, I mean, that gets really fuzzy because even…

Dan: Well, you have to come up with what’s the total number of things that she could’ve caught.

Denise: I know. And as you’re going on and reading that book, even if you’ve previewed it, all of a sudden you notice that that’s an inference. Oh, she inferenced that and I didn’t notice that, you see what I mean?

Dan: Yeah, you make it simple, just the idea of just doing three things is so much more attainable for her and it’s easy to go beyond it once you’ve hit that.

Denise: And I find myself much more going towards the kind of goal where I will see the skill demonstrated a certain number of times. So much better than percentages, most of the time.

Dan: Give me an example of something that was too narrow.

Denise: Brown’s grammatical morphemes, which we’ve talked about, are a great indicator of progress of language. But some of them are unpredictable on how often they occur. So I had this client who I had used a goal like this before that she’d use some of those really early grammatical morphemes to demonstrate progress and, and that worked for like plurals. She would sit down, she’d love to talk about a book. And the plurals were just spilling out of her mouth. I was like, this is a great way to measure. So the next time her goals came around, I chose the morphemes that were next on the list that she wasn’t demonstrating yet.

One of them was possessive S, another one was irregular past tense verbs, and I’m sitting with her and I’m modeling the heck out of them. And her responses always took another direction. I thought that if we talked about this, that a possessive S would naturally be part of her response. No, that’s not who I talked about.

This irregular past tense verb would naturally be part of her response. No, it was always something different and it wasn’t bad. I mean, she was progressing in her language, but it just, I couldn’t capture it. I couldn’t measure it. I even videoed a session and this was really time-consuming. I mean, language samples are great to take every once in a while.

And it showed me she was progressing in other ways, ways I hadn’t written the goal about, but she wasn’t demonstrating the possessive S and the irregular past tense verbs. They were just, weren’t being pulled out. And I thought, well, this is just frustrating.

Dan: And she was making progress, but it wasn’t progress on this specific, tiny little detail that you had chosen.

Denise: Yeah. And it was just, I couldn’t pull that measurement out. As it turned out, what I really worked on was sequencing. When I got her to be able to sequence things that happened in our session, then I was able to move her on to stories and her syntax took care of itself. Uh, and it will continue to take care of itself and this particular child. I’m not going to write those kinds of goals anymore. So my underlying goal actually became to get her to the point where she could tell stories. And telling stories improves language in wonderful and sometimes unexpected ways. So to have syntax goals when a child is just beginning to tell stories or trying to get there, well, you don’t really know what’s going to come out of their mouths.

What you want them is to…

Dan: At that point, you’re still just thrilled that something’s coming out of their mouth that’s the story.

Denise: Yeah, you’re trying to get them to the point where they could tell a sequence or something. Um, and you don’t even need that syntax goal.

Dan: What else trips you up as you’re writing goals?

Denise: Specifying too many conditions in which the behavior will take place. So we have different levels of prompts in any single session. You could be all over the place with what kinds of prompts they need, tactile, visual, verbal, gestural. And I used to think, oh, I would put this kind of prompt in my goal.

Well, then you have to, if you’re truly accurately taking data, have some kind of system for saying, well, I used a gesture prompt here. I used the visual prompt here. I used a verbal prompt here. Oh my gosh. That’s just, that’s just crazy.

Dan: So too much detail can then trap you into a…

Denise: I did not be able to put your pencil down.

I have learned to write what I want to be independent within a certain period of time or what I want them to do with some assistance. And I don’t get much more detailed than that because in the stream of therapy and a dynamic therapy session, you are constantly adjusting to the level of assistance they need and the kind of prompt they need. You know, that’s online shaping that we call it.

Dan: Can you give me an example of what, one of your old goals?

Denise: I might’ve written a goal that with a verbal prompt, a child will tell a complete narrative with the five narrative aspects. But maybe they don’t need a verbal prompt cause we’ve got these icons we use.

So maybe they would just meet me to point to that symbol that represents that part of the story.

Dan: So how would you modify the goal, then?

Denise: If my goal is for them to do it independently, you know that a child will independently tell a story, including all the five main story parts. But if I know they need assistance and I don’t expect them to get to independence within that timeframe, I would just say with assistance or with cueing. Yeah, don’t say it has to be a verbal prompt. Don’t say it has to be a gesture prompt on site. I mean, that’s just too crazy.

Dan: So you got to watch how many qualifiers you’re putting in on your goals because those qualifiers can box you in.

Denise: Yes, because you’ve got to do online shaping. You. Within the therapy session, you’ve got to just provide what is needed at the time, then. Why track that? Just track whether they’re independent or not independent.

Dan: Yeah, makes sense. What about it? I mean, obviously putting your pencil down, you know, means you’re not taking data, but you still got to take data. How do you take data quickly?

