This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Frequency of Therapy
By Pam Marshalla
Q: How often do you see your clients?
I always set once per week as my “must have” level. That is unless they are only on consult, follow-up, or the later stages of carryover.
Over 35 years, I have found that once per week is sufficient for most kids, both the easy kids and the low functioning ones.
Easy kids can do perfectly well with once per week, and low functioning clients do not move fast enough to warrant more than once per week of my individual time. The pervasive belief today is that more is better. But I have not found that to be true. Especially if there are other people in his environment at home and school who are stimulating him in various ways.
With my very severe kids I explain to parents that their kids are going to need therapy throughout their entire school career, and I tell them––
It’s not MORE therapy NOW that makes the difference. What makes a difference is GOOD therapy over the LONG HAUL.
This is my basic “rule” and of course there always are exceptions.
I struggle with this at almost every ARD. Parents in my district are wanting more time added at each ARD. I have several non verbal kids that have 90 minutes a week and in self contained units. My response is to tell them their time is sufficient. I would love to reduce it due to lack of progress but I know the response will be that they must need more time if they’re not making progress. So I don’t mention reducing it. Any suggestions?
I do not know what an ARD is… However, I think you are saying that these are kids in self-contained classrooms. That means that there is MUCH more wrong with them than just a speech problem. Unless I am mistaken, these are kids with cognitive deficit, and probably neuromuscular issues as well. If they are in a self-contained classroom today, they must be fairly low. In my experience, a child cannot talk any better than he can think. Thus if he is functioning at a 1-2 year level cognitively, then he should talk no better than a 1-2 year old. The problem we are having with parents today is that we never tell them that their child is MENTALLY RETARDED. Now I am fully aware that this is a highly charged, politically incorrect term these days. But because we are not using it, the parents think that their kid’s only problem is speech, or they do not realize the relationship between cognition and speech. Then they think that we are not doing our jobs because the child is making limited progress. The solution for this is to spell out the issue– Your child is basically functioning like a toddler, and the best he will communicate is like a toddler. I have certain ways I tell them this– gently, compassionately, kindly. But I tell them. I help them understnad this by talking with them about how the child plays, how he follows directions, and how he answers questions. I also use any cognitive test results that may be available. And again, I teach them that it is not more therapy now that helps him… It is good therapy over the long haul. I hope that helps
Let me also add this… Some school districts are clamping down on this tendency for SLP’s to provide what I call “babysitting” services. They set EXIT criteria. If the client has not made this progress or that, then he is DISMISSED from therapy. The RTI model also is helping to alleviate some of this, depending upon how it is being used. My suggestions is that you get away from making these decisions on a case-by-case basis, and get together as an SLP unit and set EXIT CRITERIA. In private practice this is easy… You simply tell the parents that they should not be paying for therapy that is doing their child no good. In the schools, however, therapy seems free. But it is not free. Your salary is paid for by tax dollars. According to the ASHA guidelines, it is UNETHICAL to provide therapy services for which you as the therapist deem is unnecessary. In my opinion therefore it is unethical to do what you are doing. Do not feel alone. This is happening all over the country. We are giving MORE HOURS of therapy to kids who make very limited progress, and we are giving almost no time at all to the highest functioning kids who could actually be fixed. Charles Van RIper must be rolling over in his grave.
I love you! I’ve only been in this profession for 3 years and since Ive discovered your blog I read it every couple of days and have learned so much about real situations and real kids Thank you for your dedication to this profession.