If you provide services to families in the home or via teletherapy, you have the advantage of helping them apply AV techniques to their natural environments in real time. But that’s not always possible. How can center-based clinicians or teachers make what they do with families “translate” once the families leave their clinic or school? How can we make center-based services realistic for parents?
The first thing we need to do is work on parent coaching skills, getting really good at knowing how to pull back the curtain and let parents know… it’s not magic!
Next, we might think about how to replicate the home environment, even in our center-based sessions. While it’s tempting to make use of the well-stocked toy closet down the hall, if the family doesn’t have access to those toys at home, that’s one more cognitive leap they have to make to transfer not only the strategies you’ve taught them, but also the activity, to their daily routines. Instead, think about ways that you can use toys or objects to recreate things that happen throughout the family’s day: pretending to cook a meal together, or wash clothes, or setting up a pretend gas station or supermarket. These are all things that they are likely to encounter once they leave your facility, making generalization of skills much easier.
You can ask some strategic questions to partner with parents to improve their ability to take what they’ve learned with you and do it “live,” such as:
“How do you usually play with this/ do this at home?” Rather than assume that I know how mealtime or bath time or playing cards goes in the family’s home, I would rather hear directly from them what this looks like before I intervene and mess up the good thing they have going! Remember, my job is just to enhance the listening and spoken language component of their everyday interactions, not change them altogether.
“We’ve worked on XYZ today. When might this work at home?” to help them think about where in their daily routines these goals might pop up. Helping the family understand a goal (e.g. third person singular -s, he walks, she talks) is great, but it only gets you halfway there. We need families to be thinking of a trigger in their environment that will present an opportunity to practice this goal (“Oh! I know. This would come up when we talk about what our neighbors do for a living, like he cuts grass, she sells shoes…”).
Another downfall I often see in therapy is when a clinician brilliantly models an AV strategy for parents and then closes up the session by saying, “So you can try [auditory closure/wait time/ acoustic highlighting/etc.] at home this week. Bye bye!”
There was once a time that I was very guilty of this myself. But then a parent taught me a great lesson. She came in the next week after I had given her an “okaygivethisashotbye” exit the week before, excited to show me what she had done with her child that week, and proceeded to demonstrate what she thought was acoustic highlighting… and couldn’t have been farther from my goal… and the only person to blame for that was ME! I know we are communication professionals, but no matter how clearly you think you’ve explained something to a parent, I never want that family to leave our session without having had a chance to practice a new skill or technique with me, together. How else can I know that what I think I said really translated to the parent? How else can we calibrate together? Bottom line: If I haven’t given you a chance to try it out with me, I can’t be sure that you are going to do it at home.
“Home carryover” is key for children to make progress. One hour of therapy a week, or even five days of school a week, are just a drop in the bucket of a child’s life. But I think we need to go from thinking about “home carryover” of therapy objectives, to “therapy carryover” of what’s really happening in the home, just plussing up the speech, language, and listening components. That’s when really “carryover” will occur!