Improving Patient Outcomes Through Report Writing

A comprehensive SLP case study and sample report analysis in the high school setting.

In the school setting, reports are the most important things you will write. They are usually the single piece of communication sent between practitioners, and they are typically only written every 3 years. Let me repeat that: EVERY 3 YEARS. That is not very often, and a lot can change in 3 years, especially when you are working with adolescents. So, as SLPs, it is crucial to write thorough speech and language reports. And if you're someone who feels like 'no one even reads them anyways', I'm here to tell you I do! I read *almost* every single report written about the students on my caseload, including psych reports. When it comes time for a triennial, I do a deep dive into previous progress reports, SLP and psych reports, and goals. How do you expect to write a comprehensive speech and language report if you don't put in the legwork? Through comprehensive report writing, we can improve patient outcomes. Granted, I love diagnostics, and my background is in research, so I thoroughly enjoy writing reports. It's is one of my favorite pastimes! I know report writing is not everyone's favorite, which is why I am providing a comprehensive sample report at the end of this post!

For the most part, triennials can be pretty routine, especially if you've worked with a student for a while. But, that's not the case for all of them. Last week, I finished writing one of the most difficult reports to date -- and I used to do swallow diagnostics at the hospital, so that's saying a lot.

Case Study

A 14-year-old male transferred into the high school district in early October. He is currently a freshman. There is no record of him attending school in 6th grade, and he was pulled from 7th grade after a few months, and no record of schooling since then. He was found eligible for special education under Emotional Disturbance and Other Health Impairment (ADHD and anxiety) and was receiving speech and language services for articulation and language. His most recent speech goals (in 2019) were 'th' production and figurative language, so it appeared he had made some great progress since his initial evaluation. On his last IEP, his mom had reported concerns with his socialization and short-term memory. Because this student had not been in school for 2 whole years, I wanted to do a comprehensive speech and language evaluation, which meant articulation and phonological assessment, all of the CELF-5 composite scores, pragmatic assessment, and I even sprinkled in an oral mechanism exam. I don't usually do a formal oral mech exam unless there are severe articulation deficits or my SLP senses start tingling.

Oral-Motor Examination

After writing the reason for referral, background information, and behavioral assessment, I typically start with my oral motor findings. I think it's important to start there in case something is abnormal. This helps the reader know off the bat why there might be articulation or voice deficits. The reason I did an oral mech exam with this student was that he had frequent odd posturing of his mouth, as in he would open his jaw as if he were about to yawn but didn't. There were no red flags in my oral mech findings, so I asked him about it. He said that it just feels good. Interesting.

Speech Assessment

Then, I move on to the speech assessment. I gave the Goldman-Fristoe Test of Articulation 3rd Edition (GFTA-3). He received a standard score of 40 (confidence interval = 39-57, percentile rank = <0.1) on the Sounds-in-Words test, which is in the very low/severe range. Because of his inconsistencies, I ran a Khan-Lewis Phonological Assessment (KLPA-3) analysis. My district has a Q-Interactive account, which will conduct the analysis for me, which is such a time saver! He received a standard score of 40 (confidence interval = 39 to 57, percentile rank =<0.1). When compared to peers of the same age and gender, he uses more phonological processes which results in a score that is in the very low/severe range. He presented with gliding, cluster reduction, stopping, and deaffrication, but they were super low frequency and inconsistent. It boiled down to difficulty with 'th' (voiced and unvoiced), distorted /s/, and difficulty with L-blends.

Fluency & Voice Assessment

Usually, there's nothing to report in these areas, so they get lumped together for most of my reports (except stuttering!). However, I will note if there is abnormal or atypical fluency or voicing. For this student, both were within functional limits. I made a note of slight hyponasality.

Language

Now, for the bulk of the report -- language. My go-to language assessment is the CELF-5. If I have a student with severe attention deficits, I will use the CASL-2 since the CELF-5 Core Language Score has 2 subtests that require adequate attention (Recalling Sentences and Understanding Spoken Paragraphs). The CELF-5 has better psychometrics compared to the CASL-2, which is why it's my preferred language assessment. I also throw in the PPVT-5 and the EVT-3, which are the receptive and expressive vocabulary assessments. I give those first because it gives me a good understanding of their attention, testing fatigue, and semantics. All 3 of these assessments are on Q-Interactive, which calculates the scores for me and saves me loads of time.

