Expressive Goal Planning, AAC, and Data Strategy – Transcript Summary

Context & Participants

• Conversation about a therapy session focusing on mobility, communication, and goal planning for a client (Hudson).
• Mobility discussion: client arrived in a wheelchair, was rocking in a positive way; team notes surprise at mobility level and expresses relief/credit to client.
• Safety and permission: team discusses obtaining verbal permission from family to assist with transfers; follow family’s lead on scheduling and physical assistance; emphasis on respecting client and family preferences.
• Team dynamic: casual collaborative tone; both speakers reflect on their assumptions about the client and adjust plans based on observed abilities.

Session Planning & Baseline Goals

• Expressive goal baseline: one clinician is uncertain if they can baseline an expressive goal today and plans to review the SOAP note and upcoming goals.
• Review of prior session approach: previously tried a picture-based approach; plan to modify strategy today.
• Proposed baseline activity: remove most toys and present a few targeted items (e.g., rings) to observe gestures and initiation.
• Emphasis on insight from previous session: gestures and reach toward preferred toys (dinosaur, chicken) indicate potential symbolic or non-symbolic requesting.
• Strategy for testing symbolic communication: place an actual photo of the desired toy on the ground next to the child and pause to observe response; if no symbolic response, reassess the goal toward increasing symbolic requests.
• Distinction between non-symbolic and symbolic communication: non-symbolic gestures or vocalizations (reach, gesture without a conventional symbol) are still communicative, but the goal may shift toward symbolic modalities if that is the child’s trajectory.
• Consideration of AAC options: low-tech picture symbols, high-tech devices, or any modality (multimodal) to support symbolic requests.
• Coordination with others: question about whether to involve Katie for AAC decisions today; plan to consider multiple AAC systems and goals.

AAC, Multimodal Communication & Goal Writing

• Core concept: multimodal communication systems allow using any modality (unaided or aided) to achieve a goal; do not limit to a single device.
• Clarification on AAC terminology: AAC can encompass any level of technology—from no-device (gestures, signs) to high-tech speech-generating devices.
• Sample language for goals: emerging communicators need goals around vocabulary, communicative function, and requesting using symbolic modalities.
• Example given for expressive goal structure:
  • By end of semester, given an AAC device and/or verbal speech, the student will meaningfully communicate protest with a word or gesture in rac{8}{10} opportunities.
• Practical phrasing option discussed: replace “AAC device” with “multimodal communication systems” to allow unaided and aided methods to support the goal.
• Data collection alignment: goals should consider multiple modalities; the data can reflect use of different representations (sign, picture symbol, device, etc.).
• For exploration: the team plans to send additional resources (guest speaker slides) about goal writing for basic concept identification and expressive goals.

Baseline Data & Data-Tracking Guidelines

• Data targets discussed: a) number of opportunities per session (e.g., a defined time frame like a 15-minute segment or a full 50-minute visit), b) number of successful symbolic requests, c) presence of gestural cues.
• Trial structure vs. accuracy:
  • Baseline may be tracked by opportunities and attempts rather than strict accuracy if opportunities are limited.
  • Example: tracking whether the child demonstrates a skill in a given number of opportunities, e.g., 5 within a 15-minute window or within a 50-minute session, etc.
• Criterion discussion: choosing whether to track accuracy (percentage correct) or number of demonstrations within a defined frame; the teacher notes that accuracy can be skewed if opportunities vary across sessions.
• Suggested formats:
  • Target: five independent symbolic requests in a 15-minute visit ext{(i.e., }5 ext{ independent symbolic requests in a } 15 ext{-minute visit)}.
  • Example data: if the child makes 7/10 symbolic requests in a given session, that is rac{7}{10} = 0.7 (70%).
• Adaptation of criterion: can also track the total number of demonstrations of the skill across the whole visit (e.g., 0–10 opportunities in a given session) and adjust goals accordingly.
• Gestural cue consideration: when tracking two-step directions, note whether a gestural cue was required; write goals as two-step directions with/without gestural cue to capture modality support.

Two-Step Directions, Gesture Cues & Modality Flexibility

• Example directive: two-step prepositional directions with a gestural cue vs without.
• Practical observation: most of the child’s directions in the session involved gestural cues; plan to document cue usage when writing goals.
• Data interpretation: if the child follows directions with visible gestural support, this should be reflected in goal criteria (e.g., two-step directions with/without a gestural cue).
• Strategy: keep data collection focused on opportunities to demonstrate the skill, not just the number of successful trials; track a mix of symbolic and non-symbolic attempts.

Sequencing, Environment & Motivational Design

• Environmental design to elicit communication: place desired items (e.g., a chicken, a dinosaur) within reach or slightly out of reach to prompt requesting; avoid over-holding or withholding to reduce frustration.
• Activity structuring: adjust the task to balance motivation and opportunity; simplify language when necessary; consider toy choice and placement (e.g., “put the elephant on top of the sit-and-spin” to test persistence and following directions).
• Motivation through context: test different activities and toys to determine what motivates the child to initiate a request; track which activities yield more communication attempts.
• Example of contrived opportunity: hide a desired item in a container that the child cannot open easily, prompting a request for help or for the item itself.
• Goal progression: early goals may target requesting an object, then requesting more action, and eventually requesting help or using core words.

