I have a client eval....what now?

Gathering Case History That Actually Leads to Clinical QuestionsA solid SLP assessment interview isn’t “good conversation.” It’s structured listening that turns a client’s story into specific, testable clinical questions. You’re gathering facts, noticing patterns, and tracking how communication problems show up in real life - at work, at home, in school, on the phone. That’s what lets you move from “she said she can’t find words” to “how often does word-finding breakdown occur during timed conversational tasks, and in what contexts does it improve with cueing?”

The core move is translation: client narratives → communication-relevant details → clinical questions you can use to guide screening, standardized testing, and treatment planning. You don’t get that translation by writing down everything. You get it by asking the right follow-ups, confirming details, and organizing what you learn into categories you can act on (speech, language, voice, fluency, hearing, cognition/communication, social impact).

Key takeaway: Your job in the assessment interview is to convert a client’s lived narrative into precise clinical questions - without losing rapport or accuracy.To do that, use these three steps:

Set rapport with purpose (warmth + clarity about why you’re asking).

Gather case history with targeted follow-ups (frequency, triggers, impact, and context).

Translate narratives into clinical questions (what you need to measure next, and how you’ll check it).

The Interview Map: Rapport + Case History + Clinical QuestionsBelow is a simple “interview map” you can carry in your head. The goal is consistency. You’ll still adapt to the person in front of you, but you won’t drift into vague note-taking.

A good interview map has three layers:

Rapport layer: You signal that you’re listening and that their story matters. You also reduce anxiety by naming what’s coming next.

Case history layer: You collect communication-relevant data, not just general life facts.

Clinical question layer: You end each key topic by turning what you heard into a question you can test later.

Guided example you can copy (short and specific)Client narrative: “My son started stuttering in third grade. It’s worse when he’s nervous. He avoids talking in class.”

Case history notes (communication-relevant): onset ~third grade; situational increase with anxiety; avoidance behavior in classroom; impact on participation.

Clinical questions (testable):

1) What is the frequency and severity of disfluency across speaking situations (class participation vs. 1:1 conversation)?

2) Does performance improve when the child is given a structured prompt or reduced time pressure?

3) Are there associated language planning differences (e.g., word choice delays) that co-occur with moments of disfluency?

Notice what’s missing: you didn’t try to measure severity during the interview. You gathered enough to decide what to measure and where.

Hands-On: Turn a Client Story into Clinical Questions (Without Losing the Plot)Time required: 25-35 minutes

Materials needed: pen/pencil, notebook or worksheet, and the case vignette below

Your Turn: Build Clinical Questions from a Case HistoryUse the vignette and follow the steps. Don’t skip the “translation” part - this is the whole point.

Read the vignette once and underline anything that sounds like communication behavior (not background life facts).

Read a second time and mark four details you can use later:

onset/timing

triggers/context

frequency/severity clues

impact on daily communication

Write a 3-5 sentence case history summary using only communication-relevant details.

Ask 5 follow-up questions that would tighten your case history.

At least 2 questions must ask about context (where/when it happens).

At least 2 questions must ask about impact (what changes because of it).

The last question can ask about history (e.g., prior evaluations, medical factors, school supports).

Translate into 3 clinical questions you could use to guide screening or testing.

Each clinical question must be phrased like a measurement target (what you will check).

Include at least one question that mentions comparison across contexts (e.g., phone vs. in-person, class vs. one-on-one).

Completed example (so you know what “done” looks like)Vignette: “I can’t get the words out sometimes. It started after I had a bad flu last year. My coworkers say I sound frustrated. It happens most when I have to explain things quickly. When I write notes first, I do better.”

Case history summary (3-5 sentences):

The client reports word retrieval difficulty that began after a flu ~1 year ago. Episodes are most noticeable when explaining information quickly at work. The client reports increased frustration and coworkers report sounding frustrated. Performance improves when the client writes notes first before speaking.

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