I specialize in treatment and assessment for
childhood apraxia of speech (CAS)
Therapy Strategies used
play-based & drill-based language instruction
routine based parent coaching
Different Therapy Approaches and Services Offered
Currently available to California residents only, however, please inquire if availabilities can open up in other states. Deer Speech Therapy started offering teletherapy when the COVID-19 pandemic hit in March 2020. Teletherapy looks a little different for everyone. Many young children or children with various differences are unable to attend to a screen to learn. Your child is not required to engage with a therapist over a screen nor are they even required to be in the room. Many families choose teletherapy to learn how they can support their children in their own home. (Read more on Parent Coaching and Routines Based Intervention)
Parent Coaching and Routines Based Intervention
Parent coaching is a type of therapy that fully involves family members and caretakers. The clinician comes in as a resource to the family. At first, she needs to learn about the family dynamic and observe how caretakers interact with their children. In the beginning, parents might express goals they have for their children and are encouraged to express any concerns they have. After the initial intake, the clinician will suggest some strategies to try to help encourage your child’s communication development. These strategies will be practiced and learned during therapy sessions. Learning new strategies might occur through reading handouts, talking with the clinician, observing the clinician, watching videos, and practicing the strategies during the session. Caregivers continue to use the strategies throughout the week during everyday routines such as bath time, snacks, reading, playtime, etc. Families are encouraged to take videos of daily routines and share them with the clinician. Together they can talk about how to incorporate in strategies during those times. Therapy might occur only 1-2 hours per week, however, the family can carry out hours of intervention every week.
This strategy is recommended for early intervention populations (birth to 3 years). It is recommended for younger children because family members are the child’s first teachers. Parents know their child the best. They have a deeper understanding of their child’s needs and abilities. Parents also have more time with their children. Young children aren’t always willing to perform at certain times. The caregivers have more flexibility with their time and can carry over the strategies when it is best for their child. Overall, the child will have more learning opportunities that can support faster development.
With this model, the clinician will not bring in materials (most of the time). This is because it is easier for parents to learn strategies and generalize the skills with what they have in their home. When the clinician leaves, the family will think about how they used a strategy with a specific toy, book or activity so the next time they engage in the same activity it will be easier to continue using the same strategies. Often times when a clinician brings in toys, it makes the parents feel they need to buy specific toys to get those strategies to work. New toys aren’t necessary because the strategies can work with almost any activity. It is also a lot cleaner for your child since many children mouth toys.
This approach can also be effective for older children who require more intensive intervention with family members who want to play an active role in supporting their child’s communication.
Parent coaching with a bagless approach is a requirement in some states for the early intervention population since it is considered best practice. Many therapists who serve early intervention populations in California are not trained in this method. If your child has other therapists or has seen a speech therapist before, then therapy was probably clinician directed. Some therapists tell parents that the parents “distract” the child and tell them to stay away. Deer Speech Therapy is committed to include families….ALWAYS!
The clinician might alternate between coaching and traditional clinician-directed therapy depending on the family’s and child’s needs that day.
Traditional Clinician Directed
This strategy is best for school-aged children who need direct therapy for speech and language delays / disorders. Therapy might either be structured as adult-directed or child-led. Adult-directed means the clinician has specific activities and directs the child to participate in the specific tasks. Child-led means the clinician follows the child’s lead and incorporates in opportunities for the child’s goals to come up in what the child is already doing.
It is often best for the clinician to work directly on some specific targeted areas such as articulation, apraxia, fluency, and school-age language & processing. Children learn from getting consistent practice in a short period of time. The clinician can set up opportunities for this to happen in a clinician-directed therapy session (for school-aged children).
Every child has very different needs and learning styles. The clinician has many different tools in her toolbox that she is able to pull from. Sometimes she doesn’t know what tool will work until she tries it and see how the child responds to it. From there, she adjusts therapy to meet the child’s needs.
Even though this therapy is more clinician-led and directed, parents are still welcome and are incorporated into the process. The clinician often teaches a new skill to the child during a rapid therapeutic session, but then parents are encouraged to assist with generalization of new skills. Parents might be encouraged to participate in part of the session so they can learn ways to support the development of the new communication skill. Parents are not required to sit in during the session but some still choose to do so.
With clinician-directed teletherapy, it is usually recommended to have an adult nearby even if not fully engaged in the session. An adult might be needed to help redirect the child or help with technical difficulties. Some older children are completely independent, in which an adult close by isn't necessary.
Therapy at School & Social Skills Support
The clinician is able to provide therapy within the child’s school (if the school is in agreement). Therapy at school can help the child generalize communication skills learned at home and might be more convenient for the family. Therapy in the school setting might be a “pull-out” or “push-in” model. “Pull-out” means your child would be taken into a separate space to do therapy such as a different room, separate corner of the classroom or playground if the class is inside. “Push-in” means that the clinician would join the child in his/her class and assist in communication goals within the classroom setting. The clinician can adapt most language goals to be incorporated into classroom activities.
Social skills can be addressed with your child’s peers at school. The clinician can help support peer bonds and work on social skills such as turn-taking, initiating play, negotiating play, conversational skills, sharing, etc. Over the years, the clinician has seen that when she is treating with a “push-in” model, other children will naturally come over to want to join the clinician and child. When the peers come over, she models social skills for the child to learn. After she has been in the classroom many times, she might see some of the same peers now playing with the client and using the social skills learned. Most of the time social skills are addressed in a “push-in” model. However, depending on your child’s needs and the activity in the classroom, your child might be pulled out with one other peer in a small group.
Co-treatment is when the clinician works with the child at the same time as another professional such as an occupational therapist, physical therapist, vision therapist, behavior therapist, etc. Co-treatment sessions may be scheduled on a consistent basis or may be scheduled occasionally as needed. Co-treatment can be beneficial so the clinician can better understand all of your child’s unique needs and goals. The clinician can adapt her therapy approaches to help the child’s development in other areas. She can incorporate in behavior, sensory, and other strategies the other therapists are implementing.
Co-treatment can be especially beneficial for early intervention-aged children who are seen in a clinic setting. The clinician can learn what strategies are helpful to the child and help the parents carry over the strategies in the home environment.
Resource & Counseling
The therapist can serve as a support to the family and provide resources. Being a parent isn’t easy and it may seem even more challenging when you have a child with communication delays. At times, family members need to process their emotions and discuss challenges that come up with their child. The clinician will listen and support the family’s needs. She might ask questions to help the family problem solve the situation, refer to educational resources, refer to support groups and/or refer to other professionals. It should be noted that the clinician is not a licensed psychologist or marriage and family counselor. She is able to provide support to help with your child’s communication delays, however, she will need to refer on if you need additional support.
The therapist can observe your child at school if requested. She can see how the child interacts with other children and observe how they are able to communicate in this setting. She can consult and discuss with teachers and provide support and strategies to help the child thrive in the educational setting.
IEP Meetings & Behavior Therapy Meetings
The clinician is able to attend meetings in your home or school setting as requested. The clinician is able to share her observations, discuss your child’s communication needs and discuss strategies that the child has been responding to. Please provide notice to the clinician to assist with scheduling and indicate how long you would like her to attend the meeting. Some IEP meeting can last a long time, and she can indicate to the team she has a time limit so they ensure they cover her area before it is time for her to leave.