Supporting Families and Saying Goodbye

 Alaina’s recent post about supporting receptive language got me thinking about all the different ways we support language and communication for our clients. Specifically, I started thinking about different ways in which we support families. Clinicians are educators as we teach a family about communication and language. We are listeners as we consider a family’s specific needs, cultural and linguistic background, and preferred style of interacting with us as professionals. We are also advocates as we collaborate with other professionals to best support our client’s readiness to learn.

I have supported families as they are discharged from therapy many times but I have not really considered how we best support them through this process. It seems reasonable to state that having a child with a communication disorder may be a very emotional experience. For those clinicians who may be interested, David M. Luterman’s Counseling Persons with Communication Disorders and their Families, is a nice reference. As I write and think, I can see how it would be difficult for a family to be done with therapy (and thus, perhaps, why they may require a different kind of support). I want to help families focus on the positives (e.g., celebrating their child’s success) and look forward to the extra time and resources that they will no longer be putting into therapy.

As I consider ways to support a family as they transition out of therapy, here are some strategies I am practicing:

1. Consider scheduling a time for a bigger conversation, one that is set apart from the child’s regular therapy time.
2. Ask parents to talk about their child’s communication. It seems likely they will reference how much progress the child has made which will be helpful as they begin to consider being discharged.
3. Use different media to celebrate the child’s success, and to remind parents how far a child has come.
3. Organize information about the child’s progress and current level of performance in a few different ways. Some parents may appreciate tables with standard scores, percentile ranks etc. This may not be as meaningful or helpful to other parents. Providing some written narration about the child’s progress could also be helpful.
4. Find a balance between listening to the parent while still being the expert. (This one is difficult for me!) We know parents are the expert on their child, but as clinicians we are the expert with respect to communication and language.
5. Provide tips for parents for ways they can continue to support their child’s communication at home and in the community.

What strategies do you find helpful for families as they transition out of therapy?

Five Receptive Language Supports

As I was thinking about how to start this post, I considered Hannah's recent post about how Speech & Language Pathologists (SLPs) search the internet for information. Since I'm writing this post about how to support children who have a severe receptive language disorder, I'm guessing that this post might come up for SLPs who are doing searches for "receptive language disorder" or "receptive language goals" as they are writing their students' IEPs or their patients'/clients' plans of care. However, this post doesn't have goal ideas as much as ideas about the support that we, as communication partners, can give as we are communicating during our therapy sessions.

Receptive language disorders can make it hard for children to pay attention. What would it be like to have a receptive language disorder? It is impossible, as an outsider, to know what that experience is like, but second-language learning might be a good simulation. When I spend time listening to people speak in Spanish, a language in which I am proficient, it becomes very clear why someone with decreased receptive language skill would lose focus after a while and want to take breaks to do something easier. I know that as I take part in a Spanish-language conversation, it becomes almost painful as the conversation continues and I try to maintain comprehension.

A supportive Spanish-speaking partner goes a long way to help me participate in conversation, so I can empathize with why support is so helpful to children with receptive language disorders, too. One way that I structure speech and language goals is to include a phrase like "...with moderate support." I don't conceive of this support as a process of giving hints that lead the child to an answer that I have deemed correct. Rather, I look at support as a way to diminish the communication barrier so that a child can take part in a natural process of communicating and making connections. Here are five ideas for what this support, whether it's "mild," "moderate," or "maximal," might look like.

Five Supports for a Child with a Receptive Language Disorder

1. Slowing down and pausing to allow processing time.

2. Writing while speaking, and giving the child the opportunity to practice reading/repeating each sentence that you have written. This support is potentially appropriate for any children interested in written words, even if they do not yet read. Writing while speaking serves to slow the adult waaaay down, and gives the child visual indication of word boundaries.

3. Acting out, drawing, or showing pictures while speaking.

4. Repeating the exact same sentence (same words, word-order, and intonation) multiple times.

5. Using language that the child has already learned through her interests (the sentences she can recite from her favorite TV shows, movies, and books, modified to fit the context).

Searching

It seems reasonable to state that Speech & Language Pathologists who use the Internet as a resource are likely to encounter loads (a very technical word) of information. I was curious about general search terms, so I recently did a quick search. “Speech and language goals” revealed 2,790,000 results. “Articulation goals” revealed 6,720,000 results. SLPs may also search for activities targeted toward specific age groups (e.g., “preschool”) or themes (e.g., “dinosaurs”). Combining these two terms (“preschool + dinosaurs”) reveals 2,630,000 results. One could imagine pairing many different age groups with many different themes/ideas to yield even more results.

Given the quantity of information available, I am curious about how SLPs select resources. Do they return to websites because activities from those sites have been interesting to kids? Do they return to websites because the resources are free? What information do SLPs find when they search for activities to target goals that are commonly addressed? Are there better ways for SLPs to share information?