Case Scenario: Speech Report & Cycles Treatment Plan

How long has it been since you conducted an independent/relational analysis or wrote a full report and treatment plan?  As we all know and understand, it doesn’t happen often in the school setting due to caseload numbers and piles of paperwork.  I am always thrilled to write reports and treatment plans in private practice, clinical, and outpatient medical settings.  As I was looking for a piece of info in an old report this evening, I was reminded that there is an art to crafting a comprehensive report and treatment plan.  Pour a cup of coffee, sit back and remind yourself of the depths of knowledge we possess as Speech Pathologists!  No, this report and plan are not earth shattering; however, I think we forget the amount of information and detail we could share with our colleagues and team.

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Report Example -Fictional Names and Demographics

Background and History

Reece Anderson, a 4-year, 1-month-old male, is the only child of David and Kristie Anderson.  Reece was seen on August 10, 2017, for an evaluation at the Vanderbilt University Speech Clinic in Nashville, TN.  Dr. Kalb, of Centennial Pediatric Group, referred Reece due to his speech articulation errors.  The client’s parents report difficulty understanding Reece unless the context is known.

Mrs. Anderson indicated that Reece sat at 7 months and began to crawl at 9 months.  He took his first steps between 12 and 13 months.  Reece began to hold his bottle at 7 months and fed himself finger foods between 10 and 11 months.  Mrs. Anderson expressed unremarkable details regarding Reece’s expressive language development.  Conversational skills, specifically turn-taking skills, developed around 2 years of age; however, Mr. Anderson indicated that content had to be inferred.   Reece uses simple questions and makes relevant comments during conversation; however, the problems with intelligibility make it difficult for him to communicate with peers and preschool teachers.  Mrs. Anderson reported that her son often omits sounds in words such as “ig” for “pig” or substitutes sounds such as “wop” for “rock”.  Hearing, receptive language and nonverbal intelligence were within normal limits; although, recurring otitis media was reported.   Mrs. Anderson reported an unremarkable pregnancy and no family history of speech/language disorders.

Insta free speech report

 

Assessment Information

Independent Analysis

An independent analysis was completed on an elicited single word speech sample using both objects and pictures.  The independent analysis addressed the client’s unique speech inventory.  All speech sounds the client produced were recorded regardless of whether the sounds were used correctly.   The independent analysis included a phonetic inventory, phonetic distribution, and word shape analysis.

 

Acquisition of Speech Sounds Produced
Early 8  
m – mom X
b – baby X
y –yes  
n – no X
w – water X
d – daddy X
p – puppy X
h – house  
Middle 8  
t – toe X
ng – baking  
k – cookie X
g – gum  
f – four  
v – van  
ch – chair  
j – jump  
Late 8  
sh – shoe  
th – thumb  
s – soap X
z – zebra X
th – the  
l –lion  
r – truck  
zh  -measure  

The client used 10 different speech sounds in the 50 utterances recorded which included: /m/, /n/ , /p/, /b/, / t/, / d/,  /k/,  /s/,  /z/, / w/.    Plosive sounds were used more frequently in the sample.  Only two of the nine fricative sounds were produced and affricates were not produced.  The client produced only one sound past the alveolar ridge, /k/.  The /k/ and /z/ were produced once during the sample.

The phonetic distribution analysis allowed the clinician to determine where the client used specific sounds in various syllables.  For example, if the client produced /s/ at the beginning of the word as in “sun”, it was recorded as being produced in the syllable initial word-initial position.  The phonetic distribution data indicated the client used nasal, plosive and approximate sounds /m/, /n/, /d/, / t/,/ w/ in the syllable initial word-initial position.   The client used the plosive /p/ and fricative /s/ in the syllable final word-final position.   Plosives /t/, /d/, /b/, /p/ were used most often at the syllable initial within word position and the nasal /m/ was the only phoneme produced at the syllable final within word position.  Consonant clusters were not used.

