‘Real-Time’ Treatment Is Unrealistic Working on daily living activities with increased parent involvement is an important goal for early interventionists and families. However, the suggestion in “From Couching to Coaching,” that clinicians can meet the requirement of working on activities at the actual time it is done in the house is unrealistic and misleading. ... Inbox
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Inbox  |   December 01, 2018
‘Real-Time’ Treatment Is Unrealistic
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Special Populations / Early Identification & Intervention / Practice Management / Inbox
Inbox   |   December 01, 2018
‘Real-Time’ Treatment Is Unrealistic
The ASHA Leader, December 2018, Vol. 23, 4. doi:10.1044/leader.IN1.23122018.4
The ASHA Leader, December 2018, Vol. 23, 4. doi:10.1044/leader.IN1.23122018.4
Working on daily living activities with increased parent involvement is an important goal for early interventionists and families. However, the suggestion in “From Couching to Coaching,” that clinicians can meet the requirement of working on activities at the actual time it is done in the house is unrealistic and misleading. The example in the article purported that if the child was working on brushing her teeth, the therapist should come early or late in the day when that activity would be happening naturally in the family’s routine.
In my experience, there is no way a therapist can regularly switch schedules for one client, especially a full-time early interventionist who may have 30-plus families to serve and may be driving to many different locations/towns daily. Rearranging times for one client would mean having to contact several other families to reschedule their appointment times, too, and would most likely result in children missing services due to schedule conflicts—not to mention conflicts with the therapist’s own personal and family obligations. Most families want a set time every week so that they can schedule all the other things they need to do.
Also, the article states that the clinician should provide therapy in a variety of natural environments (for example, a grocery store). In the perfect world, most therapists would love the flexibility to choose the environment where the therapy is being provided—however, I know my state will not pay if the service is not provided in the agreed-upon location.
Rae Brown, West Paterson, New Jersey
Author’s response:
Scheduling visits at times when activities are happening has become quite realistic for early interventionists across the country. Consider the following tips:
  • Move your entire early-intervention caseload to real-time scheduling. Then you will not be required to rearrange other families’ visit times when trying to flexibly schedule for only one family.

  • Schedule the next visit at the end of the current visit, so you know what activity will be the focus and when to go. This prevents switching visits because you will be scheduling only one to two weeks ahead.

  • Schedule families living near one another on the same day. You have multiple times in a day to accommodate a variety of family activities.

  • Most activities happen multiple times a day (meals) or do not have to occur at a set time (laundry), so you have many options when to schedule.

  • Activity settings for a family do not usually change with every visit, so you may visit on the same day/time until the caregiver masters that activity.

  • Most families do not want regular visits later in the evening, because it may not be a good time for them, either. Have the parent use cellphone video to capture the challenging moment or plan to visit once at that time to observe the activity and provide real-time assistance.

Check with your state about paying for services across natural environments. States do not typically refuse to pay for service when in a natural environment and properly documented.
Dathan Rush, Morgantown, North Carolina
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FROM THIS ISSUE
December 2018
Volume 23, Issue 12