When I got my first job working with children through early intervention I was really excited. Early intervention refers to services and supports provided to children with developmental delays and disabilities age birth -3 years old and their families. During these first 3 years of life it’s a critical time for speech and language development because children have growing and developing brains. If there is a delay or problem with development during this time, supports and therapeutic services should be started as soon as possible. So being able to help children during their prime developmental years was something I was looking forward to.
In my previous jobs I worked with adults and school age children (kindergarten – high school). I was used to providing direct instruction. Preparing therapy activities in advance, then delivering those during therapy sessions. Parents or caregivers were educated after the sessions on what they could do to help with generalization of skills. With about 7 years of experience as a speech language pathologist I felt like I was well experienced. So I thought it wouldn’t be that difficult to transition into working with a new age group.
Oh, was I wrong. I would later find out that I did not have experience delivering the type of service recommended for children in early intervention. Everything I read and heard about the SLPs role in early intervention was about parent coaching and less direct instruction. Working with children and families in their daily routine activities. Helping parents learn language facilitation strategies and how to use them during their daily routines. I didn’t really know what parent coaching was or how to do it. My excitement turned into nervousness. I didn’t know where to start.
I came across an article that referenced a study where 68% of SLPs reported having low skill levels in working with infants and toddlers and that 60% of graduate programs provide little to no training in early intervention (Brooks, Hensale, Roberts, 2016). I know I surely felt unprepared when I first started in early intervention. But I jumped right in and gave it my best shot. I spent hours researching intervention strategies and parent coaching techniques. As my caseload got bigger and I worked with more and more families, I started to feel more comfortable in my role as an early intervention SLP. I am going to share with you some things I learned along the way. Tips to help you get started during your first couple of sessions with families.
1. Get to know the child and the family and what goals the family has for the child. During your first visit with the family ask the parent/caregiver to tell you a about the child. Ask what are their goals for the child’s communications are. Have them prioritize the goals so you can focus on what’s most important to the family. Review the goals in the child’s current IFSP with the family. Ask questions about the child’s current level of communication skills. Examples of questions to ask:
“Is child currently imitating sounds or words?”
“What sounds or words is the child using independently?”
“Is the child currently using any gestures or sign language?”
“How does child let you know what he/she wants?”
2. Explain to the family what therapy will look like. Let the parent/caregiver know that therapy is a team-based approach including you and them. Discuss your role as the speech language pathologist. Explain that you will coach them on ways to facilitate vocabulary growth and language use in their child. You will educate them on strategies to help address their child’s needs and coach them on using those strategies with their child during structured activities and daily routines, especially when you are not there Discuss with the parent/caregiver their role. Explain to them how they will be expected to be an active participant during sessions. Discuss the intervention model that will be used. The intervention model I was taught is the “I Do, We Do, You Do” model (see below) Explain the benefits for their child of them learning and using language strategies on a daily basis. Review that your there to help them meet their goals they have for their child.
I Do: Explain the strategies and model doing the strategy with the child in activities.
We Do: Help the parent/caregiver use the strategy with their child. Coach them during the process with suggestions on words to use things to try.
You Do: Allow the parent/caregiver to practice using the strategy with their child independently. Watch and provide feedback and allow for reflections at the end.
3. Observe interactions between the parent/caregiver and child. Take notes (mental or written) on how the child plays with toys, interacts with people, make requests, protest, and more. Ask the parent to engage with the child, if they haven’t been already to see what that looks like. Try to focus on activities that are important to the family and activities that are part of their routines. Example of some things to say to lead into this may be:
“Can you show me some activities you do together”?
“I see he/she likes playing with cars (or whatever the child is playing with), how does he/she respond when you join in to play too?”
“Can you show me” or Let’s see what he/she will do”
“What are you usually doing at this time?”
4. Introduce language strategies and educate the parent/caregiver with information supporting the strategies being introduced. As you are watching the interaction between parent/caregiver and child you will notice where the parent or child needs support to help make the interaction more successful. This is when you can introduce language strategies. Explain what the strategy is and how it can help with speech and language development. Go through the intervention model.
5. Review and reflect what you and the family practiced. To begin ask the parent/caregiver to reflect on what worked and what didn’t work (and why). Remember the your role as SLP is to help the parent/caregiver help their child to learn. Ask them for their input on new ideas to try. Provide feedback on how things went. Share your ideas for things to try.
6. Plan for the next visit. Have the parent/caregiver discuss what they’re going to work on until the next visit. Explain that you would like them to share what worked and didn’t work during the next session. Then discuss what the goals will be for the next visit. Talk about what activities or materials to have ready for the next visit.
The biggest thing I learned from my experience working in early intervention is how important parent/caregiver participation is in the process. In the same article by Brooks, Hensale, Roberts, 2016 the authors referenced a study that reported how parent’s behavior subsequently affects their child’s behavior and how changing the behavior of one inherently changes the behavior of the other. They referenced another study that found parents feel less competent as a parent when they see others successful at getting their child do something they have not been able to do. As SLPs we don’t want a child to create dependence on us nor do we want parent/caregivers to feel like they cannot help their child learn.
I hope this information is helpful. I also hope it helps SLPs feel more confident starting out in early intervention. I didn’t discuss different language strategies to use. Maybe that will come in another post. I wanted to focus more on how to move into the role of coaching as a SLP. Good Luck!!
Brooks, M Hensale, T, & Robers, M. (2016), More Than “Try This at Home” –Including Parents in Early Intervention. Perspective of the ASHA Special Interest Groups, SIG 1 Vol 1(Part 4). 130-140.
Kynisha Cloud, M.S. CCC-SLP