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

The Interview Map: Rapport + Case History + Clinical Questions

Below 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 History

Use 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.

Follow-up questions (5):

1) How often does this happen per day or per week, and does it vary by task type?

2) When you write notes first, how much does your accuracy or ease improve (slight/moderate/major)?

3) Do you experience any effortful pauses, sound errors, or use of filler words during these moments?

4) Any similar issues with reading or writing, or is it mainly spoken language?

5) Have you had any prior evaluations or medical workups since the flu?

Clinical questions (3):

1) What is the frequency of word-finding breakdown during time-pressured conversational tasks compared with written-prep conditions?

2) Does the client show measurable differences in lexical retrieval accuracy between spontaneous speech and speech following written cueing?

3) Are there associated speech motor or fluency changes (e.g., increased pauses, revisions) that co-occur with retrieval failures?

You’re aiming for the same structure: summary → targeted follow-ups → measurement-ready clinical questions.

Your case vignette (use this for your work)

Client: 28-year-old graduate student

Story: “My voice gets tired after about ten minutes of talking. By the end of a meeting, I feel like I have to push to be heard. People say I sound breathy. It started about two months ago after I had nonstop coughing for a couple of weeks.”

Details mentioned:

• happens most during meetings and presentations

• worse when the room is loud

• improves with whispering or silence for a while

• no known swallowing trouble

• occasional throat soreness after long speaking

Your Turn: Fill it in

1) Case history summary (3-5 sentences):

____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

2) Follow-up questions (5 total):

• __________________________________________________________________________________________________

• __________________________________________________________________________________________________

• __________________________________________________________________________________________________

• __________________________________________________________________________________________________

• __________________________________________________________________________________________________

3) Clinical questions (3 total):

• __________________________________________________________________________________________________

• __________________________________________________________________________________________________

• __________________________________________________________________________________________________

Completion check: You’re done when (a) your case history summary includes onset + context + impact, (b) you wrote exactly 5 follow-ups, and (c) your 3 clinical questions sound like they could guide screening/testing.

Applying the Interview Map in Everyday Situations (So It Doesn’t Fall Apart)

If you want this to work when you’re tired, stressed, or meeting someone who talks fast, you need “real-life” rehearsal. Here are three situations that force the same translation skill, just in different formats.

Scenario A: The parent who gives a “timeline dump.”

A caregiver starts with birth history, daycare names, and every cold the child ever had - before you hear anything about communication. Your move is to keep rapport while steering: “Thanks - there’s a lot of helpful background. I want to focus next on how the communication changes day-to-day. When do you notice it most, and what does it look like in the moment?”

Expected outcome: You end up with context (school vs. home), triggers (time pressure, group settings), and impact (participation, frustration), not just dates.

Scenario B: The adult client who describes frustration but not behavior.

They say, “I’m embarrassed because people don’t understand me,” but they don’t say what they do when they can’t find words. Ask for concrete examples: “In the last week, tell me about one moment it happened. What were you trying to say? What did you do - pause, rephrase, start over, avoid the topic?”

Expected outcome: You’ll be able to draft clinical questions like “Does performance change with cueing or rephrasing attempts?” instead of only knowing the emotional impact.

Scenario C: The student who “knows the problem” but can’t quantify it.

“I talk too fast” is common, but it’s hard to measure. Use short anchors you can compare later: “Is it more like a few times a day, or almost every speaking turn? Does it happen more in class discussion than in one-on-one conversations?”

Expected outcome: You’ll get frequency estimates and context differences, which lets you plan whether you need tasks that compare spontaneous speech vs. structured speech.

One more thing: translation isn’t a one-time event. You’re doing it repeatedly. After each major topic - onset, current patterns, impact - you ask: “What clinical question does this create?” That keeps the interview from becoming a notebook marathon.

Reflection: Make Your Translation Tight and Your Questions Testable

Answer these questions in writing. Keep them specific - use your vignette work as the evidence.

• Which part of your follow-up questions most improved the accuracy of your clinical questions, and why?

____________________________________________________________________________________________________

____________________________________________________________________________________________________

• Look at your 3 clinical questions. For each one, underline the part that tells you what you would measure (frequency, severity, context comparison, or improvement with cueing).

____________________________________________________________________________________________________

____________________________________________________________________________________________________

• What detail did you almost leave out because it felt “too small,” but later turned out to be the key to a testable question?

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Quick Self-Assessment Quiz (No Guessing Required)

Answer these questions using your interview map. Write your answers briefly.

• In the interview map, what is the difference between “case history notes” and “clinical questions”?

____________________________________________________________________________________________________

• Name one follow-up question type that helps you get context differences (e.g., phone vs. in-person).

____________________________________________________________________________________________________

• Write one clinical question that includes a comparison across contexts. Use this format: “What is the difference in _ between _ and ___?”

____________________________________________________________________________________________________

• True or False: It’s okay for clinical questions to be vague as long as you’ll test later.

____________________________________________________________________________________________________

Answer Key (For Your Check)

• Case history notes capture communication-relevant details from the client (onset, triggers, impact). Clinical questions are testable targets that guide screening/testing (what you will measure and how).

• Examples: “When does it happen most?” “Where/with whom is it worse?” “How does it change in a quiet vs. loud setting?”

• Any correct comparison across contexts, such as: “What is the difference in perceived vocal effort between presentations in loud rooms and one-on-one conversation in a quiet office?”

• False. Clinical questions must be clear enough to guide what you’ll measure next.

End of chapter one. 4 more chapters in the full book.