Written by Jessica Fischer, early childhood speech-language pathologist at Northwest Area Education Agency
For 15 years, I have been practicing as a speech-language pathologist in the educational system. I have served children from birth to 21 years old in home settings, inclusion classrooms and exclusive settings. Through my years of experience, I have developed a strong passion for working with the youngest communicators. Today, this has evolved to working with children and families birth to five years old.
As my career path has evolved, so has the research how we target communication with young learners. Infants and toddlers learn best from their primary caregiver since this is the person who spends the most time with them and can potentially provide the most opportunities for practice. With this knowledge and research available to clinicians, coaching the caregiver through the Primary Service Provider model is now being implemented across Early ACCESS employees at Northwest Area Education Agency.
Coaching the caregiver model has provided me, as the coach, with a new perspective on how all families have different priorities and ways of interacting with their child. This has also forced me to have a mindshift that coaching is different than direct therapy services. When the parent or caregiver takes the lead in the home visit, they are much more likely to follow through and carryover the strategies discussed and practiced to target a specific skill or desired behavior.
I am working with a family whose child struggles to use spoken words. We have problem-solved and reflected on several strategies with multiple opportunities for practice through months of coaching the family. As the months have gone on, the parents have built their competence and confidence and are willing to make decisions with my guidance. During a recent home visit, the family wanted to try the strategy of focusing on one word between visits to embed into their daily routines. In the past, I would have picked the strategy for the family and, in this case, I would have picked the target word. I guided the family to determine what word they felt would be best to embed into their daily living activities.
The mom decided that she wanted to work on the word “eat." She was going to model the sign and say “eat” at mealtimes to encourage her child to begin using “eat” to communicate. This was the joint plan for the time between visits with me. At the next visit, we began reflecting on how the intervention of targeting the word “eat” had gone. Mom said it didn’t go well. When I asked her why she felt it didn’t go well, she said it was not a word that they practiced enough. With the kids going to daycare every weekday, that left one meal time each day that they could practice this skill, and she felt this did not provide enough opportunities for practice.
This was such a monumental moment for me as the provider/coach. With the trust and the relationship that I have built with this family, they were able to reflect and adapt their focus to help their child improve his communication. We followed up with discussing if the family wanted to continue with the target word strategy and mom said “yes” that she was going to target “more” because that could be embedded into any routine throughout the day and offer many more opportunities for practice.
It has been so exciting to see the changes in children's communication skills and family dynamics when the caregivers are supported through the coaching model and reflective practices. When learning opportunities are embedded into a family’s routines, the progress is substantially greater than when a child gets direct services two to three times per month for 30 minutes each session with no carryover from the caregiver.