How do SLPs and other therapists determine the amount of therapy a child needs to significantly improve his skills?

Well… it should involve lots of analysis and thinking outside the box to tailor each treatment plan to your patient.

However, most SLPs will recommend the standard 2x/week for anywhere between 30-60 minutes… most of the time 30-45 minutes is what’s given…

Many Doctors like to prescribe this also… even if they have not evaluated the patient in terms of communication… That is mind boggling…

I believe that less is more…

Therapy can be anywhere from 1x/mo to 2x-3x per week depending on the patient…

I rarely see a patient more than 1x/wk and generally see my patients 2x/mo… They all receive a home exercise program which is expected to be implemented into daily routines…

See… I like to empower my parents and caregivers… I feel like you see greater improvement and more parent satisfaction with less is more.

Here’s what I look at:

age, type of delay/disorder, severity of delay/disorder, delay vs disorder, patient motivation, family support, prognosis, environmental factors, behavioral factors, concurrent diagnoses, maturity level, cognitive functioning levels, etc…

(Must take graduate level diagnosis/treatment courses to get more valuable information about treatment plans)

Lots of things to consider when recommending therapy… Less is more in order to empower families… because the more therapy you give the more your families depend on you…

In essence, you are encouraging dependence rather than independence with more therapy, better outcomes…

Ultimately, therapies are given to increase their skills in communication and obtain the highest level of independence the patient can attain (prognosis). So less is more…

Having said that… Family support is a valuable tool to supplement therapy services…

See… I can see my patients every single day for an hour… but if the families are not following through with strategies and home exercise programs… little change will be noted…

Here are some things to think about:

If you see your patients every day for an hour:

1. How much change will you see from 1 day to the next?
2. Will your recommendations change from 1 day to the next?
3. Are you empowering your families or are you fostering dependence?
4. Is the patient receiving enough time to process and assimilate strategies learned?
5. Have you given the families and your patients enough time to implement and practice?
6. Are you incorporating parent education and prevention in your therapies? (important for families who are still growing)

Now ask yourself the same questions regarding the standard 2x/wk 30-45 minutes…

Now… Some patients may need the standard 2x/wk 30-45 minutes… but most do not… especially the younger ones…

Try it… 2x/mo 45 min to hour… include direct tx time and indirect tx time via the parent

Again… relying heavily on parent follow through is key…

if you want to see significant changes in your patient’s communications… your families must follow through with strategies…

Here’s an example:

If your patient goes to the doctor and the doctor prescribes antibiotics. (This is considered the MD’s recommendation and strategy). The patient does not take the antibiotics as prescribed and comes back to the doctor 1 week later and then continues to come back everyday with the same complaints…

Who is doing their job? Who is not doing their job? What can the doctor do to improve the patient’s health, if the patient is not following through with the strategies?

Nothing… A doctor is no miracle worker… and if you don’t get the surgery or take the medication or do your exercise and eat a balanced diet as prescribed by the doctor… you will die…

because ultimately their job is to maintain your health in order for you to live as long as possible through recommendations…

So if the patient doesn’t take the medication then the doctor can’t help them… This is why the phrase “against medical advise” exists.

Well… Our job as SLPs is to facilitate communication for our patients… but we are not miracle workers… if our families do not follow through with our prescribed recommendations and/or strategies… an increase in frequency will not cure the problem…

Here’s another tidbit… make sure that the patient and their family understands that you are using the phrase “against therapist advise” or “limited family follow through” or “against therapist recommendations”… Use it outloud and in your paperwork…

document, document, document… 🙂

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