The client produced two monosyllabic word shapes; however, he preferred using vowel/consonant  (VC) pattern as in “at” over the more difficult consonant/vowel/consonant (CVC)  pattern as in “cat”.  The client produced a variety of multisyllabic syllable shapes.  The syllable structures VVC and VCVC were used most often in multisyllabic words.  The client closed 63% of syllables with a consonant sound.

insta apostrophe

Relational Analysis

A relational analysis was completed on an elicited single word speech sample using both objects and pictures.  The relational analysis addressed the client’s unique speech inventory compared to the adult model.  The relational analysis included The Assessment of Phonological Processes, categorization of speech sounds by manner, and a percent consonants correct analysis. 

The Assessment of Phonological Processes addresses error patterns in clients who exhibit multiple speech sound errors.  The client produced correct syllable structures for all 50 single word utterances.  For example, the word “basket” contains two syllables and the client produced two syllables in his utterance; although, some speech sounds were deleted or modified.  The client was able to produce consonant sounds after a vowel sound consistently (postvocalic singletons) with 6% of occurrence; however, the omission of the prevocalic singleton occurrence was 73% e.g. (gum->um).   The client exhibited the following phonological processes 100% or more: consonant sequence reduction e.g. (string->ing), and class deficiencies in producing the liquids /l/ and /r/ e.g. (rock->wock).  Class deficiencies in producing strident sounds such as /s/ and velar obstruents such as /g/ where notes with 95% of occurrence.  The client’s phonological deviancy score of 81 indicated a severity rating for phonology of profound.  

An additional analysis of phonemes by manner was conducted to address substitution errors and omissions of speech sounds.  Stops (/k/, /b/, /d/, /t/) were deleted in all positions and were replaced by other stops or fricatives.   For example, the final /t/ in “basket” was replaced with /s/.  Fricatives were deleted in the initial and final positions and replaced with stops.  For example, the final /f/ in “leaf” was replaced with /p/.  Affricates were deleted in the initial position or replaced with stops and fricatives.  The nasal sounds were replaced by stops and fricatives.  The glides /j/ and /w/ were deleted or substituted with a schwa.            

The client’s use of consonants was measured by using Percent Consonants Correct (PCC). The PCC was calculated at 13% which indicated a severity rating of severe.  A rating of severe is given with percentages less than 50%.

Insta group of squid

Summary & Recommendations

The client exhibited profound phonological patterns characterized by omissions, class deficiencies and substitutions of speech sounds which are interfering with his intelligibility. Left untreated, his articulation disorder is likely to have negative social and educational consequences.  The prognosis for improved speech intelligibility is good based on the client’s ability to produce 10 of the 24 consonant sounds and parent involvement.    

It is recommended that the client receive direct (1:1) speech therapy services.  The client should begin treatment immediately at the University Speech Clinic.  Four 30 minute sessions are recommended, weekly,  in order to address phonological errors.   An individualized treatment plan based on the cycles approach would be most appropriate for correcting errors.  The speech therapy services will continue for a 10-week block (over the Fall 2017 semester) emphasizing prevocalic singleton omission, cluster sequences omission and stridency errors. 

The client should continue individualized intervention for an additional 8-week block consisting of four 30-minute sessions, weekly, at the University Speech Clinic during the Spring 2017 semester.  The clinician will continue to target the errors outlined above.   It is further recommended that Mrs. Anderson monitor Reece’s articulation in order to document any regression during the break between semesters.     

Long term goal:  The client will increase speech intelligibility.

Short term goals:  The client will increase intelligibility by facilitating the emergence of the following primary phonological patterns:

  • Prevocalic singleton omission (initial /p/ and initial /k/)
  • Consonant cluster/sequence (initial /sp/ and initial /st/)
  • Liquid /r/

As the client’s articulation and intelligibility improve, his language may be further evaluated to assess the further emergence of morphological features.


