Wednesday, November 30, 2011

Therapists Consulting with School & Daycare Staff

It seems this year has been extra crazy and busy, which means I haven't blogged near as much as I did the previous two years...oh well, if life even slows down a bit, then I'll get back to blogging more. Ironically, I don't watch television very often or do other things that you would think should take me away from my blogging, yet somehow the days and evenings fly by!

In addition to me working part-time for an early intervention program in which I work in homes, daycares, and in the community with children ages birth to three years with special needs, I also work part-time for myself. I see a few children on a weekly basis as well as conducting consultations and evaluations for a local school district (not the one I work for ECI or the one my daughter attends). So, this year I have learned a lot about billing insurance companies, facilities, and Medicaid...lots of lessons have been learned! But the biggest thing that I've enjoyed doing this year (besides being a Mom of two children and a wife) is providing consultative services.

Consultations are really important and that is why most school occupational therapists spend most of their time doing that versus direct services. Because the therapist is only around a child a small part of the week (or for some kids even less), and the parents, teachers, or daycare staff are around them for the majority of the time, then doesn't it make sense to teach them a few simple strategies that can make a difference in that child's life. Some of the suggestions can be as simple as putting the child at a table that faces a less "busy" area and therefore is less distracting so the child can remain seated and do his "work". Ideas may also be as simple as rewording requests, keeping instructions short and simple, using a picture schedule system, or making sure the table/chair is at the appropriate height which provides better support for handwriting and focusing.

Consultative services doesn't mean that the child doesn't also need direct therapy, it just means that there may be adaptations to the environment that could make a functional difference. It might also mean that teaching the adults to interact differently with the child could make a difference. For example, for a child who transitions poorly between activities at a daycare one suggestion may be to give him a one minute verbal update of what will be coming next. Predictability often lessens anxiety in children with developmental disabilities, especially the children with sensory processing disorder (SPD) and autism spectrum disorder (ASD).

I've learned through the years to not get all of my "therapy kicks" out of directly interacting or touching the child. When I was first out of college, I wouldn't have dreamed that I could help out a five month old with Down Syndrom so much unless I was literally touching the child helping him to roll over or helping with some other motor or feeding skill. Yet, now I know that if I show the parents a few strategies for "tummy time", positioning while holding/feeding the baby, and diapering that I'm making a big, maybe even bigger difference than I am by directly working with the child. It has been a change for me not to be the one to feed the client, but to be the one guiding the parent either verbally or physically. After all, it's not "all about me"!

So, if your child gets direct services only at a clinic, then ask the therapist if she/he is willing to do a home visit at least once. Insurance may or may not pay for it, so funding could be an issue. If you can't afford to pay for the home therapy visit privately, then videotape the surroundings of your home during the daily routines that are difficult such as toothbrushing or meal times; have the therapist view it and give any suggestions on how to help that routine go smoother. Maybe the therapist will also be fine with you participating in the therapy session at the clinic so you can learn some activities to do with your child in between sessions. At the very least, get a handout individualized to your child on activities or adaptations that would be beneficial.