#171: How to Structure A Speech Therapy Session

Speaker 1:
Hello there, and welcome to The SLP Now Podcast, where we share practical therapy tips and ideas for busy speech-language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.
Hello there, and welcome back to the podcast. Today we get to chat about a sample routine and how you might structure a speech therapy session. I dug into the research several years ago, trying to figure out how I could implement evidence-backed strategies within each of my therapy sessions just based on how I'm structuring things. I looked at a lot of the education literature because there wasn't a lot of super-clear structure in what I was finding in the speech therapy journals. And so I spread out a little bit and distilled what I found into this basic five-step structure. And so we'll go through the five steps. And then as we go through, we're going to chat about some of the nuances and what things might look like and what we might shift around. And then of course, within every session we are using our clinical judgment.
So this little framework that I'm going to share, it might not be a perfect fit for all of your students on your caseload, and we definitely will need to make adjustments based on our students' needs. But this little framework can help us make some clinical decisions and troubleshoot when things come up. A lot of times when I go through this structure with speech therapists, there's a lot to celebrate. There's a lot of things that we're automatically doing, and there's maybe just little teeny tiny things that we can tweak along the way. So without further ado, let's dive into step one.
So step one is check-in. The purpose of this step is to establish rapport with our students. There is a tremendous amount of research on the importance of establishing rapport. And the check-in gives us the opportunity to connect with our students on a personal level, and it allows us to do a quick pulse on where our students are at. It helps us decide if we need to make any adjustments or offer any supports so that our students are prepared to participate in the session and that they are ready to learn. So an example of what that might look like, if a student walks in and is really, really, really sad. If I just ignore that they're sad and just jump right into reviewing the goal cards, and collecting data and diving into an activity, the student might be really sad for a particular reason, and sometimes we can't do anything about that. But sometimes just asking them how they're feeling and giving them the opportunity to share, offering sympathy, can give them just a little bit of a boost, where they're able to participate a little bit more.
The same applies if a student walks in and they are just moving all over the place and they are really, really high energy. If we have a couple supports in our back pocket, maybe we can offer alternative seating, maybe we can do a quick brain break or do a quick movement activity to help bring them to a more midline level, so that they can be focused enough to participate in the activities that we have planned. So some things that we might do for the check-in is a quick temperature check, where you can have a visual or you can just ask your students how they're doing. But the temperature check, you can use a scale of one to five, 1 to 10, and they can let you know how they're doing on that number scale. If you google temperature check, there'll be tons of options on Teachers Pay Teachers, and that can be a fun way to start your session and work on a bunch of vocabulary and executive function skills, all of that. So that's one option. Also, having a visual schedule can be really helpful, so that they know what to expect.
That brings us to step two, which is assess. So we want to review our students' progress. And some activity ideas here are to review students' goals. I will talk about this in a future episode, and I'll link in the show notes to what that might look like. But I have my students review their goal cards, and for the assessment portion of my session, I will collect a quick probe. We'll have a whole episode on this assess part of the framework next week. So make sure to subscribe if you aren't subscribed already to check out that episode.
Then step three is to teach. As a young clinician, this is a step that I often missed. I don't know that I consistently collected probes. I think the students walked in, I checked in with them, I was good with that, and then we just dove into practice. I completely skipped the assess and teach steps of this framework. And if you listen to the episode next week, you'll get a really, really good feel for why assessment is important. And then in future episodes, we'll dive in more into some teaching strategies and everything, but it is important to meet our students where they're at and provide them with appropriate support. I might show them a visual for the skill that they're working on, or I might do some of that initial teaching to show them or tell them what it is that I expect them to be able to do. So for articulation, this could be some elicitation strategies. For vocabulary, it might include pre-teaching some words. For grammar, it might include some focus stimulation or some visuals to break down the skill. There's lots of options here.
Then step four is to practice the skill. And for me, this looks like a lot of literacy-based therapy, structured drill activities, all of that good stuff. And then step five is to wrap up the session. I like to close out the session by discussing student progress. I'm not the best at assigning homework, but this would be a good time to do that. I like using parent communication apps. I don't always have time to message every single parent every session, but I try to check in at least every few weeks. And some things that I might do, like if I'm doing a literacy-based therapy unit, I might send home a link to the YouTube read-aloud for the book that we're working on. And that's easy to share with everyone. I might take a quick picture of the story grammar organizer that we made during the session, so that they can practice retelling at home. There's a number of things that I can just quickly take a picture of and send off or just send a quick note on something to focus on.
And then I can review the plan with students for the next session. This is also when I wrap up my documentation and just document which supports the student benefited from, because that is therapy gold right there. And those are the five steps. One, check-in. Two, assess. Three, teach. Four practice. And five, wrap up. So check-in obviously is always at the beginning of the session, and the wrap up is always at the end. But assess, teach, practice, that's the core, the heart of your therapy sessions. The time that we spend in each of these can really vary. So maybe the assessment portion of your session is pretty consistent, maybe you just spend a couple minutes at the beginning of the session checking in where students are at, but then you administer a quick probe and the student is at 0% accuracy. We might spend the entire rest of the session teaching, and we might not even get to the practice stage.
Or maybe we'll start with assessment, we'll do some quick teaching, and then spend the rest of the session practicing. Or maybe we assess the student, that score is really high on the probe, so we jump straight to practice. But then they are struggling in context, so we need to jump back to teaching. We do a little bit of that and then jump back to practice. So you can see how this is a really dynamic process. There's not a super time-ordered agenda of, "Okay. Two minutes, assessment. Three minutes, teaching. 20 minutes, practice," is very dynamic and we adjust based on what we're seeing in the session. So hopefully that was a helpful overview. Be sure to head to slpnow.com/158 to check out the show notes for this episode, and we'll see you in the next episode.
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