I've realized through many years of working with various populations, that consistency & routine is a key factor in progress. Once the child realizes what is expected (through a consistent routine), unwanted behaviors will decrease. The beginning of the year with a new student is always the hardest for me. I have to see the student and determine present level of functioning, then I can set a routine for him. Sometimes it's smooth sailing after that; sometimes I have to continue to tweak the routine throughout the year.
With my student this year, the speech routine goes something like this:
I start off with a story from Noisy Stories (Joan Rivard). We use signs and the sounds in the story to promote any kind of communication. I use the same story for a month to give the student time to learn the signs and attempt the sounds that are targeted.
The book includes a smaller version of the stories that can be copied and sent home. I include the signs with the "small book" since mama really likes to work on it at home! It takes a little time on my part to copy each individual sign from the book & then trim it to fit, but like I said, mama likes to work on it at home.
2) We had been spending a lot of time with PECS, but he's to the "making choices" level. The only problem is that I realized he chooses the picture that on the right side whether or not it's a preferred item/activity. So, I backed up and chose an activity to work on crossing his hand over to the other side to pick up the picture:
I have/made several of these stories several years ago. Right now we're just concentrating on him crossing his hand across his body to take the picture without using the other hand, and put it on the page. My plan is for him to (in the very near future) begin to make a choice when given 2 choices. I consulted with the COTA so that we're expecting the same thing out of him. Again, I stay with each story for a month.
3) Bilabials. My little one loves music (thank goodness!), so I use these puppets/miniature animals to sing a modified Baby Bumble Bee. I incorporate signs along with CV syllables to encourage production of bilabials/vowels as well as signs. I sing/sign the song extremely slow so he can participate.
I have him sign his choice (given 2 choices) of what animal we're going to use for the next verse.
4) We end the session with The Hokey Pokey. After each verse, he either uses PECS to request music, or signs music to request another verse.
That's our routine for now. As I said earlier, sometimes the routine has to be tweaked a little bit; what may be reinforcing to the student at one point in the year may not be later. I'm a firm believer in attempting all modalities of communication and seeing what the child is going to choose. The trick is to find something that interests the child to tap into and then constructing a routine around it.