Private therapy has its perks. It is, by nature, more flexible than a typical 9-to-5. Therapists can build their caseloads around their lives, location and specialty. Say you don't want to work Tuesdays. Then don't. Say you only want to work on the Upper East Side. No problem. Say you only want to work with children with autism. Go for it!
But working in the home -- in other people's homes -- can have some major downsides. For therapists and caregivers alike, it is best to know the ways in which home care may not be ideal -- and how to quickly fix the situation.
1. Turf War: Private therapy in the home is vastly different from conducting therapy at school or in a quiet office space. Oftentimes, there is a whole lot you as the therapist are able to control. Other siblings, access to toys and TV, people coming and going. There can be far too many distractions.
How to Avoid It: When possible, establish a workstation from the get-go. Request a kid's table in a quiet room away from distractions. Parents and kids will learn very quickly that when you arrive, it's time to get down to business.
2. Manipulation: Kids know how to work it, that's for sure. Hostage negotiations can look like a walk in the park in comparison. I've had kids tantrum, throw toys, whine, beg, and outright refuse to work, etc. when they do not get their way during a session. Inevitably, they will turn their attention to the person who will most likely give them what they want -- whether it be the parent, grandparent or babysitter who is nearby.
How to Avoid It: Get on the same page, ASAP. We all know you are not trying to be the bad guy, but if you say that the bubbles must wait until after the worksheet is completed, then Mom can't say otherwise. It undermines your authority and leads to a wasted session.
3. Wasted time: You arrive and the child you are supposed to be working with is sleeping. He needs to be woken up -- and at 3 years of age, that's no easy feat. It involves lots of yawning, whimpering, crying. There go 10 minutes. You arrive in the middle of snack time. You're all prepared to target that pesky "r" sound, but not when the child is scarfing down Goldfish and apple juice.
How to Avoid It: Establish a set schedule and make sure everyone sticks to it. Whether it is once, twice or three times per week, arrive on time and prepared to begin therapy. Set the example and make your expectations clear, and request that snack, naps, etc. not conflict.
4. Limited Follow-Through: Working in the world of special needs, education and health care, we know that we have a limited amount of time with our clients. Even an hour a day -- a lot, by most therapy standards -- leaves another 23 hours a day without us. Now, I'm not advising round-the-clock therapy. In fact, I actually encourage enthusiastic parents to only work on therapeutic activities for a maximum of 20-30 minutes a day when I'm not there. A child who requires speech therapy sees language and communication as a hurdle -- I don't want it to become something aversive. But the core of a child's daily social interactions -- focused around play, social interaction and structured, predictable routines -- those goals should not only be targeted during "therapy time," but all the time.
How to Avoid It: Work with the family to develop realistic targets for specific goals that can be achieved throughout the day. Teach parents how to achieve those goals during key points of the day. For example, if the goal is following directions in sequence, getting ready for bed is a prime time to target that goal. Mom can instruct Jake to first put on his pajamas, then brush his teeth, then use the bathroom, and last pick out a book to read. If Jake follows all the directions in order, he can receive a sticker on his chart or a special treat.
5. Lack of Support: Private home care can often be an isolating experience for both the families and therapists.
How to Avoid It: Encourage parents to get involved in therapy and ask questions frequently. Connect parents with other families whenever possible. As therapists, reach out to colleagues for new ideas. We all hit roadblocks sometimes -- use friends, supervisors, the Internet, etc. to troubleshoot and brainstorm new ways in which you can best target goals.
Providing therapy in the home can be a rewarding and valuable experience, building wonderful relationships between families and therapists that can last for years. Just remember to establish rules from the start and get everyone involved.
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