Early Intervention Is Being a Good SLP Good Enough? Features
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Features  |   February 01, 2002
Early Intervention
Author Notes
  • Nancy Keenan-Rich, is an SLP, currently providing services through the Dutchess County Early Intervention Program. She has a degree in child development/early childhood education and contributes to a local column on communication issues related to children.
    Nancy Keenan-Rich, is an SLP, currently providing services through the Dutchess County Early Intervention Program. She has a degree in child development/early childhood education and contributes to a local column on communication issues related to children.×
Article Information
Special Populations / Early Identification & Intervention / Features
Features   |   February 01, 2002
Early Intervention
The ASHA Leader, February 2002, Vol. 7, 4-26. doi:10.1044/leader.FTR1.07022002.4
The ASHA Leader, February 2002, Vol. 7, 4-26. doi:10.1044/leader.FTR1.07022002.4
“We expect EI providers to interact with families in such a way that they enhance parents’ abilities and confidence to nurture their child’s development. Our goal is that parents will be able to say, ‘ I can help my child.’”
—Beverly Allyn, director, EI Program
Dutchess Co., Poughkeepsie, NY
In the field of early intervention (EI), service providers are encouraged to embrace the philosophy of family centeredness in natural settings. This requires a shift from the traditional child-centered model to a relationship-based model involving the family as active participants—a collaborative process.
I am a veteran speech-language pathologist with experience in a variety of settings, having treated infants, children, and adults within the entire spectrum of communication disorders. When I decided to devote myself to EI, I thought—naively, it turned out—that it would be an easy transition given my experience and my training. Also, I had recently completed a master’s degree in child development with an emphasis on the 0–3 age group, which bolstered my sense of preparedness.
Although I, like many clinicians, had always included family members in the treatment process, I decided to adopt the complete EI philosophy of family centeredness. I was prepared to collaborate with parents to include them as partners, so to speak.
Family Involvement
Initially, I was struck by the fact that I had become privy to aspects of family life not usually available to practitioners in a school, clinic, or private practice setting. I had studied family systems and was now seeing firsthand how this concept played out in the everyday lives of parents, children, and other caregivers.
Family beliefs, values, and priorities became the backdrop for services. Whereas I previously held an ideal concept of how family members might participate in EI, I now began, for the first time, to appreciate circumstances within the family that might influence the process—parent personalities, stress, boundaries, and the various pressures created by an extended family.
My studies in environmental risk and infant mental health proved invaluable in developing a deeper understanding of issues such as domestic violence, child maltreatment, and poverty. At the same time, family cohesiveness and resilience were evident in the face of stress. An infant mental health perspective made it easier for me to determine priorities—for example, trust and the establishment of firm relationships may initially take precedence over speech production goals for a child exposed to domestic violence.
Although familiar with multicultural issues, I soon realized that each family has a culture of its own, aside from its ethnicity, race, and religion, and that the same sensitivities apply—openness, flexibility, and the ability to be a good listener and respect differences in childrearing. Entering each household meant entering a unique world in which I had to learn the rules. There was the mother, for example, who had to adapt her quiet style and become more verbal when she realized that her son, who had a communication delay, would benefit from more language opportunities. There were the home-schooled children with little knowledge of popular culture, for whom I had to tailor my intervention accordingly.
Even with a background in child development, the transition to family-centered services presented new challenges. I remember one anxious parent who objected strongly to a hand-over-hand approach that I was using to facilitate a play activity. I suspect that her son’s motor-planning difficulties were hard for her to witness. I never had the opportunity to explore her feelings because she requested a different clinician after this session.
I also discovered that one size doesn’t fit all, and even my best intentions regarding implementation of the EI philosophy required readiness to adapt to each family. One case, for example, involved a child with hearing loss who was in the care of her aunt for most of each day. The parents seemed reluctant to participate and offered no explanation why they didn’t. I eventually became aware that there were significant family stresses. Since the parents were not receptive to emotional support services, I decided to take full advantage of the aunt’s availability and capability. The child progressed very well.
Relationships
Before collaboration can begin, relationships must be formed. Not unlike a first date, this could be either awkward or comfortable, I discovered as I became acquainted with family members. The relationship went beyond establishing rapport and involved more than giving assignments, information, and suggestions. I became attuned to family strengths and increasingly discovered that different family members could play a part in intervention. There have been many older sisters who loved participating and playing teacher. Activities could easily be designed to allow this to happen.
Now as I knock on the door I feel like an ethnographer, an observer-participant documenting in my mind’s eye the particulars of each family system. I observe how the family communicates, note the impact of the child’s needs for services on family members, and begin to explore ways of working together.