Denise: I learned this from one of my speech therapy assistants, when I was still working at the school. This is awesome. She uses four symbols for her data. A tally mark, just straight up and down line, is an unqualified yes, they did this independently. There’s no question about that. A circle around the tally mark means they were almost independent. They just needed the little cue from you.

A check mark means considerable assistance from you. And then a minus, they just didn’t get it. So with those four things I can say whether, someone’s independent, whether someone needed a little bit of assistance, whether they needed a lot of assistance, or they they’re just not even getting it. I mean, I rarely use the minus because most of the time you want to be working at the level where they’re successful, right? So if you got a lot of minuses, so, okay. It’s too hard or I’m not giving them assistance, you know, I need to step something down, but that is really quick and easy for me. And, you know, hardly it looks like I’m using the pencil at all and I don’t need to do it every single time. I might do it for a certain section of the therapy.

Dan: Okay, so we don’t want to track what they’re not doing. You know, no minuses. That makes sense. It’s errorless learning and all that. How do you write a goal to progress to that end goal so that it doesn’t just become the big nebulous out there?

Denise: I love that question. Uh, levels of sophistication are a great way to work towards mastery.

For example, rather than saying the client will demonstrate symbolic play, you might describe the levels of symbolic play, because we do have a lot of levels. Just for example, an action on themselves, an action on others. So for example, like they pick up a toy cookie and pretend to eat it – and action on themselves, or they pretend to comb their mom’s hair, or something like that – an action on others. Or with two toys, instead of now one toy, they’ve got two toys and they’re playing together with two toys. So the car drives into the garage. So they’re doing symbolic play with, with two objects. The next level they’re doing symbolic play with an object that represents something else.

A ball is an apple and they pretend to feed it to an animal, puppy or whatever. And so that’s so much better than saying they’ll just demonstrate symbolic play. Yeah, because that might be way out there. The ultimate of symbolic play that someone who’s not really well-versed in this would consider symbolic play, but you as a speech therapist, no. No, we got to step up to this symbolic play where they’re actually been able to do imaginative play with peers. That can be way out there. And also you can quantify, um, different place situations or how many situations do you want to see it in? Because I can pretty easily get a child to pretend to eat that play food, but that’s one instance of symbolic play with themselves, and I think three or five is much better.

So you might say they’ll demonstrate this kind of symbolic play in this many situations. Oh, and also I want to talk about this word I love, robust, isn’t that a great word? When I was exploring what to do with a client who was quite impaired, and we did a podcast just a while ago about the development of gestures, the developmental sequence of gestures.

The reason I stumbled on that is I ran across the goal someone had written that said, that the client will use robust gestures. And I thought, what a great way to describe, oh, they’re just kind of barely doing this. And do I really count this? And, or is it robust? Well, other people know yes, this is what they mean. So, yeah. So, so you can use that, use that in your goals. I love that.

Dan: We’ve talked a lot about goals that are really tracking individual, you know, smaller levels of progress, but how do you still keep focused on the big goal without getting, you know, all messed up?

Denise: I love using tracking forms. In fact, we’ve created some tracking forms just as we’ve been doing this podcast. So the phonological awareness tracking form that I have, and by the way, we’ll link all these in the show notes. I love using that. The gesture development tracking form, if you’re a PROMPT therapist, they’ve got their own kind of tracking form that, tracks change in motor skills. There’s a tracking form that David Kilpatrick has with his Equip For Reading success program, I use all the time.

Dan: So you’re taking those tracking forms to measure the overall large goal, but individually on that tracking form, you have your, you’re having the individual objectives, the objectives that get you there.

Denise: Yeah. And they’re usually broken up into like sections, for example, just taking my phonological awareness tracking form, I do not write a goal for every single one of those objectives, say, in a section. That would be like too much with my pencil. I choose a couple of really key points. This is what this child really needs. Yes, I will check the others off, but I’ll just choose a couple of really key ones to measure because you do not have to measure every single thing the child does that’s great.

You know what I mean? Yeah. Yeah. You just pick the high points. This would indicate a big change and measure those.

Dan: And then, but it also keeps you on track that if you start seeing something that is lagging behind everything else, then, oh, maybe I need to focus on that.

Denise: Yeah. Speaking of the big picture, I have seen a lot of goals in my career that were written as if the end goal is just right there, and the child’s going to get there in that timeframe when that wasn’t actually the case. Um, if they’re not likely to meet that goal in that timeframe, that’s really discouraging for parents because those goals tend to get rewritten almost the same, the wording has changed slightly so it looks like you did something and maybe you actually did something, but it’s not reflected.

Um, that’s not helpful for anyone. The parents are thinking, is my child even progressing? What are we doing? So it’s much more helpful for me to ask myself as I’m writing a goal, at what point am I going to move on? At what point am I changed my expectations for what we’re doing? That needs to be my goal.

