#069: Curriculum-Based Therapy Bootcamp – Therapy Planning

Let's dive into some therapy planning ideas, making this happen with our caseload. And so before we dive into the actual therapy plans, I wanted to share, because when I present on curriculum based therapy, I get a lot of questions about the goals. And I was confused about this at first, because it's like, we're just targeting the student's goals in the context of in using the curriculum as the context, and so we could target essentially any goal with that. But I realized that some speech therapists were writing... they were approaching goal writing in a different way, and so it was harder for them to make that match. So I found that starting with thorough evaluation was incredibly helpful because some of these SLPs were writing goals based on formal language testing results, which is great. We definitely want to include formal testing in our evaluation.

It's oftentimes required, but we want to pull additional information and consider other pieces of data when we're writing our goals. We don't want to just write goals based on the self subtests or whatever assessment we decide to use. So some other things we can do are use curriculum based assessments. So I used to use ones from Nicole Alison, and then Maureen from The Speech Bubble had some that I used as well. Also the SLP toolkit has some good curriculum based assessments as well. So just find a set of assessments or build a small library of curriculum based assessments that you can use, because that can be incredibly informative, and those are nice. We do our formal testing typically every three years, but the curriculum based assessments are nice to readminister on a yearly basis and it gives us some information about... it helps inform our year to year goal writing as well as the overall goal writing.

And then another thing that's incredibly, incredibly important is a language sample or multiple language samples. If we have time at the end, I can share a quick overview of some time saving tips, but if you can't find them, just Google SLP now language sample and the first result that'll pop up will include an explanation of how I set that all up and how I make that happen without taking a ton of time, because language samples can be very time-consuming. But I found that the system that I set up saved me a lot of time. Some things that you can do, a conversation sample is one that I like to grab, just seeing what language they use interacting with peers. But the students use, or anyone really, uses different language in different contexts.

So I think it's incredibly interesting to get a conversation sample to see what their like informal speech is like, but we can also get a narrative sample, whether they're generating their own story or doing a retell, or an expository sample where they're summarizing a text. This is especially interesting for older students. Or persuasion, like having them persuade you on whether the school day should be five or 10 hours or whether summer break should be five months, whatever it is. I built a small set of language sample prompts, and then I was able to use those across students. There's not fabulous data to help us understand, especially as students get older, you can get some numerical data to pull from if you use [inaudible 00:04:39] or something like that, but there's just not a whole lot to pull from.

And so I found it really helpful to... I gave the same types of language samples across my caseload and then I'd also borrow some typical students to get an idea just to calibrate my understanding and help me decide what warranted goals and what didn't. So that was super helpful.

And then I'd observe in the classroom, that could be incredibly informative. I would ask parents and teachers for input because I want to know how the student is doing in the classroom and what they're noticing or what parents are noticing at home. I could connect with the students and see what their goals are, what do they want to be when they grow up and just getting that buy-in, at least trying to tie their goals to what their... tying their speech and language goals to their personal goals, if at all possible. And then of course reviewing past progress.

So I would pull all of those elements into the evaluation and that made it really easy to start figuring out which goals I wanted to target, because I started to see connections. So maybe I noticed... and it's interesting too, because it could help me rule in or rule out potential goal areas, or it would help me identify areas that I needed to probe a little bit more to figure out if it warranted a goal or not.

But for example, some students would bomb the grammar subtest, but when I gave them a language sample, expository and persuasive language samples, their grammar was beautiful. And so that told me that writing a grammar goal might not be the best option. It's something I definitely would want to look into why they didn't perform well on the grammar subtest of the formal language test. But if I'm observing them in the classroom, their grammar is great, and in the language samples, the work samples from the classroom, those all indicate that the student has appropriate grammar, then that the test... the result from that grammar subtest isn't necessarily very helpful.

Usually when I get all of these different results, I start mapping it out. I noticed this as an area of need and this as a strength, and then I just would write those out for each of the assessments that I gave, and then I could kind of start to draw parallels and figure out, okay, this is what's going to help the student most. These are the goals that I'm going to focus on. I'm going to support these things by providing these accommodations or whatever it may be. And it helped me come up with a really comprehensive plan of attack that I could stand behind and that I could explain well.