 

Insta elf joke

TREATMENT PLAN: Cycles Approach

Session 1

  1. Review: The session will begin with a review of the prior week’s production practice word cards.   (30 seconds)

Word cards: Pig, Pea, Pan, Pie, Peach

  1. Auditory Bombardment: The client will listen to 20 words containing the target phoneme/p/ with amplification through headphones.  Reece will place headphones on and listen to the word list with amplification that has been previously recorded on a portable recorder.  (2 minutes)

Word list:

  1. Popcorn
  2. Penny
  3. Pea
  4. Puff
  5. Penguin
  6. Purple
  7. Paw
  8. Peach
  9. Playground
  10. Pear
  11. Pig
  12. Parrot
  13. Paper
  14. Puppet
  15. Peek
  16. Pencil
  17. Plate                              
  18. Pool
  19. Pants
  20. PianoPin Must ReadChildren's Booksfor the month of December
  1. Target words : Reece will color pictures of five target words on 5” x 8” index cards. The clinician will place the 5 index cards on the table and ask the client to select one, label it, and color it.  The label word will be written on the bottom of the index card.  (2 minutes)

Target words: Paw, Pool. Pear. Pig, Pea

  1. Production Practice #1: Reece will participate in experiential play production practice activities.  The first practice activity will be based on a Go Fish game.  Duplicate picture cards containing pictures that correspond with the 20 word list from auditory bombardment are used to play Go Fish.  The clinician will shuffle all 20 cards, give Reece five cards, and keep five matching cards.  The remaining cards go into a pile on the table.   If Reece has a card that the clinician wants, Reece must say the picture on the card correctly before the game can resume.  Also, if Reece wants a card from the clinician, Reece must say the word three times before he gets the card.  (8 minutes)

Antecedent:  The clinician asks Reece if he has a “pants” card reminding Reece that he must say the word “pants” three times before the card can be given.

Response:  Reece hands over the “pants” card.  He says, /ant/, /ant/, /ant/.

Consequence:  The clinician states that he did not hear the /p/ sound at the beginning of that word.

Antecedent:  The clinician models the sound and tells Reece that he needs to hear the /p/ sound. 

Response:  Reece responds /p/.

Consequence:  Great!

Antecedent:  “Now, say /p/ three times”.

Response:  /p/, /p/, /p/.

Consequence:  “Awesome /p/ sounds!  Let’s keep playing”.

Antecedent:  The clinician asks Reece if he has a “paw” card. 

Response:  Reece responds, /aw/, /aw/, /aw/

Consequence:  “I didn’t hear the /p/ sound at the beginning of that word.  You can’t have the card because I didn’t hear the /p/ sound”.

Antecedent:  “Now say /p/ three times”.

Response:  /p/, /p/, /p/

Consequence:  Perfect!  Let’s keep playing.

Antecedent:  “What card did you want Reece”?

Response:  /paw/, /paw/, /paw/

Consequence:   “Excellent Reece!”.

Production Practice #2 – Memory is a fun activity that combines both cognitive and articulation skills.  The clinician makes (2) copies of the five target words.  The target words are on large cards with large type.  The ten cards are turned over and placed on the floor.  Reece will select a card and then try to find the matching card.  When he finds the matching card, he must say the word three times.  (5 minutes)

Production Practice #3– The Treasure Hunt activity will require Reece to find target words around the room.  Target words will be written on large index cards and placed in fairly obvious places around the room.  Reece must find a target word card and say the word three times before placing the card in his treasure chest.  This game will be reserved for extra needed time during production practice.  (5 minutes)

  1. Stimulability Probing: The initial /p/ will continue to be targeted in the next session.  The following words are selected based on stimulability probing.  Reece is asked to imitate the following words:  (30 seconds)

Word list: Push. Pop, Plate, Puff, Peg

  1. Auditory Bombardment: The client will listen to 20 words containing the target phoneme/p/ with amplification through headphones.  Reece will place headphones on and listen to the word list with amplification that has been previously recorded on a portable recorder.  (2 minutes)

Word list:

  1. Popcorn
  2. Penny
  3. Pea
  4. Puff
  5. Penguin
  6. Purple
  7. Paw
  8. Peach
  9. Playground
  10. Pear
  11. Pig
  12. Parrot
  13. Paper
  14. Puppet
  15. Peek
  16. Pencil
  17. Plate
  18. Pool
  19. Pants
  20. Piano
  1. Phonological Awareness Activities: Activities such as rhyming and syllable segmentation of the target words are incorporated for a few minutes each session.  (4 minutes)
  2. Rhyme Detection:

Clinician: “Rhyming words are words that sound the same like boat/coat and shell/bell.  We are going to practice finding words that rhyme.”