Example Scenarios, Tools & Materials for Symbol Pictures

• Concrete plan for symbol-based testing today:
  • Print a couple of symbols (e.g., dinosaur, chicken) and place them on the table or just out of reach to see if the child points or gestures toward them.
  • Use a clear container to hold the chicken so the child must request it to obtain it.
  • Plan to model using the symbols and then prompt with a cue if needed.
• Symbol creation workflow:
  • Copy/paste images (e.g., a yellow chick) into a Word document, print with color, and prepare a few symbols for the session.
  • If a preferred item like a chicken is identified, create a symbol for it even if the exact toy is not available.
• Core vocabulary & future targets:
  • Introduce a core word like “help” as a recurring target later in therapy to support functional communication.
• Documentation note: ensure the symbol set is accessible and understandable for the child and family; plan to align with the family’s expectations and any device used.

Multimodal Goal Writing: Practical Language & Examples

• Ground rules for expressive goals: emphasize multimodal communication rather than prescribing a single AAC device; allow any modality that achieves the communication function.
• Important phrases discussed:
  • “Given access to multimodal communication systems” rather than solely referencing an AAC device.
  • Include both unaided (verbal, signs, gestures) and aided (pictures, device) representations.
• Example goal revision:
  • By the end of the semester, with multimodal communication access, the student will meaningfully communicate protest with a word or gesture in at least rac{8}{10} opportunities.
• How to handle devices in goals:
  • Do not require a specific device in every goal; instead, specify access to multimodal systems and allow child to select the most effective modality.
• Resources & future learning:
  • The team will share slides from a guest speaker on goal writing for basic concept identification and expressive goals; aim to illustrate how to include multiple modalities and functions.

Scheduling & Seasonal Goals (Spring, Fall, Summer)

• Recommended goal load by season:
  • Fall: 3 goals (a good number for fall).
  • Spring: 3 goals (three is also suggested for spring).
  • Summer: 1 ext{ or } 2 goals (shorter treatment period).
• Rationale: more goals in spring/fall to capture ongoing progress; fewer goals in summer due to shorter treatment period.
• Data planning across seasons: maintain consistency in data collection methods across seasons; ensure goals remain measurable and achievable within time frames.

SOAP Notes, Data Integration & Documentation Practices

• Integration of feedback: the present discussion is used to refine the current SOAP note and to adjust the session plan for next week.
• Suggested approach for the SOAP note:
  • Keep the note concise but explicit about: baseline status, planned symbolic testing, and data collection method.
  • If needed, you can revise goals into the body of the SOAP note for coherence without retroactively editing prior entries.
• Data transparency: you should indicate how many trials or opportunities were provided, how many were successful, and whether cues were used; this helps in determining the target criterion for the next session.
• Practical tip: don't overly fixate on achieving a perfect “10/10” in a single session; instead, track progress across sessions and adjust based on opportunities and child engagement.

Ethical, Philosophical & Practical Implications

• Family-centered care: respecting family wishes and gauging permission for physical assistance and transfer activities.
• Autonomy & preference: respecting the child’s wants and providing opportunities to communicate them while avoiding unnecessary withholding of preferred activities.
• Flexibility in modality choice: ethical emphasis on not privileging one modality; support multimodal access to communication and adapt to the child’s evolving abilities.
• Real-world relevance: the approach aligns with best practices for emerging communicators, joint attention, communicative initiation, and prelinguistic communication development.
• Practical constraints: balance between data collection rigor and session practicality; flexibility to adjust goals based on ongoing observations and family context.

Resources, Next Steps & Follow-Up Actions

• Resources mentioned:
  • Slides from a guest speaker on goal writing.
  • Randy’s resources (to inform language use in goals).
• Action items for the student:
  • Print and prepare symbol pictures (e.g., dinosaur, chicken) for the next session.
  • Create a simple data plan: decide on whether to track based on opportunities or time windows and how to record cues used.
  • Consider describing goals using the term “multimodal communication systems” rather than tying to a specific AAC device.
  • Email a copy of the symbol pictures or save them for quick reference during sessions.
• Next steps in supervision: the supervisor is open to flexible goal formatting; the student should integrate feedback into the next SOAP note and session plan without requiring retroactive edits.
• Final reminder: align goals with practical session flow, family expectations, and the child’s active engagement in both symbolic and non-symbolic communication.

Quick Reference: Key Terms & Concepts

• Joint attention: shared focus between child and caregiver on an object or event.
• Joint engagement: the child’s active participation and engagement during shared activities.
• Communicative initiation: child’s initiation to communicate intent or needs.
• Prelinguistic communication: early forms of communication not yet using conventional speech, including gestures and vocalizations.
• Symbolic modality: use of a symbol (picture, word, sign) to represent an object or action.
• Non-symbolic gesture: reaching, pointing, or other gestures not yet tied to a conventional symbol.
• AAC: Augmentative and Alternative Communication; encompasses any tool or system that supports communication, from unaided to highly assistive devices.
• Multimodal communication systems: use of multiple communication methods (speech, signs, pictures, devices) to meet communication needs.
• Data metrics: opportunities/trials, success rates, and cue usage; accuracy vs. opportunity-based criteria; framed within time bounds (e.g., 50-minute session, 15-minute sub-segments).
• Core vocabulary: high-frequency, functional words used across contexts (e.g., "help").
• Goal-writing guidance: link goals to communicative function (e.g., requesting), allow multiple modalities, and set clear, measurable criteria within a defined timeframe.

Notes Summary

• The transcript centers on making the client more independent in communication, choosing and testing symbol-based requests, and integrating family preferences with clinical goals.
• It highlights the need to balance expressive goals, modality flexibility, data-driven decision making, and practical session design to support an emerging communicator.
• The next steps include printing symbol pictures, testing symbolic requests, clarifying goal language (multimodal), and reviewing goal-writing resources to strengthen accuracy and feasibility of SOAP notes.