Recently, I presented a podcourse for Speech Therapy PD where I boldly stated that SLPs need to be moving away from writing goals for percentages of fluent speech. This is not a new concept, and I am not the only professional saying this out loud! For example, see Scott Yaruss's blog post on this subject: Why don't we write goals about fluency?
Following my comment, one SLP Facebook group had a lively discussion about goal-writing and stuttering therapy. Truly, the idea of therapy planning for students who stutter brings up strong opinions. These opinions are based upon our philosophies of therapy, how we were trained, and how we view the disorder and its impact on the communication of our students who stutter.
Since the Facebook interactions, I presented a one-hour professional development for SLP Summit in January. During that presentation and in the questions that followed, I realized that I wanted to provide my own thoughts here on our blog page.
I have also received some follow-up questions from colleagues who wondered specifically about my statement that when goals are written for % of fluency, they could be challenged by a savvy parent. The goal of my comment was to stir all of us to broaden our view of what we are trying to measure in stuttering therapy. Why can a parent challenge this goal? Well, stuttering, by its nature, is variable.
Here is one example:
If we take data on Tuesday AM and the child doesn't stutter much...we are fabulous, right? Therapy is working, right? He is meeting his goals, right? Then on Thursday, we take data and the student stutters up a storm. Well, we have failed, right? The student isn't working hard enough, right?
To be certain, because of the variable nature of stuttering, any parent (or professional) who understands the true nature of the disorder of stuttering would be able to challenge a goal written to demonstrate progress in terms of consistent percentages of fluent speech.
OR...here is a scenario that is even more problematic:
What if on Tuesday our measures of 90% fluency (arbitrary) were met because the student was hiding his stuttering (changing words, using "um/uh" as starters, not saying all that he wanted to say). Then on Thursday, he was "stuttering well" because he was desensitized to showing stuttering and allowed himself to communicate freely; irrespective of stuttering. Now, which one of these scenarios demonstrates the outcome of effective communication? Of course, it is the child who stutters freely and doesn't avoid. However, this student would "never master" the arbitrary fluency goals! Need we say more?
Suffice it to say, I am not "anti-fluency." I am "anti-expectation of fluency!" I would be remiss if I didn't mention that I believe enhanced fluency can be a goal of stuttering therapy. A child's ability to utilize strategies that enhance the ease and flow of speech can be measured in stuttering therapy. However, neither of these concepts are the full measure of effective intervention! In fact, most students can't use techniques or enhance their fluency with any consistency or for any length of time unless they are also working on the cognitive/affective aspects of the disorder, helping the environment understand and support them in their communication, and decreasing the potential negative impact of stuttering on their quality of life.
To summarize, broad-based assessment leads to broad-based goals and broad-based treatment. HOW we write goals (and collect data) is important, but what is more important is WHY we are writing the goals! Effective communication for those who stutter comes from feeling that what they have to say is more important than how they are saying it. Students who stutter need us to understand that learning how to handle the disorder if stuttering is much more complex than learning how to handle a moment of stuttering.
For more information, check out our free Practical Tip Handout on writing treatment goals for stuttering therapy.
For a more comprehensive look at stuttering therapy for early childhood and school-age students who stutter, see: