Thursday, February 22, 2018

Therapy Tip: Making Home Speech Therapy Successful

It's Therapy Thursday! This is the day that I share a tip based upon my experiences as a mother of a child with special needs and a pediatric speech-language pathologist. Today's tip is one I have many thoughts on:

Making Home Speech Therapy Sessions Successful

I have been doing in-home speech therapy sessions for over a decade now. For the past 11 years, I have been primarily working in my state's birth-three program, which mandates that sessions be conducted in the child's natural setting. That means that I conduct the majority of my sessions in the child's home. Daycares or a babysitter's home is my other main setting.

Working in a child's home can be a very positive experience. There's no better way to understand how a child's delays are impacting their everyday life than to watch them in their home environment. Having a parent or caregiver in the session giving input and relating successes and challenges makes home therapy unique and personally tailored. It really is the best way to have family centered therapy because the family and the home is the focus. Home therapy is also great for the family as well. They have access to the therapist who can answer questions or give advice.

That being said, home therapy can provide its challenges to therapists. The therapists are the visitors and have little to no control over some of the things in the home at the time of the visit. As a home visitor, I try to keep in mind that I am a guest in the family's home. I shouldn't come in their house with a list of demands and needs as I am there to support the family where they are at. That being said, there's some things that hinder the child's sessions and some easy things a family can do to make the most of the time. Today, these are my suggestions for making home therapy more successful:

1. Turn off the tv and tablets! 
There are some children who are so excited that I am there that they can completely ignore a television in the room. There are some children that are the exact opposite. These children will watch the tv and ignore me despite my best efforts. Some children will grab their parent's phone or tablet if a television isn't available. It's best to make sure all devices are put out of the child's reach and the television is turned off during sessions.

Even though early speech therapy with toddlers is play based and fun, it is work and learning is happening with the child. If you were doing something that required concentration, you would want minimal distractions for you. The same is true for your child. Sometimes, adults will have a program on for them. This doesn't bother me as long as the child isn't distracted by it and the volume isn't super loud. My preference would be for no televisions though during our session.

2. Watch siblings and make adjustments.
Siblings can be a help to sessions or a hindrance. There are some siblings that really provide a benefit for the session. They can model phrases or words for the child. They can model turn taking in activities or games. The older siblings can usually pick up on what I am trying to accomplish and really provide an excellent model.

On the other hand, there are some siblings who take over or cause more problems. I have been in some sessions in which I felt like I was a babysitter for the parent. I have literally been left alone in the living room with the child I am working with plus younger siblings. Younger siblings (those under 18 months) usually cannot provide modeling that I need from a sibling. Usually, they try to take our toys or materials due to their young age and take time away from the child I am working with. It should be understood that therapy time in the home is not a time for the therapist to be entertaining all of your children without the therapist's permission.

Similarly, if there are multiple siblings that are very talkative, this too can take away from the child's therapy time. I have had some sessions where the siblings fight and talk and talk and talk to me or each other and totally cause the child I am working with to stay silent and overlooked. The therapy is less productive in this scenario as well.

I won't say that siblings should or shouldn't be in sessions. My program encourages sibling involvement, but sometimes it is almost impossible (or time wasting). My advice to you is to watch how your other child(ren) react in sessions. You should be able to see if your child is helping or hurting their sibling's speech therapy sessions. If not, ask your child's therapist.

3. Make sure your child is awake.
This may seem obvious, but your child needs to be awake for sessions. There have been many sessions that I have arrived for as scheduled and on time yet the child is fast asleep. Sometimes, an unplanned nap happens in the afternoon, and this is understandable. There are some morning sessions though that parents wait for me to arrive before waking up their child. The process of waking up the child can take up to 10 minutes of the session. As a therapist, I value the time that I have for each session. Consistently using several minutes every week to awaken a child is not a productive use of the therapist's time. Please, make sure your child is up and ready to go before the therapist gets to your home.

4. Put away the pacifiers. 
If your child is attached to pacifiers, they most likely won't be allowed to keep them in their mouth for speech therapy sessions. Some toddlers will remove the pacifier and be fine for our sessions. Other toddlers will resist the removal of a pacifier and will cause a disruption in therapy for several minutes. If your child falls in the later category, then you will need to make sure the pacifier is removed before the therapist arrives to save some time in therapy. After all, your child will be less likely to speak if the pacifier is plugging up their mouth.

5. Be engaged and participate!
The best thing you can do for your child in home therapy is to be an active participant. Watch the therapist, so you can replicate what she does later. Ask questions, report problems, and give input to your therapist. You know your child the best, so you will have good information to give.

Home therapy with your child should be a positive experience for everyone in the home. You don't necessarily need a special space or room for therapy for it to be successful. But, minimizing distractions and being attentive to your child during sessions can help your toddler get the most of their time in therapy.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice. 

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