The clinician will place two picture cards on the table. 

Clinician: “I’m going to say two words and I want you to tell me if they rhyme.

“Pig/Wig”

“Do they rhyme?”

Reece: “Yes”

Clinician: “Perfect, they do sound the same!  Pig and Wig are rhyming words.”

  1. Rhyme Production:

Place three picture cards on the table.

Clinician:  “I’m going to say a word and I want you to find the rhyming word.”

Clinician: “Find the one that rhymes with Pear ”

Reece: “Hair”

Clinician: “Yes, Pear rhymes with Hair!  Excellent!”

Home Program: The parent is instructed to read a word list to Reece once a day at bedtime.  The word list is as follows:

  1. Popcorn
  2. Penny
  3. Pea
  4. Puff
  5. Penguin
  6. Purple
  7. Paw
  8. Peach
  9. Playground
  10. Pear
  11. Pig
  12. Parrot
  13. Paper
  14. Puppet
  15. Peek
  16. Pencil
  17. Plate
  18. Pool
  19. Pants
  20. Piano

Session 2:

  1. Review: The session will begin with a review of the prior week’s production practice word cards.   (30 seconds)

Word cards: Paw, Pool, Pear, Pig, Pen

  1. Auditory Bombardment: The client will listen to 20 words containing the target phoneme/p/ with amplification through headphones.  Reece will place headphones on and listen to the word list with amplification that has been previously recorded on a portable recorder.  (2 minutes)

Word list:

  1. Popcorn
  2. Penny
  3. Pea
  4. Puff
  5. Penguin
  6. Purple
  7. Paw
  8. Peach
  9. Playground
  10. Pear
  11. Pig
  12. Parrot
  13. Paper
  14. Puppet
  15. Peek
  16. Pencil
  17. Plate
  18. Pool
  19. Pants
  20. Piano

Target words : The client will color pictures of five target words on 5” x 8” index cards. The clinician will place the 5 index cards on the table and ask the client to select one, label it, and color it.  The label word will be written on the bottom of the index card.  (2 minutes)

Target words: Pig, Pop, Push, Pen, Peach

  1. Production Practice #1: Reece will participate in experiential play production practice activities.  The bag activity will be used during this session.  The bag activity consists of placing the five target words on illustrated cards in a bag.  The client will reach in and pull out a target word card naming it as the card is revealed.  The illustrated word cards pig, pop, push, plate and peach are placed in the bag.  (8 minutes)

Antecedent:  The clinician gives Reece a colorful bag.

Response:  Reece pulls out a card and says /ig/

Consequence:  I didn’t hear the /p/ at the beginning of the word.

Antecedent:  “Make the /p/ sound  with that burst of air from your lips”.  Like this /p/.  (Clinician puts finger to lips and models the sound /p/).

Response: /p/ (holding finger to lips)

Consequence:  “That’s it!  That was a great /p/ sound”.

Antecedent:  Say “pig”

Response:  /pig/

Consequence:  “Wonderful!” 

Antecedent:  “Now say “pig” 3 times”.

Response:  /pig/, /pig/, /pig/

Consequence:  “I like the way you are putting the /p/ sound on the beginning of the word Reece”.

Antecedent:  The clinician gives Reece a colorful bag.  “Remember to put the /p/ sound on the beginning of the word .”

Response:  Reece pulls out a card and says /pop/

Consequence:   “Wonderful!  I heard the /p/ at the beginning of the word.”

Antecedent:  Now say “pop” three times.

