A few years ago, when my kids were babies, we identified delays in their development. With assistance from their pediatrician and social worker (they were in foster care at the time), we were able to have them assessed by Early Intervention and private practice therapists.
Fun Fact: Early intervention is a state-funded program that is free for families to access for children from birth to age three. You can request an assessment without a referral from a doctor. For private therapists, you might need a referral, depending on your insurance.
Personally, we have utilized physical, occupational, and speech therapists as well as what Early Intervention calls “Special Instructors”. (Special instructors have various backgrounds and provide general services for kids at risk for developmental delays but may not qualify for specific therapies.) We have had providers come to our home to provide services, and we have also seen them in an outpatient therapy clinic.
Prior to becoming a parent, I worked as a pediatric music therapist in Georgia. I saw clients in their homes or daycare as well as in a multidisciplinary clinic. About half of my caseload consisted of providing services for Babies Can’t Wait, the early intervention program in Georgia. Having that background was helpful to me once I become a parent, because I was familiar with what to expect from early intervention and private practice therapists.
If therapy has been recommended for your child, you may feel unsure about how to fit it into your life, what your role is as the parent, and more. I hope to shed a little light on the process so that your child can get the most benefit out of these services.
Assessment
The first step is for the therapist to determine what skills your child has and what their needs are. This is done by asking you, the parent, a series of questions about what your child can do. They will ask about rolling over, sitting up, making sounds, visually tracking objects, responding to familiar people, trying foods, playing with toys, and more. This is often done verbally, but they might also have a questionnaire for you to fill out on paper online. In addition to the parent report, they will observe the child. You are welcome to be present for this assessment. It should be a very easygoing, playful interaction between the therapist and child. While the therapist may ask the child to perform certain tasks, they will not push them to do so. They are seeking to establish a baseline for the child to determine whether therapy services are appropriate and what potential goals could be addressed.
Treatment
The therapist should collaborate with you in setting goals for treatment. These should be measurable and specific so that you can identify when the goal is met. If at any point in treatment you feel that the goals are not appropriate or not a priority for your family, you should feel able to speak up and address that. For children, a lot of therapy goals are addressed through play. A good therapist will explain how they are structuring the activities to address the goals you have made together. They should also give you ideas and tips about how you can incorporate what your child is practicing in therapy into your daily routine at home. It may involve exercises, activities, or things to correct. If possible, I find it most helpful to be present for my child’s therapy sessions so that I can learn alongside them. This should always be offered to you as the parent. Early intervention, in particular, strongly encourages parent involvement so that you can continue therapy activities on your own after the session.
Termination
Termination can come in a few different forms. Early intervention terminates when the child has reached a threshold of development that falls in the range of typical peers. They will begin final assessments around 30 months of age to determine if further services are needed/wanted. If they are deemed necessary, they will transition to your local school system by age three. Private practice therapists will move to terminate services once the identified goals are met and no further concerns remain that they are able to address. Depending on your insurance coverage, you may have to terminate for a period of time and resume in the next calendar year. You can speak to your provider, their billing department, the pediatrician, and the insurance company to try to have this adjusted.
Addressing Problems
Sometimes your child is paired with a therapist that is not a great fit. My advice is to give them three sessions for rapport building and establishing a routine. While they should definitely address at least one treatment goal in these sessions, they are laying the groundwork for future sessions. If your child seems resistant to the therapist’s direction, observe how the therapist handles the child’s reaction. If you are uncomfortable with how things are handled, speak up. You are your child’s advocate. If your concerns are not adequately addressed, request a change in therapists. If there is no one available from that practice, find another practice. Finding the right therapist is very important. We’ve had this come up before, and I wish we had made the change sooner because it made all the difference.
If your child seems to plateau in their progress in therapy or starts to resist going, it may be time for a break. One of my kids has been in various therapies for several years, and we’ve taken breaks from different ones at different times and it has always been beneficial for us. Even with great therapists who have really connected with them and been able to challenge them, sometimes taking the pressure off and allowing some maturity to happen enables them to come back refreshed and ready to tackle new goals.