Roles
The concepts of role sharing and role expansion are not new to the SLP. There is an energy that emerges from sharing ideas, seeing the value in parent suggestions, and validating their choices of books, toys, and play.
There are still times when I feel a hesitation about a parent suggestion, only to discover its utility when I let go of my professional judgments. I have discovered that the potential for collaboration exists in large and small ways, and is as individual as each family. For example, one family was so skilled at using the floortime approach espoused by Stanley Greenspan that I learned a great deal. In another family, a grandfather began to pattern sentences for his grandchild with PDD who was in his care during the day. At first I was hesitant to encourage this approach only to discover that the child had an excellent auditory memory and began to incorporate the sentences appropriately into his daily life.
I am less often at the center of activities than I used to be in my previous orientation where I demonstrated a technique and included parents only briefly. I have come to recognize that sharing roles with parents and building on their strengths is as professionally fulfilling as doing the job myself, maybe even more so.
Role Expansion
I have also found that my role expanded rather than diminished. For example, sometimes other services appear warranted, such as sensory integration therapy, but a parent struggling with a work schedule and other priorities may decline them. It then becomes appropriate for me to educate the parent about sensory experiences and include such activities in the intervention program. I need to be certain that I stay within appropriate limits and do not misrepresent my credentials.
I have become more comfortable providing information in areas that do not appear directly related to communication such as parenting, behavior, and stress. I am also appreciating how communication really is part of these aspects of family life, while at the same time appreciating professional boundaries.
As Beverly Allyn, director of the Early Intervention Program in Dutchess County, NY, stresses, providers should teach parents how to fish instead of giving them the fish. Providers, for example, can refer parents to the resource section of their public library. They can suggest other helpful resources, such as workshops on relevant topics, opportunities to meet other parents, and activities that provide social and learning experiences for both parent and child, such as trips to local children’s museums.
Respect
The first time a parent told me “no mess” and “no bubbles” in the house, I was at a loss. How do I proceed when there are stumbling blocks? After all, some of us don’t go far without our bubbles. How do I collaborate with a parent who is angry with me or, at least, displacing anger on to me?
For example, a mother and father did not agree with an article on 2-year-olds and sharing that I had given them. The article suggested that 2-year-olds are not ready to share and should not be forced to do so, a perspective consistent with my own values and beliefs. This became an emotionally charged issue because the parents, who had both been raised in a strict environment, believed that it was appropriate to force their daughter to share. Forcing her often led to whining and tantrums that resulted in increased family tensions.
How could I encourage language rather than whining? How could I proceed in a way I believed was correct and still respect the parents’ perspective? I explored ways to resolve the conflict.
I began by encouraging the parents to tell me how they wanted to handle sharing. Then I suggested that we could try using two of the same toys, explaining that this might encourage their daughter to share. At the same time, we could focus on having her use appropriate language in place of whining. Gradually, she might share her toys or take turns. They agreed to try this approach. I believe that respecting their beliefs was the key to resolving this conflict.
Broadening the Base
SLPs require many professional skills and a storehouse of knowledge to effectively meet the needs of the 0–3 age group. Some of us specialize in feeding, autism, or hearing loss. But early intervention is defined not only by addressing the communication needs of very young children. It is defined by how we integrate our speech-language pathology skills with EI philosophy. I believe that by broadening our knowledge base to include components of family-centered services we can better fulfill the EI mission.
The more we understand about child development, the more helpful we can be to the parents who are frustrated with their child’s behavior. The more we appreciate different family systems, the more open and flexible we can be in understanding their perspective, working with family issues, and respecting their ideas and suggestions.
When we have a deeper knowledge about risk and resilience associated with different mental health issues, the less frustrated we will be and the more resourceful we can become in collaborating with these families. This brings to mind one very young parent who had little patience with her child but was great at pretend play. This became the foundation for enjoyable interactions between the parent and child and a solid base for language development. The parent accepted counseling services for behavior management.
Not all parents will participate in the EI process to the same degree. Participation will depend on the nature of their child’s communication needs. The SLP must find ways to support this process. This may include frequently being in the driver’s seat, ready to include, demonstrate, model, and assign in the more traditional manner. As special education teacher Abbie Schiff put it, “Letting go of the child-centered model requires a delicate balance between sharing expertise regarding the child’s needs as we understand them and creating a space for the parent’s ideas, values, and perspective.”
Our training programs must include development of collaborative skills needed for successful family centeredness. For example, courses relevant to very young children can include strategies for implementing goals in a role-sharing manner. Finally, ASHA should consider an early intervention special interest group that can address the unique aspects of the EI process involving the SLP.
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February 2002
Volume 7, Issue 2