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Therapy Outside the Box - The Joys and Challenges of Therapy in the Natural Environment - December 2009

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Therapy Outside the Box, The Joys and Challenges of Therapy in the Natural Environment

By: Tawni L. Coronado, M.Ed., CCC-SLP
Owner Kids Talk Therapy

What do making peanut butter and jelly sandwiches, McDonalds' Playspace, and answering the door in your pajamas all have in common?

These are all things that can only happen while providing therapy in natural environments... therapy outside the box has so many benefits! When I first started seeing clients out in the community, I was a little nervous...therapy with no walls? No boundaries? It seemed a little too “unstructured” for my taste and I wasn’t sure if I’d be able to control things. The fact of the matter is, I can’t control things and that’s both the beauty and the beast of seeing kids wherever they’re at! If in their home, you are privy to all of the dynamics that involve the family. You get the privilege of seeing the “real” child, amongst the competing distractions around him or her--the TV, the telephone ringing, dog barking, sibling rivalry, and therapy wherever there is an available space to plop down on! The unpredictability of it, however, is what makes this type of therapy real and functional. If in their daycare, you have the ability to see how the child interacts with his or her peers and other caregivers. You can address social interaction issues at the snack table, during circle time, or at a play center. Similarly, a play area, such as McDonalds' Playspace, can also provide a natural and unpredictable setting to work on pragmatic language skills. You’re able to practice the things that you can only talk about or read about in a clinical setting.

I definitely have to put on a different set of lenses when treating kids in their natural setting. In the clinic, the child has to adapt to the environment. Sometimes it works and sometimes not. The downfall is that at times the child will only perform something in between those 4 walls, and not when they get outside of them. When I began seeing kids outside of the clinic, it was as though there was a blank canvas just waiting to be painted! I was the one who had to adapt. Suddenly there were so many options. I could see how the child interacted at home, with his family, what the needs were and I could begin to observe what some of the families could only describe to me when I saw them in a clinic setting. We could strategize, make environmental changes if needed, and work on communication skills while participating in routines and activities that are important to them and to their families.

My first exposure was to a child with autism who wouldn’t get off of his couch. I tried everything I could to lure him down onto the floor with me, until I decided to join him (as my Floortime training would advise) up there on that big couch. We had a good time, looking at books, tossing a ball, and even hanging upside down a few times! He eventually felt “safe” with me and came on down to the floor and engaged in play.

Another time, an autistic child with limited functional communication was wanting his lunch a little earlier than planned. His mom tried to explain that lunch was after therapy, but he persisted. I sometimes eat lunch earlier than usual and have the freedom to grab something if I so choose, so I decided to “go with the flow” and end what I had planned for him to do and see where this quest to eat took us. I asked his mom to go through the routine of lunch prep and show me how she engages with her son. She said that she asks him to help by getting the jelly out of the refrigerator and set it on the counter as he watches her make PB & J. As they went through the routine I made a few suggestions in order to increase her son’s involvement in the process and expand what she was already doing with him. By the end of the task, her son was following, 2-step directives, sequencing the fine motor task of making a sandwich, attending to mom’s gestures and requests, and verbalizing the steps. A lunchtime prep became a functional communication task that was both eye opening and rewarding for mother and child! The child was no longer a passive bystander watching his mom make his sandwich from the sidelines, but an active player in the game. She could see that he was ready and able to participate more in a daily routine and his needs were validated as he was listened to and was able to accomplish a self-help skill of sandwich making...a yummy and satisfying end to his therapy session!

As I greeted my first client of the day today at his front door, still donning his Spider Man pajamas, I was reminded that natural environments provide a platform for providing therapy wherever children live, learn and play. It is family-centered, focused on strengthening and developing a child’s support system--recognizing that the family is the primary influence in the child’s life. Functional communication and socialization skills are addressed while the child is engaging in everyday activities. As an SLP in a natural therapeutic setting, I can observe children engaging in real-life activities, identify important people in his or her life, coach and encourage families and care providers to engage and communicate with their child, and provide families with emotional and informational support. It is an extremely rewarding experience to watch children grow and communicate functionally in their own environments and to help families in the process.

This Month's Featured Vendor: KidsTalk Therapy, LLC

Our thanks for to KidsTalk Therapy, LLC and Tawni Coronado for providing us with this article.

Tawni Coronado, M.Ed., CCC-SLP, owner of KidsTalk Therapy, is a speech-language pathologist specializing in pediatric communication and feeding disorders within the ages of birth to 13 years. She received her undergraduate degree from the University of Redlands in Redlands, CA in 1991 and graduate degree from Valdosta State University in Valdosta, GA in 1995. She has received specialized training in Floortime, PROMPT (Level 1), Talk Tools, sensory integration, feeding therapy, sign language, augmentative/ alternative communication, & emergent literacy intervention. KidsTalk realizes that every child is unique and deserves an individualized approach to help them reach their greatest potential. KidsTalk specializes in individual speech, language, and feeding therapy and is aimed at maximizing children's unique strengths while targeting their weaknesses. At KidsTalk, learning to talk is child's play and therefore therapy is done in a fun, friendly, and functional manner that engages the child and encourages communication.

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Tags: December 2009 Newsletter SLP Early Intervention Article