Fluency is scary!
I remember reading a survey in the ASHA Leader years ago that stated something like 40% of school-based SLPs were comfortable treating fluency disorders. I was stunned! I love fluency disorders! I’m working towards my Board Certification in Fluency Disorders! It’s my favorite part of the field! I wondered - why did other school-based SLPs think it was so scary? I surveyed my SLP friends and came to one main conclusion:
- Graduate programs don’t properly prepare clinicians for “real world” cases. My friends from various graduate programs all seemed to report that they could teach fluency shaping strategies (e.g. easy onset, pull-outs, light contact, etc.); however, the emotional and cognitive aspects of fluency were foreign. They knew that teaching fluency shaping strategies alone wasn’t enough, but figuring out how to address the other aspects was a daunting prospect.
What about you? Does treating fluency disorders scare you? Let me know why or why not in the comments. For the next three weeks, I’ll be covering assessment and treatment of adolescent fluency disorders in a three part series I’ve named “Functional Fluency.” Hopefully this series of posts will give you some new ideas to test out, regardless of your comfort level with fluency disorders! Let’s get started.
Ms. Hall, Is Anyone Ever 100% Fluent?
How many of you have Adolescents Who Stutter (AWS) on your caseloads with goals that read a little something like this:
“By 10/16, given an initial cue, Bobby will use fluency shaping strategies (e.g. easy onset, light contact, pausing, etc.) to achieve 90% fluency in conversation in the structured speech therapy setting across three sessions as measured by clinician observation and data.”
Wow, 90% fluency in conversation! What an awesome goal! That’s what every anxious, embarrassed, “I-just-want-to-be-normal” stuttering teen desperately wants, right? Unfortunately for their desire to blend in, it’s our job as competent clinicians to NOT give them a goal like this.
“What!?” you may cry, “Why not? What’s wrong with a goal like that? Increased fluency is the ultimate goal, right? We’re only successful when our students stutter less!”
I’ll tell you why I find goals written like this to be problematic and why we need to distance ourselves from the idea that increased fluency is the ultimate goal for AWS.
How many of your AWS have amazing days where they are so wonderfully fluent that you feel like the most competent SLP in the world? How many of your AWS then come back the next week, a dysfluent, anxious mess and you wonder if they’ll ever be close to hitting that 90% target you set at their IEP a few months back?
This is the reality of fluency disorders: Your AWS will have good days and bad days. Unlike articulation and language, where we hope our interventions stick and their disorders remain manageable long after we’ve exited them from services, your AWS are likely going to be managing their views on stuttering and their strategies for attaining fluency forever. If we keep focusing solely on the narrow idea of increasing fluency, we miss the bigger picture.
So What’s the Big Idea?
Hopefully none of what I’m saying is brand new information to you. But I’ve even caught myself writing a % fluent goal for a student; I had to force myself to take a step back from the IEP and examine what exactly it was that this student needed. The main point I think we have to remember when designing a treatment plan for AWS is that our goals and treatment have to address the underlying concerns - not just the outward, fluent behaviors.
Case Study: One day out of the blue, a 17-year-old student came to me after school and said that he had never had speech therapy but that he stuttered and he wanted help. We sat down and started talking about the goals he wanted to accomplish. “I don’t want to stutter anymore,” he told me with perfect fluency. As we talked, it became painfully obvious that he was a textbook covert stutterer - he was obsessed with “how much” he stuttered; he had never spoken to his parents about his stutter; he circumlocuted, used many filler words, and often started sentences with the word “so” in order to get around a block. He knew absolutely nothing about stuttering.
So… did I write him a % fluent goal and hammer techniques until he’s an easy onset and light contact machine who never once stutters? He was already ~98% fluent, so would a 100% fluency goal been truly appropriate? Of course not. But if we’re not measuring an AWS’s success on % fluency, then how are we supposed to measure progress?
Short-Term and Long-Term Goals Ideas:
There’s no right way to answer the question of measuring progress. Below you’ll find some examples that I have used to move beyond the standard fluency % when writing goals. Again, all students are different and you may very well have AWS on your caseload who have needs that stretch far beyond these samples! Trust your clinical judgement; you know your students and their needs, even if it does take a little bit of mental effort to sort it all out.
“By 10/16, given moderate clinician support, Bobby will create a short presentation about fluency (e.g. types of dysfluencies, the speech mechanism, famous people who stutter, etc.) and deliver it in a classroom presentation as measured by clinician observation.”
“By 10/16, Bobby will independently write a short essay (3 - 5 paragraphs) discussing (i) different types of dysfluencies (ii) why it is OK to stutter (iii) how it feels when stuttering “takes control” and (iv) how his perception of stuttering has changed since his previous IEP meeting as measured by student work samples.
“By 10/16, Bobby will independently tell three of his new 11th grade teachers that he is a Person Who Stutters as measured by observational data.”
“By 10/16, given minimal clinician assistance, Bobby will research at least 2 stuttering social media groups (e.g. National Stuttering Association, Stuttering Foundation, etc.) and write a short essay on what he learned about the community of People Who Stutter as measured by student work samples.”
I hope discussing the need to abandon measuring % fluency as progress has helped you to better define the needs of the AWS on your caseload. Next week I’ll discuss my go-to ideas for activities and resources for use when conducting sessions with AWS.
As always, it doesn't have to be fancy, just keep it fun and functional!
- Jillian, the No-Frills SLP
No comments:
Post a Comment