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Considerations in Developing Home Programs - Featured May 28, 2010

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Considerations in Developing Home Programs

By: Holly Strange, MS, CCC/SLP

Families of children with special needs face a variety of challenges based on the severity of disability, family level of education, economic status, and access to treatment. Therapists have often held that improved outcomes in treatment are directly related to early and intensive intervention, carry-over of treatment goals into the natural environment, and the child’s level of motivation and participation in therapy. In 2009 the American Speech-Language-Hearing Association (ASHA) published a Pre-Kindergarten National Data Report based upon data collected using the National Outcomes Measurement System (NOMS) which evidenced the value of increased treatment intensity and home program completion in achieving improved functional gains and multiple levels of progress.

Although we know that frequent/intense treatment leads to the best outcomes, services are often limited due to insurance restrictions, financial reasons, and geographical difficulties. Not only is this a challenge and source of stress for parents and caregivers, but therapists also experience significant frustration with an inability to provide services as frequently as indicated. In an attempt to maximize services and outcomes (in the face of limitations and restrictions) many therapists have become more reliant upon the benefit of providing families with comprehensive home programs. To meet the needs of our clients we must adapt and find effective and creative ways to provide treatment activities outside of the traditional therapy setting.

Oftentimes, the families of children that we as therapists treat, are under significant stress, in part because of their child’s disability. This stress is compounded by limited access to the services they want and need for their children and the added responsibility that wearing the “therapist hat” adds to their already full plates. When providing parent education, home programs and caregiver instruction, remember to keep it simple, keep it short, and make it fun and motivating.

One of the most important things we can do when training parents/caregivers is to simplify the process. It is very helpful if you provide a framework in which they can better conceptualize the overall process and the steps between the starting point and the goal. Within the framework, the steps toward the goal need to be manageable and specific. The activities that you include in the home program need to be geared toward these goals with targets clearly lined out. Do not assume any information is self-explanatory; it is best that everything is spelled out. Asking for feedback from parents/caregivers will allow you to be sure that they understand the information and the process clearly.

In establishing home program activities for practice, therapists need to consider the following:
  1. Practice on a daily basis is the most efficient/ effective way to improve articulation, language, feeding or communication goals.
  2. Home program activities need to focus on things the child is able to do, but requires practice and feedback to do effectively. Including undeveloped skills will lead to frustration for both the child and the caregiver.
  3. Because families of children with special needs are busy and experience significant stress, therapy activities to be carried out at home, should be simple, time efficient, cost efficient, and motivating for the child. In addition to regular daily activities, families of children with special needs often have physician appointments, and other therapy appointments. Caregivers are much more likely to provide the child with practice at home or school if techniques are simple, detailed and quick.
  4. Children must be motivated by treatment activities provided with your home programs. If the activities are not perceived as “fun,” children will not engage in the activity, and the practice will not occur, as it will become burdensome for caregivers.

With more and more constraints being placed upon direct service provision, there are many home program activity options now available. Families can use the more traditional worksheets, workbooks, and flash cards or the newer computer games and websites. Having a variety of options on hand is best when trying to meet the needs of many different families and children. Worksheets and workbooks are usually more cost-effective, but don’t offer the same fun factor as games. If you do include worksheets, workbooks, and flash cards in your home program, remember to include specific examples of ways to make completing the task more fun so that the child will stay engaged.

Computer games are being recognized as a great tool to enhance learning given the fact that most children love to play computer games so motivation and interest is intrinsic. They also have the added benefit of increased independence for the child, lessening the burden on the caregiver. Computer programs often have reporting features that can be helpful in monitoring progress and in providing useful information to the therapist. Cost can be a drawback for some, but overall the benefit afforded by interactive software is usually worth the monetary outlay.
We all know frequent practice is key to skill development and speech/language skills are no different. If the children on your caseload are practicing intensively and engaging in motivating activities, treatment outcomes will improve, pleasing both parents/caregivers and therapists.

This Month's Featured Author: Holly Strange, MS, CCC/SLP

We thank Holly Strange for providing us with this article for our newsletter

Holly Strange, MS, CCC/SLP is the owner of Comprehensive Speech Therapy, LLC, a private outpatient therapy practice and Advance Games, LLC, an educational software development company, both in Baton Rouge, Louisiana. She received her master’s degree from Baylor University in 1996. Holly has received specialty treatment training in several areas including: NeuroDevelopmental Treatment, the PROMPT™ method, the Hanen™ method, Fast ForWord™, Therapeutic Listening™, and Deep Pharyngeal Neuromuscular Stimulation (DPNS). She is also a certified provider of the SpeechEasy™ fluency-enhancing device. Holly has worked extensively with neo-nates, infants, children, and adults with a variety of speech, language, cognitive, and feeding problems. Her special interests include oral-motor, motor-planning and auditory processing disorders.

While practicing as a speech-language pathologist, Holly conceived of the idea to utilize speech recognition technology to create games for speech therapy practice and Advance Games, LLC was born. Getting children to speak clearly and to practice newly developed sounds daily is one of the biggest challenges facing parents and speech therapists and Holly’s primary goal was to create an interactive way for children to participate in articulation activities in a fun to play computer game format.

Advance Games’ first computer learning game, Say-N-Play, utilizes Eduspeak (a voice recognition engine developed by SRI, International) and provides a fun and visually engaging environment for children between the ages of four and nine to practice speech sound pronunciation. The idea for Say-N-Play was originally developed to provide children with speech difficulty an engaging alternative to traditional speech therapy drill activities. The game has, however, turned out to be an excellent product for all children as a means of reinforcing proper sound and word pronunciation. It also offers the additional benefit of reading skill development as all words are presented in the written as well as the pictorial format.

Tags: Article SLP OT PT Newsletter 28 May 2010 Parental Involvement Early Intervention