My starting targets all depend on where the child is. I utilize all 3 cueing modalities, including verbal, visual, and tactile cues. I use the touch cues from the Moving Across Syllables program with good success. I like to write therapy goals working through a syllable AND placement hierarchy. For example, with someone who had imprecise vowels only, I would start by working on short and long vowels in isolation. If someone had imprecise vowels and an inconsistent consonant repertoire, say for example, they had trouble with bilabials, I would work on bilabials in CV combination, then CvCv, CVC, etc. I like to structure my treatment according to motor learning principles so sessions are heavy on drill, but also heavy on reward because these kiddos are working so hard! I think you have to be flexible and constantly looking for ways to motivate your the child. If they aren't able to attend to drill at a table, then I get creative and think of whatever "game" I can to get in as many speech productions as possible in the early stages of therapy. These kids are usually in therapy for a long time, so creativity is a must. Although I am often limited by insurance requirements, I try to see children with CAS for at least 3 sessions a week, if able. I always include family in sessions because they need to see and be there for our little treatment successes and know how to provide cues at home.