Getting Started in EI – Therapy Materials!

I believe that Early Intervention is early sobriety / getting clean,

getting back on track.

My most popular toys: Parents Pound a Ball (leave the hammer at home!!)and Squeaky Sorter; any kind of "pop-up" toy; wood fake food with velcroed pieces that can be "cut" with a wood knife,  Mr. and Mrs. Potato Head (watch them closely...they may be eaten); stacking toys with sound; the Flip Book for artic; puzzles with big knobs or small number of pieces( I found a great resource on the internet that can replace a lost piece; underthegreenroof.com. They also make puzzles to your specifications..have a great baby photo you want made into a simple face puzzle? They do it all and are super friendly.

Because I sit on the floor, I always bring a colorful "oilcloth." I recently found a really cute patterned one with sock monkeys

( purchased a yard and a half) on the internet. It has generated lots of questions and language from my toddlers.

I have worked with several preschoolers lately who make me work hard (and think about strategies when I should be sleeping!). The May, 2009 issue of American Journal of Speech Lang Pathology has a great article about the 6 best Evidence-based practices for eliciting speech from less than willing clients: "When Simon Says Doesn't Work". Hopefully this link will get you there.  

http://ajslp.asha.org/cgi/content/full/18/2/133  

Good luck (we've all been there ~ and still go there! LOL)

Melanie Waters    

Grace -

Sorry for the delay in responding to your comment....I can definitely appreciate where you are right now and I remember being there!! I've decided to continue this "Getting Started" series and tomorrow's post will address your question(s) and the issues surrounding how therapists can begin their initial EI homecare visits....!!

Although I am currently working with preschoolers in a center-based program, I have done EI therapy in homes in the past.  Geri's suggestion to try and find a place where you can work without distractions and have more control is important.  She's also right when she says to adjust the length of each activity if you see a 'meltdown' potentially developing.  You want to try to end the activity on your terms, not when the child decides to stop. You'll also need to find out what is motivating to this child from week-to-week and even within each session,  so that he'll be willing to interact with you to get the reinforcers.  I have used pictures  to let even very young children see their choices of  reinforcers, after they've had a chance to explore different options.  Then I try to use the pictures to show a simple schedule where they can have a desired toy after they do an activity of my choice.  This lets them see that they will get something they want within a reasonable time.  Learning to wait is one of the hardest things for young ones to learn, especially if they have special needs.  You'll be surprised at some of the things that  might motivate him.  It's also important to have the parents limit the amount of time he can play with these toys when you're not there, because otherwise their value as rewards could decrease.

I admire your enthusiasm.  As Stephanie has often said, when you do home-based therapy your job as a speech pathologist encompasses alot more than simply doing therapy with a child.

Good luck!

Hi Grace,%0d%0a%0d%0aWelcome to EI, and temper tantrums and activities and entire sessions that don't always work out.  Thank you for your brave and honest letter.I am actually looking forward to reading other peoples suggestions, because even though I have been doing homecare for 11 years I still need ideas.Grace, I wondered what other therapies this child was getting. In my state we have behavioral therapists, usually highly trained special educaters who can help deal with challenging behaviors. They also provide family training.%0d%0aWith some children( challenging behavior, limited attention.), I have found it helpful to be in a small room, door closed, seated at a small table against the wall, with you blocking them from getting up, as much as possible   Still need to be open and flexible though.%0d%0a Edible reinforcement (if ok with Mom) could also be helpful. I use tiny pieces of cereal or cookie, sometimes paired with a verbal prompt or verbal praise. Sometimes children do better when Mom is not in the room, although she certainly needs to be involved.%0d%0aIn terms of tantrums, some children need to be left alone to finish their tantrum,have a few moments to calm down ,and then redirected back to therapy.  IF tantrums are that long and frequent, you need a behavioral therapist. An OT(presuming he qualifies) could also give you some techniques for calming. I think that the most important qualities to develop in this field are patience and a sense of humor. The world is not going to fall apart if something doesn't work out. %0d%0aI try and make sure that all activities have a beginning and an end. Very often I need to shorten an activity because despite my best efforts, the child can't attend anymore. I think eventually you will be able to feel this child's rhythm,  Be patient,flexible and have a sense of humor. Hopefully you will get alot of responses so that you could choose what feels right for you.%0d%0a                              Good luck and Welcome to my world.%0d%0a                                                   Geri,SLP

Help!

I had my first home visit today! For a little 2.5 boy, using few words or vocalizations with concern for possible autism diagnosis.  The family has taught him 15-20 signs and he has started to pair vocalizations with them per mom's report! He is so cute and such a little flirt...but I feel lost! I know tons of strategies to build on his communication,  but in grad school they don't teach you what to do when the child DOESN'T respond to those strategies! I was able to get him to attend to a puzzle and request "more" with a sign/vocal one time.  When he realized I wasn't going to just dump the puzzle pieces out and was instead making him tell me "more" for each piece, he just said, forget the puzzle!! and moved onto something else.  

When mom did not allow him to have chocolate milk, he threw a tantrum and refused to do anything but cry.  How do you work with those behaviors!? Mom says he is so stubborn and anytime you try to press for communication he will throw a fit until you give in.  Mom is very frustrated, obviously! But so is the child, to the point where he will hurt himself if he is not given what he wants.

1. Do you just model, model, model signs/words and hope he eventually starts using the signs/words himself OR do you press for him to use them himself?

2. How many times do you "hold out" before you give in?  If you say, "tell me more" and he does not do it, do you repeat yourself 3 times, 5 times, 100 times? before you give him what he wants??

3. How much behavioral issues, as the speech therapist, do you address? He had at least 3 time outs/spanks while I was there, so clearly they need some strategies but I just don't know WHAT they are!?

Any help would be much appreciated!

Terri,

Very true!! I can't believe I forgot to mention these. I have both in my car at all times.....thank you for the reminder!!!

These items are all great but whatever you do, DO NOT forget the hand sanitizer and sanitizer wipes! These two items are essential when going from location to location and at times not having a restroom available.

Grace ~

I would definitely observe and interview the family for your first visit. Also, if you can co-treat with a coworker (especially one that has been working with the family for awhile), that is usually a really helpful way to ease into a new home. You could bring in a small bag with a fun toy or two (bubbles are always a good ice breaker) just to help build rapport with the child.

I attend trainings through my job often and they also provided literature for me when I first started working there, so you may want to ask at your place of employment. I also read, and still use, a book entitled "The Late Talker" - I usually share the parent chapter with families. Good Luck and let us know how it goes!!

Stephanie,

Thank you so much for this most.  It was incredibly perfect timing.  I am a new CFY, and am starting my first home visits this week.  In grad school, EI was a brief part of only one course so I feel more than slightly terrified about venturing out into homes. The big emphasis of the information on EI that we were give was on routines based intervention. We were given strict "no bag" instructions.  However, I think your list of resources makes sense and I will work on finding the balance between "no bag" therapy and having the materials I need to elicit the best speech/language possible.

Do you have any advice on what the "first" session should look like? Is it appropriate to just go in and sort of observe and build a rapport with the child without specifically targeting goals?

Also, are there books or courses you would recommend for getting some EI basics down?