We are pleased to welcome Susan Moon Meyer, Ph.D. as our guest chat host tonight,
April 8, 2002.  Dr. Meyer will lead us in a chat about about Documentation and
other concerns for the beginning SLP.  Dr. Meyer is a Professor in the Speech-
Language Pathology Program at Kutztown University in Berks County, Pennsylvania. 
This guide offers insight into behavioral objectives, writing evaluations,
honing writing skills, professional style, writing progress notes, clinical
accountability, handling paperwork, running therapeutic sessions and evaluations
more smoothly, and self-evaluation.

<Robin>  Welcome!  We are chatting tonight with Dr. Susan Moon Meyer about
          documentation and other concerns for the beginning SLP.
<Robin>  Dr. Meyer, could you give us some general information about documentation?
<Adrienne>  Yes, and also maybe differentiate between the documentation required
          at various types of facilities (schools vs hospitals).
<Dr. Meyer>  You probably are at all different levels--undergrad, master's and Ph.D. 
          One of the most frustrating areas encountered by the majority of students is writing
          clinical reports and doing the necessary documentation.
<Dr. Meyer>  One of the best pieces of advice I can give to you is stay on top of the paperwork. 
<Dr. Meyer>  Immediately after seeing a client, write the progress note.  Immediately after
          evaluating a client, write the report.
<Adrienne>  Any advice on how to keep the paperwork to a minimum so we can stay on top of it?
<Dr. Meyer>  Yes, only think about it once!  Let me explain.  Immediately after seeing the
          client, write up the progress note and then write the lesson plan for the next
          session--this way you only have to focus once instead of twice.
<Dr. Meyer>  If you don't do it this way, you have to again think about the previous session. 
          This doubles the amount of time necessary.
<Adrienne>  good idea
<Dr. Meyer>  It's all about accountability. Keep good records.  Your records guide you--they
          tell you what to do the next session.  Should the complexity be decreased or should
          the complexity of the task be increased.  Always follow the client's responses--let
          the client lead you!
<languagerules>  Do you hand write all your SOAP notes?
<Dr. Meyer>  My students hand write their SOAP notes--they are placed in hospitals, rehab
          centers, etc. They do the work and I just supervise.
<Dr. Meyer>  Word processed notes are always neater but when you are out on the floors, it
          is more efficient and practical to write on the chart while you are on that floor. 
          Again if you go back to your office and word process your note, you are not using
          your time effectively.
<Meghan>  All of my supervisors want the SOAP notes written in a different way and it is
          very frustrating.
<Adrienne>  Amen Meghan!
<Adrienne>  same with Dx reports
<Dr. Meyer>  Do what you have to do to please each supervisor--but there is a basic format
          that needs to be followed.
<Adrienne>  Meghan, the good thing about all the differences is that you get to try them all
          out and see which will really work best for you when you're on your own.
<Meghan>  That's true-I'm learning how to write for lots of different people!
<Dr. Meyer>  Remember that one day you will be on your own and you can develop your own style.
<fluency>  I can't wait!
<Dr. Meyer>  Do what you have to do when you are in school and one day you will be telling
          others what format to follow.
<Dr. Meyer>  Writing for lots of different people can be challenging but it will make you a
          better professional writer.
<KJ>  Any sugestions for the A part of the SOAP note? I also have several supervisors who all
          want something different.
<Meghan>  I have a question about the S part, one of supervisors is very picky about assessing
          the client.
<Meghan>  I'm wondering what other people put in the S section.
<Robin>  Maybe we could go through the SOAP note format, ie, what each part means and what
          it should include.
<Dr. Meyer>  The S part is the subjective part. It includes impressions of the client's
          behavior.  These can be based on the client's, clinician's or family's impressions.
<Dr. Meyer>  An example is, Sally appeared upset today, She stated, "My best friend isn't talking to me"
<Dr. Meyer>  The O is the objective part.  This includes measurable information.
<Dr. Meyer>  The goal should be stated and then the client's performance should be indicated.
<Meghan> When you say the goals, do you mean what you plan on achieving?
<Dr. Meyer> Yes, goals are what you plan on achieving.
<Dr. Meyer>  If possible, compare the client's performance with that of his previous session. 
<Dr. Meyer>  The A section is the assessment section.  Here the objective data is assessed. 
          Briefly summarize the data and make a statement regarding the severity of the problem. 
          Strengths as well as weaknesses may be discussed.
<Dr. Meyer>  Hypotheses for why change did or did not occur may also be included in the "A" part.
<languagerules>  Do you document talking to the parents or family after a session?
<Dr. Meyer>  If something significant occurred, yes it should be documented.  Otherwise just a
          brief indication that the session was reviewed with the parent.