Then once that was all mapped out, we can look at that and we can decide, okay, story grammar is typically something that we can remediate pretty quickly. Students catch on to that and we can work through that quickly, so maybe that is something that I would prioritize, but maybe there's something that's really having a significant impact in the classroom and it's not as easy of a goal to target, but that's really, really important to that student because they want to be a newscaster when they grow up or whatever it is, and so we can use all of these factors to determine what's the highest priority, where are we going to focus our efforts, what are we going to offer supports for? And kind of move through the goals that way. I wish I had... Hopefully those general suggestions are helpful. I wish we had time to dive into a couple of full on case studies or whatnot, but that'll have to be another presentation.

So knowing what to target, we're going to compare data and select those appropriate targets like I talked about before, and then we can be strategic in what our target selection. So like I was saying, do we want something that we can remediate quickly or something that has a huge impact? What if there's... Like if there's something that is easy to remediate and has a significant impact, that'll be at the top of the list. And then if there's something that can be remediated quickly but doesn't have a significant impact, maybe that moves down the list a little bit, or if there's something that has a significant impact and can't be remediated quickly, maybe that goes up just below the thing that... so we can work through it that way.

So we know what we're targeting, we're solid on that. We've gotten feedback from the team. We have our multiple sources of data, and then we just need to start planning. So like I said, we want to share the goals with the teacher, decide which context we want to use, are we using those math word problems? Are we using the ReadWorks articles? Are we pulling from the social studies texts? Whatever it may be. So I would just work with the teachers, identify those areas, and get those organized.

So that is the context of the therapy, but I need to do a little bit of work as a speech therapist to make sure that I have everything that I need to set my students up for success. Because I do have that glue for the therapy, but I need something to actually support the student's skills. So what I like to do, I've mentioned this in pretty much every presentation, but I have a caseload at a glance sheet that I like to fill out, especially at the beginning of the year, and I go through all of my student's goals and add them to the caseload at a glance, and then I make sure to grab... So ideally we would pull an assessment or a probe for each goal when we write the goal, because when we write it, we should have a way to measure it. So in an ideal world, we would already have those all organized and ready to go. But the caseload at a glance is just a good way to inventory and make sure we have a good way to measure every student's goals.

And then we also want to have some teaching tools. So I strongly believe that we are our best therapy tool. We could have the most beautiful speech room in the world, the most beautiful materials, but if we don't have the evidence-based strategies and our clinical judgment and our knowledge to drive that therapy, it's still a train wreck, even if we have all of these beautiful things. So we are our best therapy tools.

I like the caseload at a glance because it helps me go through and make sure... it's a check for me. Like, do I know how to teach this? And so I might brush up on the evidence-based strategies that I can use to teach that skill. I also like to make sure we do want to use multiple modalities, but visuals are huge for me. I think they really benefit our students. And so that's something I want to make sure that I have a visual for each skill. Sometimes it's a fancy laminated visual from my membership site, but other times it's just something that we draw on a sticky note or on a piece of paper, and that ends up being the visual.

But I like that caseload at a glance because then that helps me prioritize. If there's 10 students working on categories and I don't feel like I have good visuals or good strategies to use to teach and support those skills, then I'm going to do some work on those, on that area instead of heavily focusing on a random goal that only one student has. And of course I want to be able to do all of the goals well, but when we're feeling overwhelmed, it's nice to be able to prioritize, and just by starting with the bigger impact chunks, it kind of just gives us that momentum to keep going through the rest of the list. So that's something that is huge and I make sure to grab those visuals and make them organize and just make sure my head is straight with all of my strategies.

And then the next thing that I want to do is just make sure to communicate progress with teachers. So that might be... and each teacher will have kind of different expectations or requests or just patience with the communication. So a lot of times it would just be I would just... during the whatever... and this is a little bit different with teletherapy I suppose, but I would just I think if I were doing teletherapy now, I would just be connecting with the teachers via email and we are problem solvers so we can figure out a good way to go over that progress.

I might just set up a monthly check-in or something, but when I was in the schools, I would just make a list of the teachers that I wanted to check in with and then I would just knock out a couple every week. I would just try and connect. You get into your communication rhythm. So like Mrs. Smith is always in the copy room on Monday morning, and maybe Monday morning's not a good time to connect, but we always run into each other and so we can just do a quick exchange there. Just kind of building that into the routines and making sure that we're communicating that regularly with teachers, and it was easy to share progress when something big happened, like a big success. I would just be motivated to share that with them, whether it's like a quick email or a quick call. Then if I was struggling, that was also a good indicator to check-in because then we can kind of work together and problem solve.

