Do you ever ask yourself if you are the best person for the job? For any children who receive related services, hopefully this question is asked frequently. When teachers create class lists for the following school year, they usually make a recommendation based on the student and the teacher's style. The students move from grade level to grade level with different instructors. Does this get done for therapy services as well? When a new skill needs to be taught do you ever consider changing therapists? Or perhaps a goal is not being accomplished - do you ever consider it may be the therapist and not the child?
For some reason in the "therapy world", occupational, physical or speech therapists may see the same child for years. For some children this is beneficial. For example, children who are medically fragile and their families may benefit from the continuity of the same therapist from year to year. Perhaps families feel comfortable with the same therapist since a bond has been created between the therapist and the child.
Many times the therapist's experience is taken into consideration when creating caseloads. For young children with cerebral palsy, a part of therapy is usually neurodevelomental treatment. Using their hands, the therapist attempts to facilitate proper movement patterns while inhibiting abnormal muscle tone. One therapist may be able to facilitate a child's movement patterns very differently than another. Perhaps ones hand placement is just slightly different or hand size is significantly different this can influence neurodevelopmental treatment. Many time parents or teachers will say "I don't seem to do it as good as you". Therefore, something to consider when a child is not reaching a specific goal is to think about changing therapists. It is not to say that the current one is not good, but you never know what a different set of hands may illicit. If you do not want to change completely, another idea is to ask for another therapist to consult on the child. Maybe the therapists could do one cotreatment session to see if a different set of hands can help the child to achieve the goal.
What about different diagnoses? Some therapists work very well with children with certain diagnoses. Just like some teachers prefer to teach math over reading, some therapists prefer to work with children with autism instead of cerebral palsy or ambulatory children versus non ambulatory children. Therapists should look closely at what type of child they work best with and offer to help if that is their "niche".
What about the goal? If the goal requires a significant amount of assistance who might be best for the job? A small therapist may not be a good match. If the goal requires a significant amount of patience like learning to ride a bicycle, an individual with a short fuse may not be a good fit. If the goal is climbing the jungle gym to the highest point
(see yesterday's blog post on this topic), a nervous individual may not be the best person for that job.
What about carry over at home or in the classroom? It is not always possible to have a choice of which adult can help, but if it is possible consider the adults' strengths and weaknesses. When teaching a skill like toilet training patience is a virtue. Teaching a child to do the monkey bars or a to use a fire pole, requires some strength and is not for the faint at heart.
Therefore, when a child is learning a new skill consider the therapist's style and experience in addition to the child's goals and diagnoses to create the best fit possible.
As pediatric occupational and physical therapists we always need to remember that one of the most important, if not the MOST important, aspect of our job is to educate. We need to let students, teachers, school staff and parents know what we do and why we do it. Without buy in from all team members goals can not be reached. In addition, in order for therapeutic activities to be carried out all day long we need to educate people how to make that happen. A 30 minute pull out therapy session may be beneficial but even better is to train someone else who is with that child all day, every day, on how to do what you do during a therapy session.
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