Ready…Set…Ponder: Why do speech-language pathologists (and other child development professionals) deliver birth-3 services in the child’s home? Why not just bring all those kiddies into our clinic rooms and bestow our communication brilliance upon them?
I’d say that we go into the home because the focus of our intervention is to engage that child’s caregiver(s) in an ongoing process of supporting his/her communication development. It can’t just be about the hour or 2 a week that we have the child in front of us in a little clinic room, because the first 3 years of life are critical for providing the richest possible language environment we can. And who better to learn how to talk to kids, play with kids, scaffold kids’ language, and foster kids’ social competencies than the parents and caregivers of those kids?!? We go into the home because that’s where 99.9% of that child’s communication development will take place.
Today I’d like to pose the argument that we need to revive the birth-3 model of service delivery in non birth-3-aged kids who need significant, ongoing executive functioning support. I wouldn’t dare to say that these are the only kids who would benefit from this type of service delivery, but you have to start somewhere, right? If you work with kids with general social communication challenges, you likely also see executive functioning deficits in those kids. Making a plan? HARD! Breaking down tasks into individual steps? PAINFUL! Self-talking your way through an activity? YEAH RIGHT! These kids need strategies to frame how they function in the world, not discrete skill training (ok, ok, some definitely need discrete skill training too, but that’s just not the best way to support improved use of executive functioning skills). Some of these kids will likely never reach a point where they can independently use a strategy like Get Ready, Do, Done (see my last post); the strategy is still fantastically helpful, but they’ll need a caregiver to cue them to use it and/or prompt them through it. These are the kids I believe would gain a world of good from receiving services to enhance the use of executive functioning strategies at home rather than in a clinic. WHY?, you ask…
- Intervention in the home = access to actually training everyone in that child’s home. If you’re working on strategy use with kids who likely will need ongoing caregiver support with those strategies/frameworks, you should be training the caregiver right along with the kiddo. Plain and simple. You are not always going to be there to support DudeFriend through the process of making a plan or figuring out what the task will look like when it’s done (at least, I hope you won’t…). But you know who’s likely to be there a lot more often? Mom/Dad/Grandma/Aunt Lulu (the caregivers)! If dad can appropriately cue DudeFriend to use a trained strategy at home, in the car, at the grocery store, AND at the neighbor’s birthday party, then you just scored some serious generalization points. How do Dad/Mom/Aunt Lulu know how to appropriately cue DudeFriend, though? You train them to do it in functional tasks (homework, getting ready for dance class, making a snack, packing a backpack, etc.) in functional settings (at home). I’m under no delusion that SLPs should start following kids and their families around everywhere they go teaching them to use executive functioning strategies in every possible setting, but think of how much more likely your work is to generalize if you train the child and the parents in the environment where they’ll be using that strategy 95% of the time!
- Intervention in the home means that your vision gets to come to life. I’m currently working with one of the caregivers of the client who sparked this post to train her in supporting DudeFriend to use our treatment strategies with various tasks outside of clinic. In my mind, I know exactly how I would set up my Get Ready, Do, Done posters in the kitchen for snack prep. BUT, since I don’t have the luxury of carrying this training out in Dudefriend’s kitchen, I’m stuck trying to describe my vision to her (and it’s hard!). She is motivated, intelligent, and wonderful, but that doesn’t necessarily mean she can read my mind and carry out my vision…and the kitchen is just 1 place where I’m encouraging them to implement this strategy. If I were able to carry this intervention out in Dudefriend’s home, I could be modeling cues and prompts, collaboratively brainstorming the best places to put visual aids, and fitting my vision in with the family’s vision. And THAT would be a beautiful thing.
- Intervention in the home means that you are actually using materials available to that family, rather than your own treatment materials that may or may not be functional for the kiddo outside of your sessions once or twice a week. Instead of handing parents tools and saying, “Here…make this work,” you can strategize with them to use what they have in the home to bring target strategies and frameworks to life. My sense is that you bring about much more lasting change when you’re not putting unrealistic expectations on the family to find or buy materials that are unfamiliar and uncomfortable to them.
In my naivety, I don’t actually know whether SLPs are out there delivering executive functioning services in the home to kids outside the birth-3 range. My gut sense is that if you’re out there, you’re one of the few, and I think that needs to change. As SLPs, we have a valuable service to be offerring not just the clients, but their families too. We work tirelessly to make activities in clinics as functional as possible for kids, so imagine if you could skip the step of recreating “home” in your clinic room and instead work on using strategies in their actual homes!
If this is already your jam, I’d love to know! If it’s not, but it sounds like a cool jam, I’d love to know too! And maybe one day we’ll team up and start a great new wave of service delivery