Essex Front Door

Door I liked in Essex, CT

I have been thinking a lot about how to address several situations I found myself in lately as I entered a home for the first time to meet a family and start working with their child. Maybe because it is the fall and I am taking several new children on my caseload, or that I just have had some especially challenging situations lately with little boys (hey, I’m not discriminating–I don’t have any girls on my caseload right now!) and their behavior.

Many of you know that I worked in the public and non-public schools for 16 years before going into private practice where I travel to homes and deliver services at the kitchen table, on the floor, in the playroom or basement. When I had my own therapy room, I set the rules, kids knew what to expect and what the consequences were for not following those rules. The first rule was to have fun of course. It is a different setting when I walk into someone’s home and I can quickly see who rules, the parents, the kids, or some combination thereof. Stephanie Dowling, MA, CCC, SLP
recently blogged on this topic for Advance Magazine and said it well,

“In the home care setting, the scenario is much different. In this situation, you are entering into someone else’s home and long before you showed up, rules (or no rules) were set. The biggest challenge for me occurs in this setting when I see a child’s true potential not being met because of how behaviors are or are not being handled. We have been sent to this person’s home to address their child’s speech and language delay/disorder, not their behavior. However, as any seasoned therapist knows, how a child behaves can and will directly affect their ability to communicate and vice versa.”  

Of course, after 35 years working with kids I am a master of distraction and can usually get them to forget their obstinance and engage in a fun game before they know it. But sometimes parents, unknowingly can get in the way and actually reinforce noncompliant behavior.

Yesterday turned out to be pretty funny but when I arrived, I wasn’t quite sure how I would resolve the situation. The little boy I had come to meet was already saying, “I don’t want a teacher,” “I’m not doing any work,” (without laying eyes on me) and moved on to “I don’t play games that aren’t mine” after he looked in my bag. It was actually so silly that it was funny. I let him rant a bit and got some history from mom, as he started to get a little more interested in my “Who Shook Hook?” game. By the end of a productive session he was asking me if I could come every day. Phew!

I’m actually going to repeat a few of Stephanie’s tips and add to them:

  • Be consistent. No matter what the situation in the home, I try to make my little space my therapy realm and stay consistent with expectations. Often with little ones (sometimes up to 3rd grade) I offer the model, “Sure Sherry,” when they are being obstinant. Somehow it stops the negative comments and moves to the positive, AND it gives a little alliteration which is fun.
  • Have fun. Kids need to see that therapy is fun when they cooperate. I bring great games, crafts, and books and they can’t wait to get their hands on them. Stephanie talked about “Being Fair” which is part of this that we don’t want to be so tough that kids can’t relax and do their best.
  • Learn what the child likes. Recently, several of the boys who challenged me at the beginning turn out to love art, drawing and even writing. I am using all these activities to motivate them and the negative behavior is diminishing. Alex Toys and  Wooky Entertainment offer great craft kids broken down into small steps to use for speech therapy session reinforcement.
  • Take it slow. Sometimes I am trying to get the most accomplished and jump right into therapy and really I should devote the session to getting to know my new friend, with a little more chat and not so many expectations.
  • Consider asking the parent to listen from the other room and see if the child focuses more on you and the therapy activity. Often this helps the child keep their focus, without two adults present. Then I invite the parent to join us for the last few minutes to “Show off” what we did.

The bottom line is I am a speech language therapist, not a behavioral specialist, (although I have had training and learned from some great co-workers), and need to have a cooperative child to get the most progress to build their speech and language. The longer I work with a family, the easier it is to partner in that process.