Dan: How many goals do you typically create for a client at a time?

Denise: I love this because I actually have a rule for myself. And when I was working in the schools, it was a max of three goals because we generally had to have objectives under each goal. So objectives or mini goals too. So a max of three goals with three objectives under each goal, that’s really nine goals, think about it. So that’s a lot, that’s a lot to accomplish in a year. Now in my private practice, I have a max of six, but I don’t really bother with writing objectives underneath them. I just write in three months they’ll do this, in six months they’ll do this. And so that’s kind of like writing the objectives. I just simplified it for myself. But no more than six and often less, as I rewrite my progress reports every six months, the whole point is, don’t have nine or ten, that’s just too many.

Dan: You know what the magic is. If you get your goals done, you can add another one.

Denise: And I’m doing that with a couple of clients. You can always do an amendment.

Dan: At work we do annual goals, which is just like, it’s too big of a timeframe to even manage. I like to write goals that’ll be achievable within a month or two. And when we get done with that, we’ll make another goal. And if we happen to get to the end of the year and we’ve accomplished ten things, it’s much better than having two things that we didn’t get done.

Denise: And ever since I started giving myself this max of goals, I find myself achieving them faster. And if I have a little bit of time left, that’s awesome. Before the next progress report is due, and even at the schools, I would have a couple of months and I’d say, okay, this is exploration time.

Now we’re going to explore what is best for you to do next. I wouldn’t be measuring those goals on the IEP cause they’d been met. Right. And you need to have that exploration time or you need to say, I mean, sometimes it’ll be very clear to you. Sometimes your path will be absolutely clear. This is where we’re going next.

Sometimes it’s not. That’s your thinking time, that’s your development time. That’s where you’re going to make those well chosen goals that you’re not going to discard when things get rough, because you know, you spend the time to make them really good.

Dan: That leads me into my next question, because at the beginning you mentioned realizing that what do you do when a session doesn’t match your measurements?

Denise: What makes data hard is when you sit down to make notes about the session, your soap notes, and you realize that’s not what you measured, that’s not what you want to measure, and it would be difficult and time consuming to measure it without changing the way you conduct the session. So, in other words, your goal is getting in the way, rather than helping you.

Dan: Ouch that hurts. So how do you fix that?

Denise: Now? I take the backwards approach. It’s all about visualization. Cause so therapist, you know what you’re likely to write down in a session, you know how your therapy sessions go. So I mentally put myself in a session with them. I visualize what I would do with them, what their likely response is, cause we know this and, what I would naturally write down. And that’s usually your really good goal right there. So you just visualize it.

Dan: Gee, I’ve heard this before from Covey. Begin with the end in mind.

Denise: So especially when I’m describing mastery of that particular goal, and I’m not talking mastery about the whole end, but mastery of this particular goal, I want to get that right. I visualize what it would realistically look like for that child, and then this timeframe, and what would I be over the moon about in six months. If they could do this in six months, I would just be doing the happy dance. I would be celebrating with them, with their parents. You know, that’s what I really want to aim for. That’s what I want to focus in like a laser.

Dan: So how often do you need to measure?

Denise: I always have a note about every session and data can look like many things, about their behavior, about something the parent mentioned, but realistically many of my sessions, especially with the preschoolers look like this, we’re shooting baskets, or we’re popping balls all over the room. We’re shooting the marshmallow bow and we’re going everywhere. I am not going to stop what I’m doing with a child to run over and make a note on my data sheet, right? I just hold things in my head. This is what they did. And I make a note of it afterwards.

Dan: So the sheet’s available if you need it, but you’re not necessarily taking data every single moment. When it’s obvious and it’s something to be noted, then you’re taking it.

Denise: That’s right. And I always have a note because soap notes are important. Record something every day, but it’s not necessarily, I mean, I’ve got six goals perhaps max, but there’s not something noted about every goal every time, right? No way.

Dan: Okay. So let’s wrap up this discussions on goals and measures.

Denise: So what does data do for us? If it doesn’t create change, it’s for you the therapist. So you can create change in therapy, we’re the agents of change, right? And so you can make adjustments and refinements.

Dan: So the important thing is to keep it simple.

Denise: As we always say, when you master the simple, the complex takes care of itself. Let’s keep the data simple, let’s keep your report writing simple and interactions with the clients at the forefront.

Dan: Well, that wraps it up for today. Thanks for joining us. And we’ll be back again with another great topic for speech therapy.

Thanks for listening to The Mindful SLP. We invite you to sign up for our free resource library at slpproadvisor.com slash free. You’ll get access to some of Denise’s best tracking tools, mindfulness activities, and other great resources to take your therapy to the next level. All this is for free at SLP proadvisor.com/free. If you enjoyed this podcast, subscribe, and please leave us a review on apple podcasts and other podcast directories .