When I was giving this student the PPVT-5 and EVT-3, I was actually shocked. These were his first assessments with me, and I thought the rest of the assessment would be a breeze based on his scores... lol. For the PPVT-5, he received a standard score of 87 (confidence interval = 83-92, percentile rank = 19), which is considered expected in receptive vocabulary skills. For the EVT-3, he received a standard score of 80 (confidence interval = 76-85, percentile rank = 9), which is considered well below expected in expressive vocabulary skills. Pretty good semantic skills for someone who hasn't been in school for 2 years!

Then, we got into the comprehensive language testing... Below are his composite scores.

Very low language scores overall. Language Memory Index and Core Language Score were his lowest overall. The Core Language Score is comprised of 4 subtests, 2 of which are included in the Language Memory Index. Language Content and Language Memory Index scores were noted to be significantly different (p = 0.05). He scored 11 points higher on the Language Content Index than Language Memory Index. So what does that mean? It could indicate stronger semantic knowledge but difficulty with applying memory to language tasks. And that makes sense given his strong PPVT-5 and EVT-3 scores, both of which rely on semantic knowledge.

His subtest scores were also very interesting...

It's strange to me that he scored a 1 on Formulated Sentences but a 7 on Sentence Assembly. My reasoning was perhaps he missed points on the Formulated Sentences due to grammatical errors when creating his own spontaneous sentences using a target word, whereas the Sentence Assembly provides you with the exact words to manipulate. He also scored very low in the area of pragmatics, but I noted the fact that he had only been at a new school for 30 days after not attending a school for 2 years.

Overall Summary

Now that we have all the data and we've identified that he does qualify for speech and/or language impairment (SLI), it's time to interpret the results. It is important to summarize your findings! Think about the future SLP reading the report. It can be such a headache to parse through the data without knowing the student. Remember that triangle model for evidence-based practice they taught you in grad school? This one:

As an SLP, it is part of your job to summarize your findings, including the evidence (data), your clinical expertise (clinical judgment), and the client's perspectives (individual basis). If we don't aim to do this in all our reports, we are failing our patients and dooming them to insufficient and ineffective therapy.

Here is a summary of my findings. I interpreted the results using the data and my clinical judgment. When I write my goals, I always include the client's perspective as it relates to his performance in the educational setting (I don't include the goals in my reports, though).

"NAME is a kind young man who presents with difficulties in the areas of articulation and language, specifically syntax and pragmatics. NAME’s scores indicate that he has relatively strong semantic knowledge and use but struggles to apply working memory to linguistic concepts. On the Understanding Spoken Paragraphs subtest, NAME had difficulty with questions that related to the main idea, details, and sequencing but demonstrated strength in inference, prediction, and social context. His Language Content and Language Memory discrepancy score highlights his cognitive communication deficits, specifically in the area of memory. NAME would benefit from memory compensatory strategies to support his learning and language development within the educational setting. Memory compensatory strategies may include written reminders, repetition of stimuli, and multi-step directions broken down step by step or written.

Regarding NAME’s Pragmatics Profile score, it should be noted that NAME has only been in school for approximately 1 month at the time this report was written. Given NAME’s shy demeanor and recently starting at a new school after not attending school for some time, his pragmatic language score should be interpreted with caution. As NAME becomes more comfortable in a setting or with a person, he demonstrates increased use of age-appropriate pragmatics, such as responding to greetings/farewells, initiating and maintaining conversation, telling/understanding jokes, and eye contact/gaze. An updated pragmatic language assessment should be considered after NAME is provided more time to adjust to his new environment.

