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Early Intervention Speech Therapy

More Changes and Challenges in EI

Published March 19, 2009 5:06 PM by Stephanie Bruno-Dowling
Earlier in the week I raised a few issues that have started to become more and more pressing in my work in early intervention.

The one that was first and foremost is the demand to use the term "daily routines". As a therapist working in a wide variety of home environments, sometimes identifying definable routines can be quite a struggle. I've been in homes where they never eat a meal as a family. They are constantly on the run, busy and scattered. This makes tracking routines and data very challenging.

Another scenario I also find surrounds the issue of toys. Toys are supposed to be the way children learn and explore endless concepts and skills. They should be part of their "daily routine". I've been in homes where there are no toys and I've also been in homes where toys are everywhere — broken and in piles and pieces all over the floor. The focus of therapy then becomes, helping the family CREATE daily routines that can be measured and recorded for the purpose of data, which sometimes diverts attention away from other aspects of speech and language.

This brings me to our next change, which is an increased concentration and demand on data collection. Our county now encourages both the therapists and the parents to keep organized and definable measurable data. Once again, for some parents this is extremely difficult and overwhelming. What I have done is create "parent charts" that I give to families to help them easily record what their child did/said throughout the day.

I would love to hear feedback from other therapists/parents on how this may be handled in your area!

Regarding therapist data, I was recently informed that it is now supposed to be submitted to our coordinators two weeks prior to every meeting. Now, one of the difficulties in our county is that we are only compensated for the time we are physically with a child. All the work we do outside of actual therapy time, such as making pictures, laminating, photocopies, phone calls, meeting/paperwork preparation is technically "non-billable time". They encourage us to do as much as we can within the home with the family during billable time; however it seems as though the list of "things to do" keeps growing and some of it will certainly take place outside our billable time.

My final issue to address has not happened yet; however I hear everyday that it is fast approaching (by May, 2009): our paperwork will be computerized. Our IFSP (Individualized Family Service Plan) will no longer be handwritten, it will be typed and both coordinators and therapists will be responsible for entering the data. I am curious how other counties in early intervention are handling computerized IFSPs? There are many unanswered questions...will the county provide laptops? How will we print out data for the families? Does this once again cut into "non-billable time"?  I have seen computerized IEPs work beautifully in several school systems; however I am curious as to how it will work in home care.

Thank you for reading today's questions and concerns. Any insights readers can offer would be greatly appreciated!


I feel encouraged hearing that "paperless" is working well for other counties out there!

A few questions to Chelsea in Louisville - does every therapist bring a computer to each home so that your therapy notes are written there? Does this now eliminate parent signatures on weekly notes and do the parents get copies of the notes after the session?

I think the idea of the IFSP online sounds great, but I'm concerned about how computerized therapy notes would work for us. We leave a copy for the family every week and it has our full summary, recommendations for the family to work on with their child, the date and time of our next session, etc. Parents rely on our notes for a variety of info, so I would be concerned if they were not able to receive a copy immediately after each session.

steph bruno, blog author March 26, 2009 9:40 PM

I have been working in the Early Intervention Program for about the past 15 years in Illinois.  I  have seen so many changes in the EI system.  I am very intersted in the IFSP and daily notes online system.  This would help us eliminate so much paperwork at the office!  I have storage rooms just full of old files.  I wish Illinois would convert to this system.

Brenda Zuccollo, Speech - President, Private practice March 26, 2009 6:22 PM
Kankakee IL

Our early intervention program has recently (in december 2008) gone paperless.  We do all out paperwork: treatment notes, IFSP's, assessments, logs of communication, online.  The database is supposed to eventually be available to parents to review in the furture, but is currently accessible to the service coordinators and therapists.  Therapists are required to maintain reliable internet access, but are not compensated for this requirement.  IFSP's are entered in real time, typically, during a meeting, into the database IF the coordinator has obtained wireless internet access on their own.  If not, it has to be entered on the coordinators time.  Therapists have the option of bringing their own laptop into family's homes to write up their treatment note and post it to the online database.  I have chosen not to obtain wireless internet access for my laptop (it's around $50 a month).  As a result, when billing is due, I upload all my treatment notes to the database every two weeks, which takes about 2 hours.  I like this system because it gives me access to the other therapist's progress on a plan, without requiring a zillion phone calls.  There are many kinks being worked out, and I'm still hazy on the ins and outs, as training was poorly done.  I think all in all it is a better way to keep records.

