Writing targets and speech therapy programmes

One thing that we do quite a lot of as speech therapists in Britain is writing targets and programmes for school staff and/or parents to work on.  I am fortunate enough to see most of my clients on a weekly or fortnightly basis now, as I work independently.  Even before that, I did quite a lot of work in specialist centres in mainstream schools so I was able to do quite a lot of regular direct therapy then too.  However, I have also been drowning under the weight of an enormous clinic and mainstream schools caseload, so I do know what it’s like to only be able to see a child once every six months, or even once ever!

The first thing to say is that I think, as therapists, we should be challenging that model.  In my experience, it rarely gets the best outcomes.

However, I’m realistic enough to know that it’s not going to change next week.  And, in any case, targets and programmes are useful for all children, even if they are receiving regular therapy.  The best progress usually happens when everyone is working together – parents, school and the speech and language therapist.

I have made lots of mistakes over the years when it comes to writing targets and programmes.  I am certainly not claiming to be an expert now.  However, today I am going to share some of the things that I have learnt over the last 13 years about setting targets and writing programmes for schools and parents to carry out.

• Be realistic.  As a speech therapist, you have loads to do, and many demands on your time.  So do teachers and TAs.  Parents generally want to find the time to work with their child, but they may have other children, jobs, other therapies, school homework, the demands of day to day life!…  Make it as easy as possible for people to follow your advice.  For home, talk to the parent and try to problem-solve together how they can fit this into their everyday life. In school, provide all the resources that are needed and show staff how following the programme is going to help them as well as the child.  For example, you might be advising a visual timetable.  Explain and show them how this will benefit many children in the class, not just the one you have come to see.
• Show them if possible.  If there is one thing I have learnt, it is that things I have written in what I think is clear language, are often not clear at all!  Often I have gone back into school, only to find that they have been working hard every day with the child, but doing something completely different from what I meant!  When you do something every day, it can be really hard to explain it in a simple way for someone else to follow.  Also, many teachers and TAs are fabulous but schools sometimes use terminology in different ways to how we use them.  As one example, schools obviously have a strong focus on literacy and when I ask about a child’s comprehension they often relate this to their understanding of what they have read.  Generally, I am not asking about that, but rather about following instructions and asking questions.  If at all possible, don’t rely on the written word to convey your message – show them!  Once someone has seen you do it, your written instructions will make a lot more sense.
• Link in to the curriculum.  I am really grateful that I have had the experience of working very closely with several fantastic specialist teachers and setting targets jointly with them.  It really changed the way that I write targets for children.  Schools are under increasing pressure to reach certain targets themselves and the National Curriculum is hugely prescriptive about what has to be taught, when and how.  When the teachers and I set targets together we would start at the curriculum level the child was working at and what they needed to achieve to reach the next level.  Then we would break that down into curriculum and language targets.  If the targets are tied to the curriculum they will be worked on all the time by everyone as a matter of course.  Otherwise we are just giving both staff and the child an extra thing to do.
• Make the targets functional.  When we are short on time, we tend to go in and do a formal assessment.  I am not against formal assessments at all – they can be really useful.  However, if you just look at a CELF form and find an error to set a target on, they can end up a little arbitrary and not very rooted into the day to day language skills that the child needs.  Talk to staff and parents and find out what the child struggles with most day to day.  They know that child far better than you do.  Is it telling people what has happened?  Or following instructions?  Or chatting to his peers?  Make sure your targets address the everyday skills that the child needs to improve.
• Explain what to do if it’s not working.  When I do direct therapy with a child, I always set some therapy targets at the outset.  However, these constantly evolve and change.  Maybe the child can’t achieve the sound I set out to target but is achieving another one easily.  Maybe I started working on one concept, but another more fundamental one came to light that needed work.  Maybe they are just not ready to achieve the target I set and I need to break it down into smaller steps.  When we write a programme and leave it in school or at home, it is really hard to prepare for all of those eventualities.  (That’s one of the reasons why I think this is often not the best therapy model).  However, we can give people some idea of what to do if it doesn’t seem to be working.  Should they call you?  How long should they give it before they do that?  Have you given a few other ideas of things they could try instead?  Are there resources you can point them to which might help?

Are you a therapist?  What have you learnt about writing targets and programmes over time?  Are you a parent, teacher or TA?  What do you find useful when you are given a programme of speech therapy homework?  Please comment below to help us all!