NAME’s articulation is an area of concern. Per his KLPA-3 scores, NAME exhibits 4 phonological processes. However, they appear to be phoneme determined (i.e. difficulty producing ‘th’ sound) rather than the true phonological process (i.e. stopping). NAME’s articulation errors, specifically difficulty with voiced and voiceless ‘th’ and L-blends, impact his ability to be understood and may impact his social interactions with peers.

Based on all available information detailed in this evaluation report, obtained via interview, file review, and formal and informal activities, in the professional opinion of this Speech Language Pathologist, NAME does meet California Eligibility Guidelines for Special Ed under the qualifying condition of SLI. It is recommended that NAME receive speech and language services. NAME would benefit from direct speech and language services to support his articulation deficits and support his receptive/expressive language and social communication skills. The IEP team will review and discuss these results and other available pertinent information to make a final determination on eligibility and need for Special Ed services. The purpose of this report is to provide information to assist the team in making that decision."

Recommendations/Goals

Depending on the student, I might include some recommendations in my report, but those are usually my speech-only students. I never include written goals on my SLP reports. The reason I don't include recommendations or goals is that I want to have the IEP team's input, which includes teacher(s), psychologist(s), parent(s), and the student. These IEP conversations provide great insight into the behaviors within the home and classroom that I don't always see first-hand. So, I prefer to come prepared with a few goals written on the IEP platform and recommendations in mind with the understanding they may change depending on the student's current needs and team input.

My 2 proposed goals for this student were:

Articulation: By 11/2024, NAME will independently produce voiced and voiceless 'th' in all positions of words at the word level w/ 80% accy across 3 consecutive sessions as measured by SLP data collection.

Cognitive Communication: By 11/2024, following a 5-minute delay, NAME will deliver a verbal message containing 1 action verb, 1 detail, and 1 subordinate clause (i.e. 'tell her to give me a call at 1 PM', 'let him know that I need to ask him a question after lunch', 'tell him I need him to make 10 copies before 6th period') to another person, given 1 verbal repetition, with 90% accuracy in 4 out of 5 trials as measured by SLP and/or teacher data collection.

I wanted to add another goal that supported his expressive language or pragmatic language. I had a lot of options for goals, but I wanted to collaborate on the most functional language goal for the student at this moment. I tossed some ideas out of what I could work on, and his parents requested a problem-solving goal due to his extreme behaviors within the home when he encounters a minor inconvenience. This is what I proposed to support those behaviors at home while making it functional for the educational setting:

Problem-Solving/Pragmatic Language: By 11/2024, when given a real-life social and/or vocational problem, NAME will identify 2 solutions and 2 possible consequences of those solutions and then identify the best solution with 80% accuracy with/ minimal verbal cueing in 4 out of 5 opportunities as measured by SLP and/or teacher data collection.

Improving Patient Outcomes Through Report Writing

This was a very comprehensive SLP report that caused a lot of thinking, researching, and analyzing. By obtaining all the composite scores, I was able to dive deeper into why his overall language functioning (aka the Core Language Score) was so low -- there is a breakdown between memory to linguistic skills, which will impact his receptive and expressive language. With this understanding, I am able to target the true deficit, memory, while supporting the symptoms, receptive and expressive language. And before you say anything, yes, cognition is within the SLP scope of practice! Per ASHA, "Communication includes speech production and fluency, language, cognition, voice, resonance, and hearing," (https://www.asha.org/policy/sp2016-00343/#Definitions).

The process of writing a comprehensive speech and language report serves as a critical bridge between assessment and intervention in the school setting. As speech-language pathologists, our role extends beyond the evaluation itself; it encompasses the responsibility to synthesize complex data, provide insightful interpretations, and offer actionable recommendations that can significantly impact a student's academic and social development. By delving into the intricacies of each assessment component and considering the broader context of the student's educational journey, we can create a roadmap for tailored intervention strategies that prioritize the individual needs and potential of every student. Through meticulous report writing and ongoing collaboration with educators, caregivers, and multidisciplinary teams, we can pave the way for effective, evidence-based interventions that empower students to thrive and succeed within the educational landscape.

If you are interested in reading the full SLP report or are in need of a report template, click below!

SLP Sample Report.docx

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