S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Play-based, child led therapy, along with structured language tasks utilized. Speech sounds assessed informally. Use of timers for transition out of treatment utilized but noted to be unsuccessful. Some crying/throwing of objects noted when transitioning out of treatment. O: Noah’s speech intelligibility throughout session is noted to be at 65% to 75% intelligibility based on context. Noah participated in a color identification game. He identified the colors blue, red, yellow, and purple with 30% accuracy. Noah was probed with a letter identification activity in which he circled or colored the letter “a” (both uppercase and lowercase) with a model in a field of other letters. He completed the activity with 30% accuracy. Noah also completed a structured following directions activity with 40% accuracy. A: Color identification and following directions continue to be at baseline. Intelligibility displays slight increase across contexts. Letter identification probed with baseline to be established. P: Continue updated POC. Add letter identification goal.

Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Play-based, child led therapy, along with structured language tasks utilized. Speech sounds assessed informally. Use of timers for transition out of treatment utilized and continue to be successful. O: Noah continues to increase his MLU with SLP. His overall intelligibility displays some increase, repeating slowly, then from model PRN when not understood. Noah was again probed with color identification activity to establish a baseline. He completed the activity with 20% accuracy. He was also probed again with following 1-step directions with 2 key words (e.g. give the pencil to the bear (when provided with 2 objects and 2 animals)) to establish a baseline. He completed the activity with 40% accuracy. Noah was also probed with a sight word activity. He completed the activity with 30% accuracy given moderate to maximal support. A: Noah’s MLU continued to display great progress. Baselines have been established for color identification and following directions with multiple key words. Noah’s intelligibility and stimulability are noted to be at a stable level. Pre-primer sight words utilized in sight word activity. Noah is noted to be emergent with sight word recognition. P: Update plan of care to reflect color identification goal, sight word goal, following directions goal. Probe letter identification and add to POC.

S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Play-based, child led therapy, along with structured language tasks utilized. Speech sounds assessed informally. Use of timers for transition out of treatment utilized and continue to be successful. O: Noah continues to increase his MLU with SLP. It is noted that his intelligibility during activities tends to decrease when excited, but he will repeat models of sounds/words when provided. Object function was probed again in session in a field of 3. Noah completed the activity with 80% accuracy. Noah was probed with color identification activity. He completed the activity with 40% accuracy. He was also probed with following 1-step directions with 2 key words (e.g. give the pencil to the bear (when provided with 2 objects and 2 animals)). He completed the activity with 55% accuracy. Speech intelligibility informally targeted. Noah’s average intelligibility throughout session ranged from 60-70% depending on context. A: Noah’s MLU displays great progress. Object function displays increases from initial probe. Color identification tasks are noted to be difficult for Noah, as well as directions with multiple key words. Noah’s intelligibility and stimulability are noted to be at a stable level. P: Discontinue MLU goal. Continue to informally assess and target informally as needed. Monitor object function goal and add to POC as deemed necessary. Continue to probe color identification and following 1-step directions with 2 key words. Continue speech sound goals as written in POC.

S: Noah was seen at the Batt School for treatment. He had difficulty with transitioning to treatment and was noted to cry and scream upon entry. Calming strategies were utilized (e.g. take a deep breath, choose a preferred activity) and successful. After initial difficulty with transition to speech, Noah worked well with SLP. Play-based, child led therapy, along with structured language/speech sound tasks utilized. Use of timers for transition out of treatment utilized and successful. O: Throughout play-based activities, Noah was noted to use increased MLU during play activities, often engaging with SLP and asking/answering questions. Object function was probed in a field of two answer choices with 60% accuracy. Noah also produced /l/ across positions of words. When provided a model, he produced the /l/ sound with 70% accuracy across positions. Noah’s overall speech intelligibility throughout the session ranged from 50-60% accuracy depending on context. A: Noah displays continued increases in MLU and is engaging more with SLP. /l/ sound continues to be practiced as an interdental /l/ to promote correct production. Speech intelligibility ranges throughout session depending on activity and excitement level. P: Continue with current POC with a continued probe for object function prior to adding to POC.

