Welcome to Week 3 in the Speech Therapy Makeover series! I’m challenging myself to “make over” some traditional speech therapy tasks so they will be more person-centered (functional, meaningful, and relevant for the people we work with). We know that person-centered care offers the best results across the board for outcomes, patient satisfaction, and efficiency of meeting goals.
Week 3 Speech Therapy Makeover Task: Clinician-centered goals: “The patient will be educated about speech therapy goals at first treatment session due to time constraints today.”
Let Me Explain: I can’t be the only one who has ever written at the end of the report that I will review the therapy goals with the patient at the first treatment session. To simplify, this means that I set the goals without the Person and I’m letting him/her know what we are doing in speech therapy when I see them next. Traditionally, SLP evaluations were completed in this order:
- Formal Assessment –> Impairment-Based Results –> SLP sets goals based on results and relays these goals to the Person
The Challenge: The sequence described above is clinician-centered, not person-centered. Person-centered care has a different structure for what an evaluation should look like. Consider the following sequence instead:
- FIRST: Person-centered interview to determine priorities and values. Through the interview, the SLP is able to offer knowledge and expertise to explain how SLP could address a problem or priority. This information is key for person-centered goal setting, and you can dig further into certain items to obtain baseline info (“You said you wish you could say where you want to golf. What golf course names are you able to say today?”). I’ve created templates in my Home Sweet Home Series and Back To Work Series to structure the interview so I can dive right into what a person is already doing and what they want to be doing, from an activity/participation standpoint in the home or work environment. This is the “meat and potatoes” of the information I need for an evaluation in order to set person-centered goals.
- SECOND: The SLP conducts a formal assessment based on the conversation. Testing measures will depend on the goals determined collaboratively, so as the SLP you will be deciding what testing to do at this point in the evaluation.
- THIRD: Collaborative goal-setting and treatment selection based on priorities of Person/family and results of assessment. The Person not only has input to what goals are set, but also the methods in how to meet those goals.
Person-Centered Ideas: The third step of a person-centered evaluation felt both scandalous and freeing to me when I started working this way. So, if someone couldn’t recall +5/5 unrelated words, but they were not concerned with their memory and expressed that they did not want to address memory…..this meant I didn’t work on memory? Yes, that’s exactly what it meant. I prioritize what the Person wants to address. By doing this, I easily establish a working relationship so that I can bring up future conversations about memory if needed, and at the minimum educate the Person that I am available to address that if their priorities change. We are teammates in therapy so together we decide how we will proceed in meeting goals.
Setting Goals: Step 1 of a Person-Centered Evaluation is rich in person-centered goal ideas. Instead of writing generic goals (“The patient will comprehend 3-step commands with 90% acc.”), I am really focusing in on more specific goals as they direct my therapy to be person-centered and focus on what that Person needs to do (“The patient will comprehend 8+ digits over the telephone to simulate work environment, with 95% acc and independence with using comprehension repair strategies.”)
Thanks for reading! If you would like more person-centered therapy ideas, please check out the Home Sweet Home Series and the Back To Work Series. Be sure to follow on Facebook or Pinterest, or sign up for email updates to receive the series right in your inbox. If you have any ideas of speech therapy tasks you think need a “makeover”, email me at [email protected].
Your comment about informing pts of therapy goals at first treatment session is well informed. Unfortunately, in today’s SNF environments, SLPs are usually expected/encouraged to complete the POC quickly at the time of assessment. So SLPs may need to learn how to incorporate pt input into goals into the POC in an efficient manner. I wonder if formal assessment based on conversation would be considered adequate for Medicare as long as that conversation is followed by formal tests. Would the results of the formal conversation assessment would be included in the evaluation report/POC. I do think these ideas to move toward patient-centered care are the way we should plan and treat, but I’m just concerned about the constraints of the SNF expectations and docment software.
Hi Kathleen! I agree there are challenges with productivity in various settings. In terms of incorporating person-centered goals efficiently, could an SLP consider basic communicate wants/needs in the SNF setting such as making phone calls, communicating with a doctor, or verbalizing a leisure activity as a way to use participation in goals? In many settings I have worked in, the formal testing by SLP is emphasized–and I think if we can re-prioritize how important the Person’s input is, the testing obviously still needs to be done but becomes less important in terms of setting the actual goals. In the settings I’ve worked in with impairment-driven goals set already in the documentation, I just switched to using my own bank of goals in the “other” or free-bank space. Thanks for the conversation!