Beyond 80-Percent Accuracy Consider alternative objective criteria in writing your treatment goals. From My Perspective
Free
From My Perspective  |   May 01, 2018
Beyond 80-Percent Accuracy
Author Notes
  • Rebecca Moore, MS, CCC-SLP, is a pediatric speech-language pathologist at the Blick Center and an independent contractor in the Akron/Canton, Ohio, area. She is also a professional photographer. rmoore1207@gmail.com
    Rebecca Moore, MS, CCC-SLP, is a pediatric speech-language pathologist at the Blick Center and an independent contractor in the Akron/Canton, Ohio, area. She is also a professional photographer. rmoore1207@gmail.com×
Article Information
Development / Speech, Voice & Prosodic Disorders / Swallowing, Dysphagia & Feeding Disorders / Normal Language Processing / Speech, Voice & Prosody / From My Perspective
From My Perspective   |   May 01, 2018
Beyond 80-Percent Accuracy
The ASHA Leader, May 2018, Vol. 23, 6-7. doi:10.1044/leader.FMP.23052018.6
The ASHA Leader, May 2018, Vol. 23, 6-7. doi:10.1044/leader.FMP.23052018.6
When it comes to writing goals, one of the most crucial components is your accuracy criterion—the number we’re reaching toward, the target we’re working hard to achieve.
When we write goals, we easily fill in “with 80-percent accuracy,” without giving it a second thought. It’s a number we seem to have settled on across the board.
But why do we limit ourselves to 80 percent? Research results from experts in the field show a large amount of variability on recommended accuracy criteria (see sources). Studies have found that:
  • Children who achieved 75-percent accuracy on articulation targets maintained or improved performance after therapy ended.

  • Students who achieved 75-percent accuracy on articulation of /s/ and /r/ in conversation retained these sounds after four months just as much as peers who were dismissed at th e 95-percent accuracy level.

  • Phonological therapy can be terminated when a target sound is produced with 50-percent accuracy in conversation, because targets continue to progress and carry over to full, correct use in conversation without additional intervention.

  • Errorless teaching requires an accuracy criterion of 90 percent or higher.

Despite the variability in these research findings, 80 percent seems to be the magic number that is so often used. It has its origins in the traditional Van Riper approach for correction of articulation errors and lingering phonological processes (target the sound in isolation then in words, phrases, sentences and conversation), as well as in applied behavior analysis therapy. It’s used as a benchmark for determining when to bump up to the next level of difficulty.
If you’re targeting speech sound errors, using rote exercises to teach a single skill or label, or improving correct use of grammatical morphemes, this accuracy criterion is useful.
But if your targets are outside of the rote or motor learning hierarchy, 80-percent accuracy may not be the best choice or even make sense. It’s a poor criterion for most goals related to vocabulary, pragmatics, parent education, conversational intelligibility, swallowing, voice and self-monitoring.
Additionally, a client’s baseline and history may make this accuracy criterion too easy or too hard to achieve in the time assigned.

If your targets are outside of the rote or motor learning hierarchy, 80-percent accuracy may not be the best choice or even make sense.

It’s all in the numbers
So, what to use instead? The accuracy criterion needs to be measurable and quantifiable. So, think numbers: number of words, number of prompts, number of reminders in a given time frame, number of exchanges with/without cues. Here are some examples.
Total number
  • Within six months, Katie will increase her vocabulary to 50 words as reported by parent and observed by clinician.

  • Within six months, in a 30-minute session, Sean will use a mean length of utterance greater than three for two-plus consecutive sessions.

  • Within six months, Bryce will understand and use 15 new verbs as reported by parents and observed by the clinician.

Number of prompts
  • In a 30-minute session, John will require no more than two visual or verbal prompts to remain on topic in conversation.

  • Thomas will require no more than one reminder to eat at a slow pace during each mealtime while at our facility in order to avoid aspiration.

Rating scale
  • Alice’s teachers will rate her fluency daily on a scale of 1 to 5—in which 1 is completely fluent and 5 is severely disfluent—for one week each month. By her next IEP date, Alice will receive an average rating >2 for two-plus consecutive months.

Instances per time
  • Max’s parents will be provided carryover language strategies to use in the home twice a month for six months.

  • In a 30-minute session, Tami will use her strategies to speak with no more than one instance of blocking for two-plus sessions.

Amount words (all, no, every, without, any)
  • While on a nectar-thickened diet, John will eat all meals without any signs/symptoms of aspiration during his hospitalization.

  • With only a written checklist on his desk, Max will complete all steps of his morning routine every day, without any additional reminders by the end of this quarter.

Different percentages
  • Sam will include more than 90 percent of final consonants in structured conversation tasks for two-plus sessions.

  • Within three months, Lila will produce the prevocalic /r/ in independent two-word phrases with 65-percent accuracy for two-plus sessions.

A ratio
  • In a 30-minute play-based session, Isaiah’s parents will correctly demonstrate four out of the following six language-intervention strategies when interacting with their child: expansion, following the child’s lead, self-talk, commenting, expectant waiting, repetition.

Avoid ambiguity
With all this emphasis on numbers, beware that too many numbers in a goal create confusion and ambiguity. Avoid stacking accuracy criteria. You may understand your intent when you write, “Will do x with 80 percent on three out of five trials for two-plus reporting periods,” but another clinician, parent, teacher or insurance adjuster is likely to be confused.
Keep it simple. If appropriate, do include the number of times you want this goal met (for two-plus sessions), but don’t add any more criteria than that. Keep in mind that others will need to read and interpret this goal.

Good goals guide your treatment, ensure continuity of services across clinicians and staff, give clients, parents and caregivers an understanding of what you all are working for, and provide a benchmark by which insurance can make a justification for continued payment of services.

Why does it matter?
Clear, understandable goals are absolutely essential. Good goals guide your treatment, ensure continuity of services across clinicians and staff, give clients, parents and caregivers an understanding of what you all are working for, and provide a benchmark by which insurance can make a justification for continued payment of services.
Other clinicians reading your goal should understand exactly what a child is working on and be able to continue treatment. A well-written goal should be descriptive enough to simply write “goal met” when it is achieved.
Keeping your goals SMART (specific, measurable, attainable, relevant and time-bound) often requires using an accuracy criterion outside of 80 percent. Break out of the mold and challenge yourself to look beyond 80-percent accuracy.
Sources
Diedrich, W., & Bangert, J. (1980). Articulation Learning. Houston, Texas: College-Hill Press, Inc.
Diedrich, W., & Bangert, J. (1980). Articulation Learning. Houston, Texas: College-Hill Press, Inc.×
McKercher, M., McFarlane, L., & Schneider, P. (1995). Phonological treatment dismissal: Optimal criteria. Journal of Speech Language Pathology and Audiology, 19, 115–123.
McKercher, M., McFarlane, L., & Schneider, P. (1995). Phonological treatment dismissal: Optimal criteria. Journal of Speech Language Pathology and Audiology, 19, 115–123.×
Smit, A. B. (2004). Articulation and phonology resource guide for school-age children and adults. Australia: Delmar Learning.
Smit, A. B. (2004). Articulation and phonology resource guide for school-age children and adults. Australia: Delmar Learning.×
Williams, A. L. (2003). Speech Disorders Resource Guide for Preschool Children. Clifton Park, NY: Thomson Delmar Learning.
Williams, A. L. (2003). Speech Disorders Resource Guide for Preschool Children. Clifton Park, NY: Thomson Delmar Learning.×
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
May 2018
Volume 23, Issue 5