Recommended Elements for a Plan of Care Used in Place of an SLP-Assistant Treatment Protocol
June 15, 2026
MEMORANDUM
Purpose
As the Board has approved the use of a Plan of Care (POC) in place of a separate treatment protocol for Speech-Language Pathology Assistants (SLP-Assistants). The purpose of this memo is to provide recommendations regarding the specific information that should be included in a Plan of Care to ensure it serves the same function as the current treatment protocol requirements.
The goal is not to add unnecessary paperwork, but rather to clarify the level of detail needed so that an SLP-Assistant can consistently carry out treatment as intended by the supervising speech-language pathologist while maintaining patient safety, quality of care, and accountability.
Background
SLP-Assistants provide services under the direction and supervision of a licensed speech-language pathologist, and the Board’s current treatment protocol requirements are intended to ensure that delegated treatment is implemented consistently and appropriately.
Under 21 NCAC 64 .0209 – Adequacy of Records, documentation must include:
- The patient’s full name;
- The nature of the service provided;
- The date services were provided; and
- Identification of the person providing the service.
Current treatment protocol expectations also require written information regarding:
- The eliciting condition – how the assistant should help create or prompt the target behavior;
- The target behavior(s) – what the patient is expected to say or do; and
- The consequences of target behaviors – how the assistant should respond to patient performance.
The supervising SLP is also expected to document that the SLP-Assistant is implementing treatment reliably and effectively, particularly when a new treatment approach or procedure is introduced.
During Board audits, one consistent pattern has emerged: most supervising SLPs are documenting treatment goals and expected behaviors, and many are appropriately listing materials to be used and cueing methods or levels of support. However, there is no evidence written guidance regarding what the SLP-Assistant should actually do if the patient struggles during treatment.
In many cases, the written documentation explains what is being targeted, but not always how treatment should adapt when things are not going as planned.
For example, audit documentation commonly includes:
- Treatment goals;
- Materials or activities to use; and
- Cueing options or levels of support (e.g., verbal, visual, tactile, minimal/moderate/maximal cueing).
What is often missing are the practical treatment decisions that experienced SLPs naturally make during therapy, such as:
- When to increase or decrease cueing;
- What to do if the patient is not responding successfully;
- Whether to model the response, simplify the task, or provide more support;
- When to step back to an easier level; or
- How to respond to repeated incorrect attempts.
For example, a Plan of Care may state:
“Patient will produce /s/ in sentences with 80% accuracy using verbal, visual, and tactile cues.”
While this gives useful information, it still leaves important questions unanswered:
- What happens if verbal cues are not enough?
- Should the assistant model the target?
- Should cueing be increased?
- Should the task be simplified?
- When is it appropriate to move back to word-level practice?
This does not necessarily mean supervision is lacking. In many cases, supervising SLPs are likely providing these directions verbally or informally. However, if a Plan of Care is replacing the treatment protocol, it may be helpful for these expectations to be documented more clearly so that assistants have consistent written guidance and supervisors have documentation that reflects how treatment is intended to be carried out.
Recommended Elements for a Plan of Care
To appropriately replace a treatment protocol, a Plan of Care should include enough information for an SLP-Assistant to understand not only what the goal is, but also how treatment should be delivered and adjusted when needed.
At a minimum, the following information is recommended:
1. Patient Information
The Plan of Care should clearly identify the patient receiving services.
Example:
Patient: Jane Doe
DOB: 05/10/2017
2. Nature of Services
The Plan of Care should clearly describe the treatment being provided.
3. Treatment Procedures
The Plan of Care should go beyond goals and include enough detail to explain how treatment should be implemented.
Many supervising SLPs already provide this guidance in practice. The recommendation is simply that key treatment decisions be reflected in the written Plan of Care.
This may include:
- Materials or activities to be used;
- Type and level of cueing;
- Cue fading or escalation expectations;
- Reinforcement strategies; and
- What to do when the patient is struggling.
A. Eliciting Condition
The Plan of Care should explain how the target behavior will be encouraged or prompted.
This may include:
- Materials or activities;
- Verbal, visual, tactile, or gestural cueing;
- Expected level of support; and
- General instructions for implementation.
Example:
“Using articulation picture cards and a mirror, the patient will practice /s/ production in initial word position during structured drill. Begin with verbal modeling and moderate verbal cueing, fading support as accuracy improves.”
B. Target Behavior
The expected behavior should be clear and measurable.
Example:
“Patient will produce /s/ in initial word position with 80% accuracy across 20 opportunities.”
C. Consequences of Target Behavior
This section is especially important because it helps guide the assistant when the patient is having difficulty.
Rather than only listing cueing options, the Plan of Care should explain what the assistant should do if the patient is unsuccessful.
Example:
“Correct responses will receive verbal praise. If unsuccessful after two attempts, provide clinician modeling and increased cueing. If difficulty continues, return to word-level practice before retrying sentence-level productions.”
Example:
“If inaccurate, provide additional visual supports and simplify the task as needed before progressing.”
Providing this level of detail helps ensure treatment is implemented more consistently across providers and helps assistants know how to respond in real therapy situations.
4. Supervisory Documentation
The supervising SLP should continue to document that the SLP-Assistant can reliably and effectively carry out treatment procedures.
This documentation should reflect that the assistant can:
- Implement cueing appropriately;
- Target expected behaviors;
- Respond appropriately when a patient struggles; and
- Use treatment procedures as intended.
- Certification Period of current POC, or date the POC will be reviewed by the supervisor.
Example Statement:
“Observed SLP-Assistant implementing articulation treatment. Demonstrated appropriate cueing, reinforcement, and ability to adjust supports when patient difficulty occurred.”
5. Session Documentation
For each patient encounter involving an SLP-Assistant, documentation should continue to include:
- Date of service;
- Nature of service provided;
- Identification of the service provider; and
- Legible signatures from both the SLP-Assistant and supervising SLP.
6. Signatures on the Plan of Care
Because the Plan of Care is replacing the treatment protocol, it is recommended that both the supervising SLP and the SLP-Assistant sign and date the document.
This helps document that both individuals reviewed and understand expectations for treatment implementation.
Suggested Statement:
“I have reviewed and understand the treatment procedures outlined in this Plan of Care and acknowledge my role in implementation and supervision of delegated services.”
Supervising SLP: _________________________ Date: __________
SLP-Assistant: ____________________________ Date: __________
Recommended Minimum Elements
To effectively replace a treatment protocol, the Plan of Care should minimally include:
- Patient identification;
- A clear description of services;
- Treatment procedures, not just goals;
- The eliciting condition, target behavior, and consequences for delegated treatment;
- Materials and implementation guidance;
- Cueing expectations and guidance for increasing or decreasing support;
- Written direction for what the assistant should do when the patient struggles;
- Documentation of supervisory competency when new procedures are introduced;
- Signatures and dates from both the supervising SLP and SLP-Assistant; and
- Information necessary to meet documentation requirements under 21 NCAC 64 .0209.
These recommendations are intended to help ensure that a Plan of Care meaningfully replaces the function of the treatment protocol while still reflecting how therapy is actually implemented in clinical practice.
For further guidance or questions please contact the Board office directly.