Academic learning is a complex activity which is not easily modified. Several models have been used to deliver learning improvement programs, including the study skills course and the discrete skills approach. These approaches make few if any accommodations for variations in individual differences or needs. Four factors, however, indicate that individual factors may be responsible for the differential effects of skill-based programs: (1) students appear more likely to learn well when they have a personal conception of learning; (2) personal causation appears important to effective learning; (3) students who set goals appear to have a better chance to succeed and a better basis upon which to choose a course of action; and (4) understanding is developmental in several ways. These variables illustrate the idiosyncratic influences which may affect learning improvement program outcomes. While most students will probably respond positively to well-designed group-oriented learning improvement programs, some students will require a careful clinical approach oriented to addressing unique personal needs. This paper describes a clinical approach to making decisions on learning improvement programming which provides a structured, decision-oriented model to address idiosyncratic developmental needs. The clinical approach is described, assumptions for decision-making for learning improvement programming are discussed, and clinical decision points are presented. The areas of assessment, goals, objectives, strategies, and evaluation are included. (NB)