In many facilities, the standard practice involves parents and caregivers remaining in the waiting room while the child accompanies the therapist to the treatment room for therapy. A shift in thinking regarding parent/caregiver direct involvement in the therapy session may result in added therapeutic gains. Working as a team from the onset allows the parent/caregiver to build competence in techniques resulting in increased confidence in their ability to help their child learn. This provides the therapist a better view of the big picture including caregiver-child and family dynamics, progress and challenges at home, and the family’s ability to apply new skills allowing the therapist to continually adjust methods and recommendations to meet the child and family’s needs. Caregivers should be directly involved in all aspects of therapeutic program planning from evaluation and goal setting to therapy provision, in addition to implementation of the home program. During the evaluation, obtaining an accurate picture of the child’s feeding skills at home is essential to appropriate therapy planning. Methods for involving caregivers directly during the evaluation to improve the quality of information obtained will be reviewed. As part of the evaluation process, caregivers should be involved in setting goals in collaboration with the therapist. Targeting goals involving skills that would make a significant impact on a family’s daily life often lead to improved engagement from the family in the therapy process. Tips for involving the family in goal setting including sometimes difficult conversations about setting achievable and realistic goals will be discussed. Once therapy is initiated, continuing to include caregivers directly in therapy is advantageous in many ways. With the caregiver present, the therapist may model and explain a therapeutic approach to target a specific feeding-swallowing skill, such as positioning, compensatory strategies, and/or exercises for practice and implementation at home. With the therapist in a coaching role, the caregiver may be provided many opportunities to practice the techniques with the child during the session and ask questions. In addition, the caregiver presence allows the SLP to ensure parent understanding of the reasons why certain techniques are being utilized, which may lead to improved implementation at home. Overall improved understanding of the techniques recommended for the home program may potentially lead to faster progress in therapy as the child is receiving quality practice of skills at home. In addition, consistent caregiver involvement assists in establishing a higher level of rapport and allows for ongoing realistic discussion of progress and quicker adaptation of the therapy plan as needed, including sometimes challenging or sensitive discussions. Many therapists have had little training in parent coaching and counseling methods. A variety of coaching strategies that directly involve parents in the therapy session will be discussed including show and share, test drive together, to the point and making the connection (Caraway, 2012). Involving caregivers directly in the therapy process with the caregiver and therapist working as a team results in improved patient outcomes, increased caregiver competence in helping their child, as well as enhanced satisfaction with the therapy process.
Laura Loveless, MS, CCC-SLP, BCS-S, CLC
Laura Loveless, M.S., CCC-SLP, BCS-S, CLC is a Senior Speech Language Pathologist at Texas Children’s Hospital West Campus and a Board Certified Specialist in Swallowing and Swallowing Disorders. She works primarily with infants and children with feeding/swallowing disorders in a variety of pediatric settings including acute care, PICU, NICU, and outpatient clinic, in addition to performing videofluoroscopic swallow studies.
Heather Greene, M.S., CCC-SLP, CBIS
Heather Greene, M.S., CCC-SLP, CBIS, is a senior speech-language pathologist at Texas Children’s Hospital West Campus. She has experience working with children ages birth to 21 years of age in NICU, inpatient and outpatient clinical settings, as well as experience completing videofluoroscopic swallow studies. Her clinical interests include pediatric feeding/swallowing disorders, acquired brain injury, tracheostomy dependent and language development of late talkers.