Chelsea Graham, SLP March 25, 2009 1:38 PM
Louisville KY

Hi Laura ~ Unfortunately we don't have a set form with routines listed that we use in our county. Basically, we simply follow a "typical" infant/toddler day - meals, snack, nap time, bedtime, diaper change, bath time, play time, daycare, playdates, local trips to playgrounds, restaurants, library, etc.

I hope this answers your question. I think you raise an important point to try to create a format outlining routines in some form. The tricky part would probably be that routines can and will vary from family to family.

steph bruno, blog author March 23, 2009 5:52 PM

Would it be possible to get a download of the form for routines you use with families?  Would be helpful to me (and others).

Laura , Education - SLP, Public School March 23, 2009 10:26 AM
Cleveland OH

Hi Stephanie! I really appreciate you doing this blog.  I am a student at Penn State looking into EI as a potential focus in Grad School.  I was wondering if there would be anyway I could get in contact with you by e-mail for a possible interview/reference.    I have been trying to touch base with a local EI Professional from my area for a paper I am currently working on.  I could not find your e-mail on your blog anywhere, but mine is  If there would be anyway you could contact me with your e-mail, that would be greatly appreciated.

Nicole English March 23, 2009 10:10 AM
Philadelphia PA

Monika ~ We are also starting to incorporate a more "bag free" philosophy into our therapy model - thanks for bringing this up - it's inspired the post I'm writing for this Tuesday. I like the quotes from the Cook and Sparks book. Thanks!!

Latisha ~ Interesting idea with the calendar. We have started to do a similiar "data keeping" practice using a notebook with all the goals we are working on as a team written out on a chart and we comment on the goals each week as we work on them. This just started. Although it's extra work, I like it because I think it helps to keep everyone on the same page. I think we need to start having the parents write in it as well - it would be helpful to track progress during "daily routines" when therapists are not present.

stephanie , blog author March 22, 2009 9:46 PM

Yes, thank you for this great blog, Stephanie!  I think you have hit on a hot topic for us new EI providers as well as the established ones.  I was inspired by Mary's (from Waukesha) excellent points, and would like to add to a comment I left last week.  In my area, the wording of the IFSP goals are provided by the parents.  We service providers can then write measurable short term goals and objectives to help the family reach the long term goals.  I am a "bag free" therapist and do not plan activities for the child/family.  I try to work with the family to fit the goals into whatever they happen to be doing at the time of my visit, or into an activity (walk to the park, snack time, play with favorite toys, etc.)  that we have decided on together.  I admit this has been a challenge at times when the parents are used to, or expecting, a more clinical approach.  I always keep two quotes from Cook & Sparks excellent book, "The Art and Practice of Home Visiting" (Brookes Publishing), in the back of my mind:  "we need more skills than just 'dumping the clinic on the living room floor' ", and "it isn't the contact hours, it's the intervention the child receives that creates changes" (McWilliams, 2005).

I haven't heard about computerized IFSPs yet, and I suppose "non-billable time" will always be an issue in home based intervention...

Monika, early intervention - SLP March 22, 2009 11:24 AM
Elmhurst IL

Hi Stephanie! Thank you so much for doing this blog. I am just getting into EI in NYC part-time as I also work in the schools. It is very difficult to provide families/caregivers with activities that can be used in the home in a half-hour.  We have to keep a calendar at the home where each service writes down an activity that the family has to do and write a plus or minus sign and a comment on why it worked or did not work. I haven't had the chance to do it yet as I had a complicated case but I'm not sure families will take the time to fill it out. The service coordinator will collect it at the end of the month.  Our IFSPs are not computerized yet in NYC but the CPSE in the Westchester area are computerized and codes are entered for goals, etc.

Latisha, SLP March 21, 2009 5:13 PM

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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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