Author: lel2133

Parent Training and Home Practice: How Much is Too Much?

lel2133

More and more, researchers in speech-language intervention are confirming what practitioners have suspected for years: that intensity matters. Research has suggested early, intensified intervention is most effective in rapid, long-lasting improvement. It would be wonderful if we, as clinicians could accommodate every child or adult 5x weekly for hours at a time. Unfortunately, conventions of time, insurance, and practicality render that infeasible for ourselves as well as our clients. In particular for young children, where such a great impact can be made with early, intense, intervention, scheduling 1-2 sessions per week is difficult enough.

The natural solution is to foster carryover and development of skills through parent and caregiver training, but often conveying importance of home practice is difficult. And, caregivers have such busy schedules, even 10 minutes a day feels like asking a lot. Beyond that, it’s a difficult, fragile line to tread when training parents on new strategies. Particularly for young clinicians without children of their own, such suggestions feel almost intrusive to make, presumptive. Of course, it’s vital to establish some sort of rapport with clients and families prior to this, to find out their daily schedules, values, practices, and work with them to figure out a valid solution.

Even so, it’s a very real fear to cross some line you didn’t know was there before. In New York City specifically, as a school-based SLP, I find it difficult to coordinate with parents, to establish carryover practices. Parents are overloaded and have other responsibilities. Children, too. But in schools—and realistically, in most clinics—they’re only receiving services twice, maximum three times weekly, usually at 30 minutes per session. That’s not nearly enough to make the sort of rapid impacts we know can be made. How can we stress the importance of daily language development practice at home when these families have so much else to worry about?

A question from a new clinician: How can we as clinicians stress the importance of intensity and establish carryover routines?

An Unanticipated Response to Intervention

lel2133

I began this school year straight out of graduate school, well-educated in Response to Intervention theories and practices, eager to incorporate at-risk work into my schedule. It’s effective, it’s important, and, more importantly, as of July 2012, it’s legally mandated in the NYC school system. I was particularly excited when I learned that, as I was working in a newly-established school, my schedule would not be immediately overloaded. After calculating my caseload, I realized I’d have a few free periods throughout the week, a myth in the New York City school system, where so many SLPs are faced with impossible caseloads of 50-60 students, working through preparatory periods and lunch and even that’s not enough to accommodate all the mandates.

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Implementing Evidence-Based Practices in Schools

lel2133

It’s an interesting time to be working in public education. With the new Special Education reform, including the recent mandate that all schools implement Response to Intervention (RTI) procedures for at-risk students, schools are scrambling to figure out how to implement widespread changes in a long-established system. As a new Speech-Language Pathologist (SLP) in a public, urban elementary school, I have the benefit of coming in without any idea of what working in a school had been like prior to the reform. Fresh off the grad school boat, I was full of ideas and research, but little practical knowledge. A little about my school: opened in 2010, approximately 250 students enrolled in grades pre-K through 2nd grade. Obviously, it’s new, and so is much of the staff; most teachers are within their first 5 years of employment. In many ways, this creates an environment primed for implementing new policies and practices aligned with the law. In some ways, we’ve made strides; in others, though, we’re just as confused as I’d imagine are many other schools. Read More