Here are 7 things therapists can do just right when assigning home programs
Occupational therapists are well trained in the approach of just right challenge. Coined by Dr. Jean Ayres, the ‘mother’ of Sensory Integration, it states that productive intervention flourishes somewhere between the boredom of too easy and the frustration of too difficult.
But what happens beyond the session? How can caregivers that carryover sensory strategies to everyday routines, but lack the professional education of occupational therapists, find just the right challenge?
Most therapists hope that modeling works. Assuming that if caregivers ‘see one’ in clinic they can ‘do one’ at home or school. That may work if caregiver is actually in session (not always so…) and if caregiver is actually paying attention (sometimes so…) and if caregiver understands the modeling was about finding just the right challenge (rarely so…) and most importantly that caregiver will remember and succeed in implementing the lesson in another setting (almost never so…).
So if caregivers are unsuccessful in setting just the right challenge at home or school, are we really surprised they do not carryover interventions and strategies into children’s everyday lives?
Here are seven 7 just right strategies occupational therapists can use to empower caregivers:
- Just right modeling: Some caregivers don’t need more than a front seat view, while others require more spoon feeding explanation of what you are doing and how you find the right challenge. It may take a few iterations to figure out what is just the right modeling for each caregiver. Start by involving the caregiver in the session when you plan to model this and keep going until you hear the penny drops.
- Just right personalization. Providing referrals to general links / Pinterest boards may fall short of getting caregivers to follow through and carryover strategies. Yet planning every hour of the day may be cumbersome. Personalizing the home program according to the family’s actual everyday routines stands a much better chance. You may not need to spell out exactly how many minutes before a shower one might do deep pressure activity, but coaching the caregiver that such activity prior to shower could reduce chances of meltdowns could be just right.
- Just right flexibility. Life is un-predictable. So you can’t know exactly what the right challenge will be in any situation, hence you can’t be too specific with the activity recommendation. On the other hand, without concrete examples most people would just do nothing, the creative burden can be too much for the working parent / teacher on a daily basis. You can equip the caregiver with a small set of options along the same sensory input but with varying levels of challenge. So in real-time the caregiver does not have to be creative and have just the right flexibility.
- Just right feedback. Some say that adapting carryover strategies is what therapy is all about. Doing it well hinges on getting accurate feedback from the caregivers. How can you tell what changes to make in your recommendations if you don’t know what works and what doesn’t? Asking kid and caregivers at the start of sessions is an easy and highly inaccurate out, overdosed with memory and desirability biases. Research shows that real time electronic measurement is the golden standard in medication compliance so why can’t it be the golden mean for home program monitoring? (perhaps the ancient Greek term of golden mean is the true origin of just right…).
- Just right availability. Weekly or even bi-weekly therapy sessions are a drop in the bucket for a developmentally challenged kiddo. Embedding the right interventions and strategies into the child daily routines can make the difference. Does this mean that therapists need to be available for their clients 24:7? How can you provide continuous support with the limited session timeslots? Most of caregivers today are Generation Y who are used to consuming content and getting support via smartphones. New technologies can help extend therapists influence without requiring their physical intervention. Setting a plan and letting technology help ensure it is carried through is no longer science fiction. It is just right for today’s parents.
- Just right targets. We are all lost without a destination. Setting targets or goals is critical to generate caregiver motivation as it is for measuring outcomes. Targets can be general with relatively long timeframes, which might suffice evaluation reports but not generate enough motivation to fuel caregivers. On the other hand, targets can get to micromanagement if that what it takes at times. For the most part, they just need to fit the bill as the motivation power source for caregivers. True, we can also use them to report progress to managers, insurers and referring pediatricians, but caregivers’ motivation is probably just the right goal for smart targets.
- Just right monitoring. The military saying “In god we trust, all others we monitor.” may be too much, but so is assuming caregivers are following through if we just tell them… We don’t need to get all 1984 (Orwell) to appreciate that most people need to know someone is looking when they are doing a good job, and have someone care and support when they fall off the sensory wagon. Isn’t that just the right job for an occupational therapist?
Ayres, A. J., & Robbins, J. (2005). Sensory integration and the child: Understanding hidden sensory challenges. Western Psychological Services.
Oren Steinberg is co-founder of SensoryTreat, providing a carryover empowerment platform for pediatric therapists and caregivers of children with Autism and other developmental disabilities.