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.