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Early Intervention Speech Therapy

Handling Behaviors in Home Care

Published October 15, 2013 8:00 AM by Stephanie Bruno-Dowling
Today's post is more of a reflection and not a clinical report about how to address challenging behavior issues encountered in the home care setting. 

I am a speech-language pathologist, not a behavior specialist. My training, education and background have all focused on the area of speech-language pathology.  Although, I have attended numerous behavior trainings through my work and have also been schooled on the benefits of positive behavior supports, managing challenging behaviors in home care is still somewhat out of my comfort zone.

Handling behaviors in a classroom, a therapy session and of course within the walls of your own home can often be challenging, but in those situations we as therapists and as mothers/fathers are expected to be in control. We are on our own "turf" so to speak. It is up to us to set the stage and maintain control. We are able to create the expectations of the children we are responsible to care for, teach, love and oversee.

In the home care setting, the scenario is much different. In this situation, you are entering into someone else's home and long before you showed up, rules (or no rules) were set. The biggest challenge for me occurs in this setting when I see a child's true potential not being met because of how behaviors are or are not being handled. We have been sent to this person's home to address their child's speech and language delay/disorder, not their behavior. However, as any seasoned therapist knows, how a child behaves can and will directly affect their ability to communicate and vice versa.  

Recently I was in a house that I had visited several times before; however at this particular session I saw a whole new side to the family's home environment. I quickly realized that the family's disorganized living space and inability to tell their child "no" had created an intense level of chaos in the home and their child who to me seems quite capable of thriving in an environment of clear boundaries and consistent guidelines realistically has the benefits of neither. What seems consistent in this home is that the rules and consequences or lack thereof are always changing. In addition, my observation during this session was that when the challenging behavior(s) would rise, the child's communication and all their foundational building blocks such as eye contact, attention and focus would fall.   

Are you experiencing challenging behavior during your home care visits???

Join me next week as I share some of my own survival techniques

when behaviors flare in home care!


I currently have at least 3 kids on my caseload that are behavior challenges. One of them, in my opinion, is due to environment and lack of, or inconsistent enforcing of boundaries. It is amazing to see how this child begins to respond in a more positive manner when simple boundaries are established during the session. Is it magic? No, just consistency and quietly enforcing some "rules".

Great topic.

D, EI - SLP November 4, 2013 9:45 AM

I know exactly what you mean. I have worked in the school setting for the past two years. This summer, I began doing EI PRN work for a company.  You definitely have to approach behavior differently when you're entering someone's home vs. a school or clinical setting.

Renita October 20, 2013 11:48 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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