The Ins and Outs of Early Intervention Speech Therapy

The author explores the benefits of early intervention speech therapy at school and home.

Working as a vendor for Golden Gate Regional Center in the San Francisco Bay Area, we adhere to the policies of providing speech therapy in the child’s natural environment. The Natural Environment policy indicates that services need be provided at home and in the child’s community — not in a doctor’s office, or other sterile environment that is not a “natural” part of the child’s daily routine. So our private practice sees the children in all sorts of environments such as the child’s home, neighborhood parks, local shopping malls, the grocery store, and even the child’s daycare or preschool.
Of all of the locations we might provide speech therapy, I have found the child’s daycare or preschool the most challenging.

Parents always ask me if we can provide the service at the child’s daycare or preschool, and I tell them that I am happy to do this but we need to continue to communicate what we are working on so parents can carry over skills at home. Sometimes I leave notes for parents but it can be difficult to describe what I did or how I got a certain skill from the child. If there is no other way, I try to schedule at least one visit a month where the parent can participate, or I might send parents a short video of what we did during the session, with the parent’s permission of course. This way the parent can be part of the process and help with accomplishing the speech goals set for the child.

I believe early intervention should highly involve the family so that carryover is stronger. The family cannot always participate or understand what we are working on when therapy takes place in daycare or preschool. Preschool staff may not be receptive to participating in the therapy, and I understand that for the teacher’s we can be a distraction to the class’ schedule. I usually mention to the parents and the school that I would like to use part of the therapy as a push-in or facilitate language from the actual daily routine. So instead of pulling the child away from the class and their peers, I will participate in the class, unless the child needs some direct work and in a quiet space.

Before I start a therapy session in a daycare or preschool, I like to get some information as far as their rules, guidelines, schedules, and vocabulary. Some schools call breakfast “breakfast,” others might call it “food time” or “snack.” If we are to help foster the child’s receptive and expressive language, I always like to check in with the staff so I refer to the activity or schedule accurately. Some preschools believe in time outs when behaviors occur; while we believe in positive reinforcement rather than time outs, we allow the school to enforce their own rules without judgment. Some preschools don’t believe in saying “no” to the child, and instead just softly redirect. Other schools have informed me that when a child hits another child that they model the term “I don’t like it when you do that.” All of these “ways of the school” help the speech therapist address the child’s speech and language skills in a way that will foster their daily experiences and allow the child to use effective communication to reduce frustration. It is vital to understand the ways of the school, much like it is important to understand the values and cultural beliefs of each individual family.

Other challenges can include the staff not understanding clearly what we do or how we do it and a preference that we work in a separate area/room (not always helpful to the child). The therapist has to have very good communication skills because we need to work with the teachers and staff without judging or critiquing while also not overwhelming the teachers with a million things to do with the child. In essence, therapists that provide therapy in these environments should have some training as to how to best utilize our skills and knowledge to best help the child meet their goals. The most important thing to consider is clear communication about our expectations, the school’s expectation of us, and how we will relay what we are doing in this environment so the parent sees value in our services.

Working in a daycare or preschool may have its challenges, but with clear communication to parents and teachers and a respect for the ways of the school, great progress can be made. I always look at going to the child’s preschool as a learning opportunity for myself. I can always use help learning new songs, new popular books, or even activities that work. But I have learned this etiquette on the job and thought I would share to see what all of your experiences have been with this.

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