S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Throughout session, play-based, child led therapy was utilized along with structured language/speech sound tasks. It was noted that Noah had difficulty transitioning out of treatment session. Use of timers will be utilized in future sessions to assist with this. O: Throughout play-based activities, Noah was noted to use increased MLU during preferred play activities. Present progressive was also worked on within the session. Noah independently produced the present progressive form of a variety of verbs with 80% accuracy. He also worked on /l/ and /r/ sounds across positions of words within connected speech. He was noted to produce speech sounds within sentences with 60% accuracy. A: Noah displays continued increases in MLU. He is maintaining his use of the present progressive and generalizing it into conversation/play. Speech intelligibility at the sentence level is noted to display some deficits, with some stimulability concerns when compliance is decreased. P: Continue with current POC. Introduce use of timers to assist with transitions between activities as well as transitions from treatment to home.

S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Throughout session, play-based, child led therapy was utilized along with structured language/speech sound tasks. O: Throughout play-based activities, Noah was noted to use 3-4+ word utterances with minimal to no cueing for utterance expansion. Present progressive was also worked on within the session. Noah independently produced the present progressive form of a variety of verbs with 90% accuracy. He also worked on a variety of speech sounds across positions of words within connected speech. He was noted to produce speech sounds within sentences with 60% accuracy. A: Noah displays increases in MLU. He also displays increases with use of the present progressive. Speech intelligibility at the sentence level is noted to display some deficits. P: Continue with current POC.

S: Noah was seen at the Batt School for treatment. He was eager to work with the SLP and compliant throughout the session. Continued rapport building noted throughout session. Throughout session, play-based, child led therapy was utilized along with structured language/speech sound tasks. O: Noah was asked a variety of “wh” questions (i.e. who, what, where) in a field of two visual answer choices. He answered the questions with 60% accuracy. He also worked on the /l/ sound in the initial position of words. He completed the activity with 60% accuracy. Throughout play-based activities, Noah was noted to use 3-4 word utterances with minimal to no cueing for utterance expansion. Present progressive was also worked on within the session. Noah independently produced the present progressive form of a variety of verbs with 80% accuracy. A: Noah was noted to show minimal interest in “wh” question activity. Presentation will be flexed for future sessions. Some stimulability for /l/ sound observed. Interdental /l/ was utilized to assist with positioning. P: Continue with current POC.

S: Noah was seen at the Batt School for an initial treatment session with a new SLP. He was timid when transitioning into the treatment room, but he began to open up with SLP as session progressed. Session is noted to be a rapport building session with probes of previous speech/language goals. O: Goals were informally assessed via play activities/rapport building. A: Goals were informally assessed and deemed to be appropriate to continue in POC. Noah displays some communication breakdowns within conversation d/t rate of speech and speech intelligibility. Length of utterance appears WFL. Use of the /l/ sound within words is noted to be difficult for Noah. Verbal/visual models assist with intelligibility displaying stimulability for speech sound goals. P: Continue with current POC.

Noah was very excited for his session today. He greeted the clinician with a big hug and transitioned well into the session. Worked on 3-4 syllable words using dot paint to mark all syllables. 90% accurate. Noah requested to play the banana monkey game so we worked on some fine motor skills while also working on conversation. Noah was in his santa hat so he practiced greeting many teachers/staff.

Noah worked on formulating age appropriate sentences while looking at books/picture cards. He did excellently with this today.
Present progressive was heard in many sentences without prompts.

Noah greeted the clinician with a big hug and was very excited for his session. Noah worked on multi syllabic words initially. He worked on using dot paints to tap out the words. He focused on 3 & 4 syllable words today. Words with L were the most challenging for him today. ~75% accuracy.
We then took a break outside where we discussed the sky and how it looked like it was going to storm. We worked on some S-blends while outside. These were challenging, even with tactile cues. Once back inside, we focused on action picture cards. Noah engaged well during this activity because he was able to dot paint the actions. His accuracy is increasing significantly with these actions in addition to him using 3+ words together to describe them. 'Doggy is digging,' 'baby is happy,' 'catching a fish.' Lastly, Noah requested play doh where he worked on actions such as cut, roll, etc.