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Early Intervention Speech Therapy

"Daily Routines" and Other Changes in EI

Published March 17, 2009 12:37 PM by Stephanie Bruno-Dowling
In today's post I'd like to discuss an issue that has become quite pressing within the county where I work as a speech therapist in early intervention. Part of why I raise this issue is to see if other therapists out there across the country and world-wide have been focusing on this element of therapy as well.

Generally speaking, one of the main goals of early intervention therapy is to help the child be able to function independently within their "daily routines".  Although this has been the main focus for as long as I have been working in EI, the emphasis on the "daily routines" element has recently increased. This term has become the focal point of our goal writing, data collection and therapeutic plan and although it makes sense in theory, it is often difficult to assess, treat and analyze.

Recently in an IFSP (Individualized Family Service Plan) review meeting, I needed to write a new speech goal for a child who is receiving speech-only services. Her main need for therapy is articulation-based. Her language skills are solid but she is still very difficult to understand.  

The goal I proposed was the following, "Child's name will improve her ability to use words to express her wants and needs across all environments". The immediate response from the county coordinator at the meeting was that this goal is too "clinical" and we are no longer able to say "across all environments". Instead we need to say "in daily routines". I would like to say that this was simply the opinion of this particular coordinator; however I have heard stories like this from my coworkers, so I can safely assume this is now a regulation of our county.

Now, I am not one to create a fuss; however the reason why I chose the wording I did was because this particular little girl is doing pretty well in her daily routines. She needs help mainly with articulation both at home and at her little school program, hence the term "across all environments". As a side note, I never realized that this was a "clinical" term?!

In general, numerous other changes and guidelines have been recently instituted into our paperwork; however no training has been provided nor has there been any official notification of changes being made. Instead, we as therapists are told what we are "supposed" to be doing and saying while in review meetings with parents.

As therapists, I believe we can play the game much better when we know the rules, but if the rules keep changing, how is anyone supposed to be successful? How are we supposed to be prepared as well as an effective resource for parents if proper training and education regarding new guidelines are not being provided?

So, my question for readers is this....is this struggle one that you are seeing in your own county or district as well and if so, how are you addressing it? 

8 comments

Hi Mrs. Bruno

I wanted to ask you some questions? I am working at a clinic working with EI students. This is new for me as I haven't worked really to much with this population. Anyway I wanted to find out what are the most effective materials I can have besides toys?? I know were suppose to play alot and follow the child's lead but I'm looking in terms of working on articulation. Is it to early to drill at that age? maybe it's a stupid question but I want them to get the most effective therapy while I have them. I was looking at some material from linquisystems and wanted to know if it's worth while buying them.

Blooming speech and language activities

Blooming category activities

Speech and language activities for young learners

Preschool language development.

what should a typical session be with these kiddos?

I guess I can play and have fun right.

anyway let me know,

Much regards,

arlene-

a, slp - private clinic January 25, 2011 1:42 AM
torrance CA

Great feedback - it is very reassuring to know I'm not the only therapist out there struggling with some of this issues. I find it so helpful to read your comments and hear the good (and not so good) of what is happening in EI beyond my little part of the world. Please keep sharing!

p.s. I can completely relate to allergy issues - I too work in homes where there is smoking and pets. I like dogs and cats, BUT I am allergic and that can be really difficult when trying to work! Most families put their dogs in another room when I'm there for therapy.

stephanie , blog author March 20, 2009 5:20 PM

I also include the phrase "across all settings" to emphasize to team members that this is the optimal way to facilitate progress for the child.  "Daily routines" sounds like a similar way to say the same thing.  

At the initial IEP meeting, I provide a "Best Practices" file to all team members with clinical material to be used by all such as scripts, social stories, contingency maps, WH & yes/no questions, etc.  As new material is collaboratively developed, it is distributed to all team members.

