Tuesday, January 7, 2014

How to Impress Families

A former student has written to me with two related issues. First, one mother she works with said she was glad “Lori” was making home visits over the holidays, “Since I was a little concerned that E. was not connecting to you as much as [the speech-language pathologist and the occupational therapist].” Lori said this made her question whether she’s missing something in her approach. “Is it wrong for me to not have that strong connection and bond with the child that I would get if I spent more time in direction interaction with him?”

Second, Lori was working successfully with a family, until a speech-language pathologist was brought on. The mother started questioning Lori’s approach. Lori wrote, “She told me the SLP brought such great toys and worked at the table with the child, getting him to do so many things. That approach is less work for the family and more impressive to have the ‘professional’ come in and work with the child.

In both situations, the mothers appear to want child-centered therapy. They have been seduced by professionals who form strong attachments to the child (or vice versa) and who sit down and do direct, hands-on intervention with the child. Those appear to be ways to impress families. Here was my answer to Lori.

Your question is familiar but not easy to resolve. First, we have an ethical obligation to give families information, including the information that it’s not what a professional does on weekly visits that improves a child’s learning and development but what the natural caregivers do throughout the day. It is not being unprofessional to put down the other professionals’ approach (although you shouldn’t do it in a put-down way); it is being ethical. Second, your relationship with the child is pretty much irrelevant to the process. I’ve always said there are three reasons for putting your hands on the child, and one of them is to show you love the child. But that’s just something to help build the relationship with the parents. Again, the ethical thing is for you to explain to that parent that how the child feels about you is actually not important. You are there to make sure that the parent enjoys—and teaches—the child. Third, it sounds as though you are in a vendor, competitive environment where, possibly, you can’t lose families or don’t want bad things to get back to the referral source (the service coordinator?). This is unfortunate and one of the deadly things about the vendor system in early intervention, because, if you have given a family the information about how children learn and how services work, and they are still seduced by the child-centered approach, you should offer to back out. Usually, one of our rationales is that there are plenty of other families needing our help. But in your market, that might not be true. You can see that I believe we should (a) give families the truthful information, (b) not cave and do useless things, and (c) not cross the line from giving information to trying to convince. When parents argue for a more hands-on approach by the professional, one line I’ve used with some but not total success is, “Your child deserves so much more than that.”

Being family centered does not mean pretending that families know better than we do how early intervention works. Remember that families are easily seduced by quick fixes, technology, and magical thinking. It’s not very sexy for some families to think that the day-to-day interactions in ordinary activities of daily living, like playing, reading, going for a walk, hanging out, having meals, toileting, and so on, are the crucibles of teaching and learning. Our role can be the healer, such as you find in the medical world, or the coach—and think here of life coach or executive coach. Those coaches don’t do things FOR their clients: They prepare their clients to handle situations. Healers lay hands on the patient, while the family observes (and prays!). The healing looks mystical, mysterious, and is of course mythological. In early childhood, it also looks fun: The kid is having a blast with the toys and other gizmos the professional brings into the home. We can think about this bounty in one of two ways. First, we could get a 17-year-old babysitter to come with new and interesting stuff and we’d be doing just as much good. Second, we could turn early intervention into a sort of mobile Target, where we introduce fun objects to children in their homes. A third way of thinking might be: I have to get this kid to do stuff with me because I believe I am effective on my hourly visits, so I’m going to take in materials to get him or her interested in me. I haven’t even addressed the ludicrousness of then removing those objects at the end of the visit; that’s so obvious that it’s amazing parents don’t see said absurdity.

Families usually are doing their best for their children, so it’s a real shame when professionals undermine their work by altering their thinking about how children learn. As you can see, my thoughts don’t give you an easy solution, but I hope they keep you strong in doing the right thing and give you the freedom to walk away if the parents don’t like your approach. In my home-visiting program, where we see 150 families at any one time, we hardly ever have families wanting to “fire” us for not being more hands-on—and we have the same situation as you do: therapists using a radically different approach from ours.

My granddaughter, Tinsley, counting carrots to leave for  Santa's reindeer. Nothing to do with the post!

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