The Challenge of Working on Speech and Language Goals With High School Students

I once had a student I'll call Everett.  Everett was a student with Autism who was a freshman in high school.  His Autism manifested itself as rigid thinking, difficulty respecting or realizing that others had valid points of view, and he wasn't the greatest conversationalist, not bad, but not great.  In addition, he had some fairly significant learning challenges in all academic areas.   He was passed along to me from the middle school SLP with social goals in the area of conversation.

And so, each week we would meet and practice conversational skills such as judging what topics were appropriate for school, how to end a conversation (he used to just walk away when he was done talking), and how to build on the comments of others rather than just talking about himself.  He was making progress and I was able to fill my data log with evidence that he was meeting his goals.  I felt like an awesome therapist.

Then, one day I went to get him out of his study hour to once again work on his designated IEP goals when I found him in front of a computer stressed over an assignment for history.  He had to create a timeline of events and he was working back and forth between an illegible handwritten list of notes and a typed list of events provided by the teacher.  He was pulling his hair out trying to create the list in order as he now couldn't read his handwriting.  He also said his teacher wanted him to do the assignment in Powerpoint or some other presentation software and, it was clear he didn't have any idea what PowerPoint was.  And, while he did have a computer at home, he didn't have any idea if it even had Powerpoint.  At this point, I threw out my plan to work on his conversation skills and mentally rearranged my schedule as I knew I was not going to get to my next student that hour either. Conversation skills were not what he needed right now.

And so, I dropped everything and helped him create a Google account.  He created a username and password which I made him copy down into his binder for future use. I also kept a copy in my notes and emailed a copy to his history teacher.  Then, I showed him how to use Google slides, a presentation app that works similarly to Powerpoint but that he would be able to access from home.  While his family had limited resources, they did have wifi.  He could even access it from his smartphone. He argued with me the entire time. "I'll do this at home," he said, "We probably have a powerpoint on my computer."  "No," I said, "we are doing this and you will thank me later."

So we open Google slides and I show him how to make a title page and add a slide.  Then I say, "Pick an event off of your list, any event."  He fights me because he doesn't know which event goes first and he wants to wait until he finds the first event in the timeline before he enters it into the presentation.  I pick the first item on the list and have him look up the date and necessary information.  Then I make him type it onto the slide while he continues to protest that it will not be in order.  Then, I make him pick another event and he looks it up and locates the date and info.  I force him to make a new slide and type in the info for the second event.  Now he is red-faced and yelling because this event actually happened before the first event he had entered.  I shush him.  "Watch!" I say.  Then I clicked on the second slide to drag and drop it in front of the first event.  Now they are in order.  I watch his face which looks like he just came downstairs on Christmas morning and got every present he asked for.  "Wow!" he said.  I can just move them around any way I want!"  "Tell me I'm a genius," I say and he does. The stress on his face is gone and he has learned to use a very powerful tool that can help him with his homework.

And so, this is my life as an SLP in a high school.  I have all of these carefully crafted goals that were painstakingly written based on the needs of the student in the month leading up to the IEP.  I know that the middle school SLP interviewed teachers and did classroom observations and teamed up with the social worker to create the goals that were included in Everett's IEP. And, he does need help in those areas, but sometimes he needs help with other things that are just as important.  With his new knowledge of Google slides he whipped through that assignment in a fraction of the time it would have taken him using the method he was using when I came upon him in study hall. And, this is a tool he can use again and again.  But, I was left with a quandary, what do I write in my data log?  We did ZERO work on his assigned goals so I couldn't report any progress.  I certainly didn't feel I could bill Medicaid for the work I had done with him.  So, I did the only thing I could think to do, I was honest. I wrote exactly what I did with Everett and how it benefited his ability to access the curriculum.  I wrote a nonbillable entry for Medicaid because the work we did wasn't goal related.

So, what's the big deal? Just help the kid and give him what he needs, right?  Well, that seems reasonable until the parent hires a lawyer or advocate and they start going through your data with a fine tooth comb.  I have had the pleasure of facing vindictive advocates, lawyers, and parents in the last several years and, even though parent's issue had nothing to do with speech, and I have had my therapy notes criticized because I didn't have data about progress toward the designated goals in every entry.

Although I am an SLP, I have had to assume multiple roles with my high school students that have little to do with speech or language.  I have consoled students who got dumped.  I have helped students get their schedules changed when there was an issue with a class.  I have helped students apply for vocational programs.  Why am I getting involved in non speechie business? As an SLP I have the unique experience of being one of the only people that they have face to face individual contact with on a regular basis.  I might be the one they choose to tell when they suffer abuse at home or get evicted from their apartment.  And, when they are sharing this information with me, their IEP goals are the last thing on my mind.

And, while I understand the need to write specific, measurable goals, I sometimes feel hogtied by them.  Our goals are so specifically defined that there is little room to address other needs that come up.  Some days I could really give a rats ass if by 2:25 sharp on the first full moon of autumn, 10th grader Beyonce can verbally explain the meaning of 10 specific curriculum vocabulary words with 80% accuracy over 3 observations as measured by the Who Gives a Crap Test of Vocabulary. Seriously?  When Beyonce has 8 missing assignments and is about to fail US History, I think I will be helping her complete one of those missing assignments even if it doesn't involve one of the predetermined curriculum vocabulary words that she will likely never use again once she walks across the stage at graduation.

At the end of the day, our job is to help the student access the school curriculum.  Some days that means helping them learn the vocabulary words specified in the IEP and sometimes it means helping them with homework, teaching them to use a computer program, or helping them cope with life.  And, if that makes me a bad SLP then so be it.