So that's what we've got there. And then we don't have a ton of time to dive into all of the therapy routine details, but my basic routine that ended up working well for curriculum-based therapy when I'm in the therapy room, it's a little different when I'm in the classroom, the routine changes, but when a student comes into my therapy room, I have them review their goals and so we just go through their goal cards. I just have them write their goal in their own words, and oftentimes they write why it's important to them. And then we just go through those. Then at the same time, I collect a quick probe, so that lets me know how the student is doing on one skill. Each student gets probed with one skill and then I can know how the student is coming into the session and it gives me an idea for how much support... or it gives me an idea of how much support the student will need to be successful with that skill.

So if we're working on categories and they scored like 0% accuracy, I am going to before diving into the category vocabulary journal, I'm going to take a step back, explain what the categories are, do some simple examples or whatever makes sense, and do some pre-teaching and all of that before we dive into the actual activity. So it just keeps me informed. But if the student is at 100% accuracy, I'm going to push them a little bit and see how they can do in context with less support. So that's just an example of how that would work.

And then I would just move through whatever materials we're using. If we're using a text, we would move through the literacy-based therapy framework and I have other courses that dive into that in more detail. Or the math word problem example, we would do whatever teaching we needed to do for specific skills or pre-teaching vocabulary, reteaching what the skill is, and then diving into that word problem and breaking it apart, and that's something that even that took several sessions to break down. So that's just a quick breakdown of what that therapy routine could look like.

Okay. And then just a quick breakdown, students come in, we review the goal cards, we pick one primary target. I personally like to collect a quick probe or just to see how the student is doing with that skill without any support. And then I grab the visuals that would be needed and make sure to do any pre-teaching or review as we dive into the unit. And then at the end of the session, I just wrap up and do a quick narrative summary of the supports that I provided. And then I enter the probe data in real time. So I have those accurate numbers.

And then the last thing we wanted to talk about is just being therapeutic in the context of therapy or curriculum-based therapy. I just have this quote to kind of drive this point home. It's by Dr. Erin and she says, "I have been advocating that SLPs engage in curriculum relevant therapy and that they use the curriculum as a context for language, but not try to teach the curriculum per se." Because we are, and this is me adding this in, but we are not tutors. We are focusing on the language processes and underpinnings. So that is our role. We are not trying to keep up with the classroom.

So if the teacher sends me like five word problems a week, I might do one every two weeks or three weeks, however much time I need to dive into the article, the word problem, whatever it may be. I go at the student's pace. I'm there for the students. I'm not trying to keep up with the curriculum. So that is one huge lesson. I remember trying to support... One of the teachers wanted me to support a book that they were reading. It was a chapter book and they read a crazy amount every day, or every week they had multiple reading assignments and I just could not keep up. I was trying to and it was frustrating, but we do not keep up. We go at the student's pace. We're teaching, we're using the materials as like the context for therapy, but we're not trying to keep up with the classroom. So we are trying to teach these skills, not completing assignments.

And then one framework that has been incredibly helpful in navigating this is Dr. [inaudible 00:20:57] framework. So I use this as a check for myself. If I feel like, "Ugh. I'm such a tutor. This was such a tutoring session." Or if I just am not feeling good about how the session went, I will take a deep breath first, and then I'll go through the framework and check and ask myself how the session went based on these four criteria.

So she says R stands for repeated opportunities. So in order to really be therapeutic and teach a skill, if we're working on categories and we're just completing a worksheet assignment, and there's one category question but the rest are something completely different, that's not enough repeated opportunities. If we're working on categories with a student, we need to give them multiple exemplars and really dive into that.

The I stands for intensive schedule. So this is something we decide when we write the IEP typically, but we want to make sure that the students are getting enough intensity. So whether it's 10 minutes three times a week or 30 minutes twice a week. Whatever they need, we can adjust that. This is typically if a student isn't making progress, it's something I might evaluate.

The other piece is systematic support and scaffolding. And last month we talked all about that, so if you want to check out last month's podcast episodes or last month's course, you'll find lots and lots and lots of examples there.

And then the E stands for explicit focus. So this is why I have goal cards for all of my students, because I want to make sure that they know what they're working on, and I just focus on one, typically just one goal a session. I might target other skills because I just can't turn it off with my modeling and all of that, vocabulary and recasting grammar and all of those strategies. But we have one main skill that we're focusing on. And then this allows us to... this gives the students the opportunity to internalize the strategies and skills instead of us just providing them with tons and tons of support and they never take ownership of it.