Ellen, , SLP Kailua High School March 20, 2009 12:30 PM
Kailua HI

This is a great blog! Thanks so much for doing this, Stephanie!  I have been an SLP in Birth to Three for close to 5 years. The program I work for has been working through all of these same issues.  In regards to goals and routines...I think the biggest shift in my understanding has been to view routines as the context in which parents work with their child not necessarily something that needs to be "fixed." Parents should be generating the goals and can prioritize the routines that they would like to use and/or improve. Our objectives can be specific to those routines chosen by the parent and what the child will be capable of learning, given their development and/or age. The more specific the goal is, the easier it will be to assess progress. Helping the parent help their child is the focus of our work. Strategies that are specific to routines help parents shape what they already do so their child can learn the skills they need to continue on their developmental path. In regards to the lack of communication within your program, your frustration is understandable. My program is finding out that the need for time to meet with other team members is crucial to this work.  There are resources out there to support this. Hope some of this helps!

Mary Judkins, SLP March 20, 2009 10:25 AM
Waukesha WI

I previously worked in center-based programs, and I am relatively new to the EI program (Chicago area).  My approach to therapy actually fits better into family-based intervention, but I do agree that the multitude of rules and procedures can be very confusing!  I have found that provider meetings, EI trainings, and a study group (where we discuss "bag free" therapy) to be very beneficial.  Networking with colleagues has been the best way to keep up to date.  I eventually figured out that the IFSP goal is a broad long term goal.  I write, and work on, my own short term goals and objectives that fit with the family's lifestyle.

I also face smokers and dogs, plus I am allergic to cats.  I finally booked houses with cats on the same day so I only have to take antihistamines once a week, and "cat day" is now laundry day!

Monika, early intervention - SLP March 20, 2009 9:42 AM
Elmhurst IL

In the state of South Carolina, the Dept. of Health is the lead agency. The Early Interventionist (who only has to have some type of education related college experience) has already written the speech goal which is very general; "Increase receptive and expressive language to age expected levels" or "Increase variety of vocalizations." There are no "objectives" like there were when I worked in Minnesota. Also, it's almost impossible to find an SLP that will do rural home visits. My biggest issues so far have been dealing with smokers and dogs. Talk about feeling isolated as an SLP moving from a big city up North to a very rural area where poverty rules! I do enjoy the variety, and have come to respect and even enjoy the dialectic differences. I love all the beautiful and amazing rural scenery of the South. There is no beauty like that of a string of laundry on a makeship wash line. I take my camera where ever I go and love all "my" babies!! Thank you for starting this blog. It's a Godsend.

Julia, Speech Therapy - Speech-Language Pathologist, Home Based March 19, 2009 6:40 PM
Society Hill SC

I think you have brought up an important point that I feel has been going on for a long time. Often IEP procedures or language come to us through "urban myth" (a therapist is told by another therapist something she thought was said by someone downtown) or through a coordinator who doesn't really understand the IEP process. I was once told that in order to make sure that the IEP team & parents were crafting the IEP together, we were to bring no notes or rough drafts to the meeting, but only blank pieces of paper!

I now often check with the speech/language official at the state level (in my case the DPI SLP Consultant), to really understand s the offical line.

Jackie Kaplan, , SLP Public School March 19, 2009 5:45 PM
Madison WI

Ah yes - the old "We must change the wording" directive! When working for an urban school system I learned to expect that directive, over the 14 years there, at least every 2-3 years. The move afoot is to write both IFSPs and IEPs in language the parents can understand. With the move toward measurable outcomes and greater transparency in the public school arena, this is understandable. I myself use the phrase, "at home and in the community" in an IFSP goal. One can further refine the language if the parent specifies the meaning of 'in the community' to mean church, playground, etc.. The more things change the more they............

I greatly enjoy your blog, Stephanie!

Barbara Cummings, EI & elementary public school - SLP, on hiatus March 19, 2009 5:43 PM
Buffalo NY

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About this Blog


    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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