Response:  /pop/, /pop/, /pop/

Consequence:  “Excellent!  Find another word!”

Production Practice #2– The sound race activity will be used during this session.  The clinician will draw two “roads” on a piece of paper (looks like a Candyland road with clearly outlined spaces to the finish line).   The clinician and Reece place a car on the starting line and the race begins.  The clinician will think of new target words and require Reece to clearly articulate Take turns saying the words and move the racecar forward as you say the word correctly. The first one to the end of their road is the winner. (5 minutes)

Production Practice #3– The Treasure Hunt activity will require Reece to find target words around the room.  Target words will be written on large index cards and placed in fairly obvious places around the room.  Reece must find a target word card and say the word three times before placing the card in his treasure chest.  This game will be reserved for extra needed time during production practice.  (5 minutes)

  1. Stimulability Probing: The initial /k/ will be targeted in next week’s session.  The following words are selected based on stimulability probing with the initial /k/.  Reece is asked to imitate the following words:  (30 seconds)

Probe List: Cat, Cut, Kiss, Cake, Cape

  1. Auditory Bombardment: The client will listen to 20 words containing the target phoneme/p/ with amplification through headphones.  Reece will place headphones on and listen to the word list with amplification that has been previously recorded on a portable recorder.  (2 minutes)

Word list:

  1. Popcorn
  2. Penny
  3. Pea
  4. Puff
  5. Penguin
  6. Purple
  7. Paw
  8. Peach
  9. Playground
  10. Pear
  11. Pig
  12. Parrot
  13. Paper
  14. Puppet
  15. Peek
  16. Pencil
  17. Plate
  18. Pool
  19. Pants
  20. Piano

insta just throw it in the bag

  1. Phonological Awareness Activities: Activities such as rhyming and syllable segmentation of the target words are incorporated for a few minutes each session.  (4 minutes)
  2. Rhyme Detection:

Clinician: “Rhyming words are words that sound the same like boat/coat and shell/bell.  We are going to practice finding words that rhyme.”

The clinician will place two picture cards on the table. 

Clinician: “I’m going to say two words and I want you to tell me if they rhyme.

“Peach/Teach”

“Do they rhyme?”

Reece: “Yes”

Clinician: “Perfect, they do sound the same!  Peach and Teach are rhyming words.”

  1. Rhyme Production:

Place three picture cards on the table.

Clinician:  “I’m going to say a word and I want you to find the rhyming word.”

Clinician: “Find the one that rhymes with pen”

Reece: “ten”

Clinician: “Yes, pen rhymes with ten!  Excellent!”

Home Program: The parent is instructed to read a word list to Reece once a day at bedtime.  The word list is as follows:

  1. Popcorn
  2. Penny
  3. Pea
  4. Puff
  5. Penguin
  6. Purple
  7. Paw
  8. Peach
  9. Playground
  10. Pear
  11. Pig
  12. Parrot
  13. Paper
  14. Puppet
  15. Peek
  16. Pencil
  17. Plate
  18. Pool
  19. Pants
  20. Piano

Session 3

Review: The session will begin with a review of the prior week’s production practice word cards.   (30 seconds)

Word List: Cat, Cut, Kiss, Cake, Cape

Auditory Bombardment: The client will listen to 20 words containing the target phoneme/p/  with amplification through headphones.  Reece will place headphones on and listen to the word list with amplification that has been previously recorded on a portable recorder.  (2 minutes)

  1. Cat
  2. Camel
  3. Coke
  4. Kiss
  5. Cut
  6. Cape
  7. Comb
  8. Car
  9. Kit
  10. King
  11. Key
  12. Kick
  13. Can
  14. Kid
  15. Kite
  16. Cup
  17. Cash
  18. Cast
  19. Cop
  20. Cook

Target Word Cards: The client will color pictures of five target words on 5” x 8” index cards.  The clinician will place the 5 index cards on the table and ask the client to select one, label it, and color it.  The label word will be written on the bottom of the index card.  (2 minutes)

  1. Kite
  2. Cup
  3. Kiss
  4. Kick
  5. Cake

Production Practice #1: Reece will participate in experiential play production practice activities.  The game that will be played for the session for production of initial /k/ is Catch a Word!  Reece will have a small plastic fishing pole with a magnet tied to a string that is attached to the pole.  Target words with a paper clip attached to each will be placed on the floor.  As Reece “catches the word”, he will have to say the word in order to get another turn.  (8 minutes)

Antecedent:  Clinician:  “Let’s go catch a word!  What did you catch?”.

