How do I conduct an assessment that is focused on the client’s preferred activity?
To ensure the client’s preferred activity is the focus of your goals, start your evaluation by determining client priorities. After that, you can select some assessments – formal or informal, as needed – that specifically inform the activity that is important to the client. This is a patient-centered approach to goal-setting (Leach, Cornwell, Fleming & Haines, 2010).
For example, a young adult with aphasia is the parent of young children who comes to you for intervention. Let’s imagine that, for this person, being able to say important things to the children (like, “Stop that!” Get down from there!”, or “I love you”) is critical, along with being able to read a bedtime story. If we know this first, before we even give any standardized assessment, we can tailor our tests to those that will very specifically relate to those personal priorities. Can the person express imperatives in any form such as gesture, intonation, some words? Can the person read single words or short phrases aloud – specifically, those with children’s level vocabulary? Or, can the person repeat single words of that same type from children’s stories? These are the skills that we need to know. The oral reading score on a standardized aphasia battery provides some information about this but doesn’t really give you everything you need to move quickly into personally relevant goals and therapy planning.
Our goal is to make every minute of contact time contribute to the achievement of one or more personally relevant priority goals. Using the Goal Attainment Scaling (GAS), an evidence-based approach, can help ensure that a client is fully engaged in setting their rehabilitation goals. It is a collaborative approach in which the client and clinician agree to a goal – such as being able to read a simple Dr. Seuss book to their child. Then, together, the client and clinician establish criteria levels for what the outcome of working on this goal might look like, and both client and clinician select a pre-treatment rating level. After a pre-determined amount of treatment time, both client and clinician assess the outcome level, using the same criterion scale. This approach is a great way to incorporate person-centered care with pre/post-treatment measures and would be easy to include in many documentation requirements.
Refer to the SpeechPathology.com course, 20Q: Goal and Treatment Selection in Aphasia in 20 Sessions or Less, for more information on goal-setting and treatment selection for aphasia during time-limited situations.