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Early Intervention Speech Therapy

Addressing the Issues: "Bag-Free" Therapy

Published March 24, 2009 11:48 AM by Stephanie Bruno-Dowling
Over the last week, I have written two posts addressing some recent changes and challenges I have been facing in my speech therapy position. As a result, many readers have shared their thoughts, comments and own work experiences in early intervention. This immediate and supportive feedback from the readers has been both encouraging and inspiring, sparking new topics of interest!

One reader brought up the practice of "bag free" therapy. This is a hot topic in our area right now as well and it goes hand-in-hand with "routine-based" therapy. The philosophy is that if we bring bags of toys into the therapy session then we are creating the activity and not really seeing the child in their natural environment.

The way I have been addressing this is by attempting to find the BALANCE between both models. With the "bag free" model there is often less pre-therapy planning involved. It also tends to naturally encourage the input of the parent. They know you are walking into their home and will treat the communication issues on an "as is" basis regardless of what activities the child may be engaged in. For these reasons, I believe "bag free" therapy is often an appropriate and necessary option.

I feel that if this is ALWAYS the therapy model I am using; however then there may be times I am not addressing all the needs of the child. For example, there are times when I want to incorporate a new oral motor tool, so I will bring it along with me. Or, maybe the family does not have many toys for the child to play with for whatever reason and language and play skills are a significant need for this child.

Regarding articulation, I also have my "bag of tricks" that I use complete with a mirror, microphone, tape recorder and picture/sound cards that I use to help practice isolated sounds. With many of my "speech only" kiddos with significant articulation issues, I use a speech book, which is always left with the family. They are instructed to add pictures and practice the activities daily. In addition; however I often bring paper and glue activities for the child to complete to add to the book. These activities help them gain the confidence and practice they need to improve their ability to make sounds and be understood by their family members. I feel it is unrealistic to ask every family to have all the different tools that I know can help stimulate speech and language.

If I know I have an activity or toy that will help a child learn and develop a specific skill, I include it in my session. The big picture idea behind this is that the parent will see what the child is capable of and will then attempt to replicate this during their own time with the child. I've given them a reference point. For some parents, they are unsure of how to play with their child and may not know what type of toys to use/buy for speech and language stimulation. By demonstrating what works, I feel I am able to be more effective as a therapist.

I see the advantages and disadvantages of both models and as I stated earlier, I try to use both as I deem appropriate. "Bag free" therapy is a newer concept for me so I would love to hear how other therapists use it and see the benefits in their early intervention speech therapy.


Sandy ~ Thank you for your comment. One thought I had in response would be to make sure you are clear on both your role in the home and what the expectations of the parents are - setting the stage early and talking to parents about the plan of care is important. That way they know what to expect and understand their role in the assistance of their child's progress.

stephanie bruno, blog author April 4, 2009 10:08 AM

I admire your ability to be "bag free", but my experience has been one of 'no toys' or 'cleaned area' to work without access to bedroom locations where toys might be available. Many of my parents appear to 'expect' toys to be brought in and leave the instruction area to attend to household chores or phone conversations or 'smoke breaks'. Most clients' families appear to expect even more than I provide (which is a lot).

Speech Pathology SLP Early Intervention April 3, 2009 1:31 PM
Lafayette LA

I have been on both the provider and the parent ends of home visits.  Young children look forward to having a new toy or special materials to play with when their "teacher" comes to the house.  It sparks their interest and can be used judiciously to keep them engaged.  

Parents enjoy having new ideas to build on for their own activities for the other 6 or more days between visits.  It works well to say: "Here is how I am using this ___ to encourage "___ and you could substitute his own ___ to do the same thing." Then show them how with their own toys or household items.

Keep your activities applicable to their everyday lives and help families make the connections.  We do not intend to entertain but to motivate and empower as well as model good communication strategies.

Donna Snyder, Deaf/HOH - SLP, MCPS March 26, 2009 1:22 PM
Rockville MD

Monika ~ GREAT suggestions and ideas. Thank you so much for sharing what you do and how "bag free" works for you. You've sparked my creativity with your ideas!! I really like the idea of going through the child's toys to find ones that support the articulation goals - wonderful ideas. Thank you!!

p.s. I agree, I never ask or expect parents to buy anything. Once in a while they will offer or ask for toy suggestions (especially around birthdays and holidays) and I do make recommendations if appropriate.

steph bruno, blog author March 24, 2009 9:08 PM

Hi again Stephanie-  I agree it was difficult to address phonological goals while going "bag free" at first, and it took some rethinking on my part.  For example, right now I have a little client who only uses a CV word shape.  When I come, we search through his toys (he has a lot) for items that represent CVC words (e.g., dog, pig, duck) to play with.  One session, he was playing with a large box when I got there.  The activity lent itself to repetition of the words "out", "fit", "foot".  His parents have been eager to participate and I often hear his dad modeling/repeating words like "up" and "beep" while they are playing.  I have another client who I see at his daycare.  Since he is working on initial fricatives, the lunchtime routine lends itself to words like "soap", "sit", "soup", "food", "fork", etc.  Just today, one little girl (25 months) I work with, brought me a phonebook.  We (her mom too) started looking for pictures of "people" and before we knew it she was imitating "more people".

I do occasionally bring toys or activities into the home, especially when we have decided to address a new goal, but usually discuss the strategy with the parent the week before.  I try to avoid making the parents feel like they have to buy special toys or items.  As we all know, kids love playing with things that most homes have: boxes, cups, spoons, balls, empty milk jugs, etc.  The key to going "bag free" for me has been to always keep the child's goals in mind, and to consistently relate strategies to the parents or caregivers while engaged in daily activities.  

Monika Zubradt, early intervention - SLP March 24, 2009 4:14 PM
Elmhurst IL

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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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