Response:  /pup/

Consequence:  “ I heard the /p/ sound.  We are practicing the coughing /k/ sound at the beginning of the word”. 

Antecedent:  “Watch me.  This sound is made in the back.  This is how we make the /k/ sound.   Now it’s your turn, say the coughing /k/ sound”.

Response:  /p/

Consequence:  “No, that is the /p/ sound that is made in the front of your mouth”.

Antecedent:  “Try making a coughing sound /k/ in the back of your mouth”.

Response:  /k/

Consequence: “Yes, that’s it!”

Antecedent:  “Now say /k/ three times”.

Response:  /k/, /k/, /k/

Consequence:  “Great Reece.  Let’s go catch another word!”

Antecedent:  “What did you catch?”

Response:  /kip/ for cake

Consequence:  “I like the way that you remembered to put the /k/ sound on the beginning of the word “cake”.

Antecedent:  Say /k/

Response:  /k/

Consequence:  “Terrific!” 

Antecedent:  “Say cake three times.”

Response:  /ki/, /kip/, /kik/

Consequence:  “Great!  Let’s go catch another word!”

Production Practice #2– Bean Bag Toss: The clinician places the target word cards in a row on the floor. A card is randomly selected from a pile of cards on the table.  Reece stands a few feet back and tosses the bean bag on the selected card. Reece must say the word the bean bag lands on before selecting a different card from the pile.  (8 minutes)

Production Practice #3– The flashlight activity will consist of the clinician placing target word cards around the room.  The clinician will turn the light off or dim the lights.  Reece must find the target word cards with a flashlight.  He will label the target card upon discovery before looking for another card.  This game will be reserved for any extra needed time needed with production practice activities.  (5 minutes)

  1. Stimulability Probing: The initial /k/ will be targeted in next week’s session.  The following words are selected based on stimulability probing with the initial /k/.  Reece is asked to imitate the following words:  (30 seconds)

Word List: Car, Cut, Can, Key, Cape

Listening Activity: Auditory with amplification is repeated.  Headphones are used with a recorder and using the word list from the auditory bombardment sequence.  (2 minutes)

  1. Cat
  2. Camel
  3. Coke
  4. Kiss
  5. Cut
  6. Cape
  7. Comb
  8. Car
  9. Kit
  10. King
  11. Key
  12. Kick
  13. Can
  14. Kid
  15. Kite
  16. Cup
  17. Cash
  18. Cast
  19. Cop
  20. Cook

Insta Teachers never really grow up

  1. Phonological Awareness Activities: Activities such as rhyming and syllable segmentation of the target words are incorporated for a few minutes each session.  (4 minutes)

Rhyme Production:  “What word rhymes with “kid”?  Hide, Goat, Lid

Rhyme Oddity: “Which word does not rhyme with car?” Star, Cat, Box

Alliteration Oddity:  “What word does not start with the same sound as “cup”?  Cop, Mutt, Key

Phoneme Deletion:  “Say cape without the /k/.”

Home Program:  The parent is instructed to read a word list to Reece once a day at bedtime.  The word list is as follows:

  1. Kit
  2. Cat
  3. Cot
  4. Coke
  5. Kiss
  6. Cut
  7. Cape
  8. Comb
  9. Car
  10. Kit
  11. King
  12. Key
  13. Kick
  14. Can
  15. Kid
  16. Kite
  17. Cup
  18. Cash
  19. Cast
  20. Cop

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