Therapy Targets, Baselines, and Goal Writing

Choosing Therapy Targets

When selecting therapy targets, consider the patient's communication needs and areas of deficit.
Prioritize targets that will be most beneficial to the client now, rather than trying to address everything at once.
Needs are all areas of deficit, while targets are the specific communication areas to address during therapy.

Number of Goals

The number of goals should be determined based on the frequency of therapy sessions.
Prioritize the most important areas of need, such as expressive language.
Collaborate with parents and teachers to identify the most significant areas of need.
Once a goal is met, consider adding a new one in consultation with parents.
IEP (Individualized Education Program) is a flexible document that can be changed at any time.

Selecting Functional Targets:

Targets should be functional, culturally appropriate, and linguistically appropriate.
Select targets that can make an immediate improvement on the client's abilities.
Targets should serve as building blocks to more advanced targets.
Use evidence-based practice to select targets.

Thorough Assessment

A thorough assessment gives an idea of what the client can do and their areas of need.
Consider developmental, functional, and cognitive needs.
When developing a list of needs, be specific and consider all areas identified in the assessment.

Nonverbal Clients

For nonverbal clients, focus on basic building blocks of language, such as vocabulary.
Prioritize basic wants and needs.
A good goal for a nonverbal client could be using three-word sentences like "I want" or "I need."
AAC (Augmentative and Alternative Communication) can be beneficial for some nonverbal clients, especially at a young age.
AAC does not hinder overall language development.

Strategies for Choosing Targets

Normative Developmental Strategy

Choose a target based on what comes next in the developmental progression of typical children.
For example, after three-word sentences, focus on expanding sentences to describe what they see.

Client-Specific Strategy

Consider the development of the specific client and where they are.
Prioritize targets based on the client's goals and interests.
Assess the importance of the area of need to the client, how often it presents a problem, and its impact on communication.
Determine if the client is stimulable (can the target be elicited with minimal support?).

Case Studies

Example 1: Cora, a four-year-old with a speech sound disorder (errors with /b/ and /r/). Using a normative strategy, address /b/ first as it develops earlier.
Example 2: Thomas, a four-and-a-half-year-old with a language delay (MLU of 1.5). Areas of need include various morphemes. Using a normative strategy, address early prepositions first.

Developmental Normative Resources

Resources include the Schiffling assessment, ASHA, Brown's morphological development, and Caroline Bowen.
Normative strategies are appropriate for children developing typically in all areas except language and speech.
Not appropriate for children with other developmental, physical, or health impairments, or for adults.
Adults have already developed language, so helping them regain lost skills is different from teaching new information.

Client-Specific Strategy Considerations

How important is the area of need to the client?
How often does it present a problem for the client?
How much does this need impact their communication?
What would allow the client to communicate more effectively?
Is the client stimulable?

Case Examples for Client-Specific Targets

Cora: Focus on the phoneme that she is more stimulable for or that is more relevant to her family (though in the example, more information is needed).
Mary Anne: A 63-year-old with Broca's aphasia. Focus on word-finding nouns to help her express her wants and needs.

Family-Based Intervention

Gather information from the family about their culture, language, values, and how much they want to be involved.

Consulting Literature

Refer to normative charts to identify developmental milestones.
Determine whether to use a developmental vs. non-developmental approach, and bottom-up vs. top-down.
Bottom-up approach addresses underlying deficits to improve foundational skills.
Top-down approach focuses on improving functional skills and participation in daily activities.

Number of Treatment Targets

The number of treatment targets depends on the setting, length and intensity of therapy, and what is achievable for the client.
Focus on what will give the client the biggest "bang for their buck."
Typically, address one to three targets.
Parent or family input will help direct the best area to start with.

Gathering the Baseline

Baseline is the patient's ability to achieve a selected therapy target in the absence of treatment.
It is collected prior to treatment to find out the starting point.
It can also be collected during treatment to measure progress.

Methods for Gathering a Baseline

Administering a Baseline Probe

A structured short evaluation of a specific selected therapy target.

Analyzing a Speech-Language Sample

A transcribed sample of 75 to 100 utterances with objective analysis.
Have an idea of what you are looking for (e.g., present progressives, plurals).

Using Data Documented in the Evaluation or Progress Report

Helpful for tracking progress and identifying areas to work on.

Developing Baseline Probes

Select the therapy targets (e.g., labeling verbs).
Prepare stimulus items (e.g., verb picture cards).
Prepare probe instructions (e.g., "What is he doing?").
Present the stimulus items and cues as needed.
Collect data (aim for 10 trials to easily calculate percentage accurate).

Calculating Baseline from a Sample

Determine how many opportunities the person has to use the target correctly.
Count how many times they accurately say it.
Divide to get the percentage correct.

Reporting on Frequency

This is useful for disfluencies.
Language sample will give you an idea of disfluencies and conversation participation.
Schools typically do not assess vocal quality (refer to ENT).
Language sample will give you an idea of MLU if the client is five or under.
Do not collect a written sample.
Use conversation or expressive sentence sections from assessments.

Using Data from Evaluation Report

Sometimes baseline data is reported in the initial assessment.
Standardized test scores do not usually make appropriate measures of baseline.
Baseline should be as measurable as the goal.
Baseline, goals, and benchmarks should all align.
Do not report standard scores in a baseline.
A solid baseline and narrative are crucial.

Administering a Baseline Probe

Example: Mary Anne can label function verbs with 10% independently, increasing to 40% given a phonemic prompt.

Analyzing Language Sample

Example: Thomas uses regular plural /s/ with 8% accuracy in a spontaneous speech sample.

Using Data Documented in Evaluation Report

Example: Cora produces initial /r/ with 0% accuracy given verbal and visual cues.
Baseline drives the goal.

Goal Writing

Being Specific

Instead of "We're going to work on /s/ sound," specify the word position and level (e.g., initial word position at word level).

Being Measurable

Instead of "an increase in vocabulary descriptive words," say "using 20 new vocabulary words."

Being Attainable

Avoid 100% accuracy or independently on a goal.
Aim for 75% or 80%.
For kids going from very low percentages to higher ones, increase the prompting level at the beginning and then reduce it.
Avoid the expectation of someone doing something independently a % of the time.

Being Relevant

Instead of "They will use fluent speech," specify "They will talk with a reduced rate of speech."
For fluency, use opportunities instead of percentages.

Time

Give yourself a timetable (e.g., specific date in schools).

Parts of the Goal

Who: Usually the client.
What: What's the behavior we're expecting?
Accuracy Level: What's the percentage that we want them correct?
Condition: What support are we going to give them?
Measured By: How are we going to measure this goal?

Smart Goal Example for AAC

"By 12/23/2024, Mr. Smith will use his AAC device to request desired food items during mealtimes in 9 out of 10 opportunities when given a verbal prompt to use the device as measured by a trained caregiver present at the mealtime."

Goal Examples

Avoid Being Vague

Original: John will understand why it is necessary to wear his hearing aids.
Revised: By December 2026, John will state five facts determining why hearing aids are important.

Unclear Goals

Original: John will increase his level of communicative functioning.
What's communicative function?
Revised: By December 2026, John will request his needs in a naturalistic setting 8 out of 10 times.