<lrevans>  Should the P continue to be the same unless you change your goals?
<Dr. Meyer>  Continuing with SOAP--"P" the plan part.  The course of treatment is outlined in the
          plan section. Specifically state the rx goals for the next session.
<Dr. Meyer>  These goals also include future diagnostic goals if applicable.
<Dr. Meyer>  Remember that the new goals should stem from the client's performance on the
          previous therapy goals.
<kimberly> In a session, do you set time aside for each goal?  And do you automatically move
          to the next goal once you reach 90%, regardless if all your stim have been presented?
<Dr. Meyer>  It depends.  One of the differences I find between a novice clinician and a more
          experienced clinician is how they approach meeting the goals.
<Dr. Meyer>  A novice clinician will work on one goal at a time.
<Dr. Meyer>  A more experienced clinician works on two or three goals at a time. 
<Dr. Meyer>  90% depends.  I like 90% as a criterion.  Many of my friends employed in the
          schools use 80% on 2 consecutive days.
<Dr. Meyer>  I teach my students that usually with young children or mentally challenged
          persons, 80% is high enough to shoot for.
<kimberly>  Thanks
<languagerules>  Does the criterion level depend on each patient?
<Adrienne>  and maybe on the task too?
<Dr. Meyer>  Yes, criterion depends on each patient. 
<Dr. Meyer>  Clinical intuition plays a role here.  You get a feeling for which clients will
          generalize a lot on their own and which ones won't.
<dd>  How do you approach writing goals for client's with Medicare/Medicaid? I know you are
          supposed to be able to show improvement, but what if the client is very low functioning?
<Dr. Meyer>  dd-good question.  Be certain you are working on "stuff" that is functional for
          that patient.  Be certain you are on that patient's level and work just a little ahead.
<Dr. Meyer>  I believe that all clients can improve BUT yes, sometimes it is difficult to prove
          it to insurances.
<Robin>  Medicare documentation is very important in terms of getting reimbursement for services!
<Dr. Meyer>  You know it!
<Meghan>  Is it more difficult to document for medicare versus private insurance?
<Dr. Meyer>  Meghan, I haven't dealt with private insurances for awhile so that's one question
          I don't feel comfortable answering.
<Dr. Meyer>  There is a lot on documenting data in a session in my book.
<kimberly>  Check out chapter 7.
<Dr. Meyer>  If chapter 7 is referring to my book, I believe documentation is in chapter 6.
<Dr. Meyer>  Glad to see you're familiar with it!
<kimberly>  Yes, it is helpful...
<dd>  Any tips for a new SLP with writing goals for Medicare/Medicaid?
<Dr. Meyer>  Be as specific as possible.  I advocate always writing well-written behavioral
<lrevans>  Is documentation different for different settings, for example, say in a hospital
          outpatient care vs. school setting, and if so, how?
<Dr. Meyer>  lrevans--yes, documentation is very, very different.  In the schools you are
          dealing with all of the IDEA requirements.
<Dr. Meyer>  Incidentally, I am currently in the progress of revising my book.  It should be
          out later this year.  There is a chapter on "preparing for the public schools".
<Robin>  Dr. Meyer is on sabbatical while revising her book.
<kimberly>  Great, hopefully that book will be out in time for student teachers...that
          chapter would be a help!
<languagerules>  Do you take a lot of descriptive data while working on language goals or
          write out the specific objectives and tally?
<Dr. Meyer>  languagerules,--both!  Descriptive data is always good to help figure out where
          to go next in terms of goals and it is also good to continue to check on carry over
          of previous goals.
<futureSLP2002> Dr. Meyer, how do you record multiple attempts at one target word?
<Dr. Meyer>  It depends on the situation.
<Dr. Meyer>  If you are talking articulation or phonology, yes--the client should have
          success.  However, I am big on counting responses differently.  A second response
          does not get counted the same as a first response.
<Dr. Meyer>  I am big on vertical response systems as opposed to horizontal systems. 
          Vertical systems are more conducive to counting 2nd and 3rd responses differently.
<futureSLP2002> If you are working with a phoneme in the initial position of words?
<Dr. Meyer>  Yes-working on phonemes in the initial position of words.  I am also big on
          making certain the client is aware that his/her response is not correct.
<futureSLP2002> Do the responses get calculated into the percentage that goes on a daily log?
<Dr. Meyer>  It depends how it is done.  I usually give the percentage for first responses,
          second responses, third responses, etc.
<Dr. Meyer>  Sometimes if only the first responses are compared with the last session,
          progress may not be evident. If you also compare the number of correct responses on
          the second, and 3rd attempts, progress is usually evident.  It is a more efficient
<LoriL> Sorry I'm so late in joining. If I ask something already answered let me know. My
          question is, do you have any suggestions for taking data during a language therapy
          session with an autistic child?
<lrevans>  good question, LoriL
<Dr. Meyer>  Lori, I am not exactly sure what the problem is with taking data for an autistic
          child but I would think it would be the same as for any other child.
<Adrienne>  Great question Lori.  It gets more complicated when clients are physically
<Dr. Meyer>  Now, if the autistic child is very active, I advocate using either a post-it
          note on my left arm (I'm right handed) or a piece of masking tape on my left arm--
          and I just keep my tally in the usual manner.  In this manner, I am free to move
          around the room with the child and still keep an accurate tally.
<Adrienne>  I have a challenging autisic child client now- it's harder to take data because
          you cannot allow a pause to record.
<LoriL>  Exactly, Adrienne.  I'm all over the room during some hectic sessions and don't want
          to miss anything significant.
<Dr. Meyer>  Try the masking tape.  You don't need to pause to record a response.  You don't
          even have to look at the post-it note or masking tape.  You can place a tally mark
          without removing your eyes from the child-after you become familiar with the system. 
          You need to find a system that works for you. 
<Adrienne>  Masking tape travels with you.
<Dr. Meyer>  I also have another tip--I never run out of tips--for remembering to record data!
<Dr. Meyer>  If you are in a situation where you have sometime to write on (like a table),
          always keep your writing utensil at the spot where you want to record.  This serves
          as a constant reminder to record each response.
<Adrienne>  Sometimes on the tasks that go quickly I use sign language to keep count of how
          many correct answers he gives then at the end I have time to write that one number
          (out of number of opportunities).
<Dr. Meyer>  Good idea, Adrienne.
<Adrienne>  Thanks.  I'm going to try the masking tape!
<Dr. Meyer>  Adrienne, let me know what you think after you try it.
<Adrienne>  ok
<Dr. Meyer>  Also--learn to use your nondominant hand to perform all other tasks in therapy--
          turning pages, flipping cards, etc.
<lrevans>  Thanks Dr. Meyer.
<KJ>  Thanks Dr. Meyer.
<Dr. Meyer>  You will be amazed at how well a session goes if you learn to use both hands--
          specifically the nondominant hand to do all therapy tasks--but the documenting which
          is the job of the dominant hand.
<LoriL>  I'll try it tomorrow.  Thanks for the tips!
<booms57>  How about using recording devices, are they appropriate?
<LoriL>  I use a tape recorder for a therapy tool, so it's tied up with his activity.
<Dr. Meyer>  LoriL, a tape recorder is a good initial tool--but it becomes impractical and
          time consuming because you have to listen to the tape.  This doubles the amount of
          time you spent documenting. Learn to record responses in real time.
<smd> Do you have any specific suggestions for tracking when doing EI with kids in the 2-3 age
<Dr. Meyer>  smd-something that is not intrusive.
<smd>  Yes- it's just sometimes I find myself naturally addressing goals that aren't "true" goals.
<smd>  The private practice I did my externship with only had 4 goals per client.
<Dr. Meyer>  Why 4 goals per client?  How long were the sessions?
<smd>  30 minute sessions
<Dr. Meyer>  smd--what do you mean by addressing goals that aren't true goals?
<smd>  Language stim or artic modeling that aren't specifically listed in their IFSP.
<Dr. Meyer>  Now I understand.  Did you design the IFSP?
<smd>  no
<Dr. Meyer>  Perhaps that is your answer.  The person who designed it came up with the goals
          he/she thought should be worked on.
<smd>  Should the goals be more vague to encompass more?
<Dr. Meyer>  No, I think goals should be specific--it makes us think more about where the
          client is currently functioning, where the client should be functioning and how to
          get him there.  Specific goals help to keep us focussed.
<smd>  I agree
<Meghan>  I get frustrated when the goals are too vague-I like them specific.
<Dr. Meyer>  I find specific goals are easier to track--you know exactly what you are looking for.
<Robin>  We have been chatting for an hour....any last questions for Dr. Meyer?
<lobsterpam>  Thanks for an interesting chat!
<Meghan>  Thank you Dr.Meyer!
<Maureen>  Thank you, Dr. Meyer, goodnight!
<kimberly>  Thank you Dr. Meyer
<smd>  Thanks for your time and great advice, Dr. Meyer.
<booms57>  Dr. Meyer, just wanted to let you know that I was glad to join tonight's chat with you. 
<Robin>  Dr. Meyer, thank you for joining us tonight and sharing your expertise!
<Dr. Meyer>  It was my pleasure.
<Robin>  Thanks to all of you who joined us tonight!  Goodnight!