Ever since we launched the first prototype of our carryover empowerment platform, I’ve been touring clinics and talking with therapists. For the most part I find these talks to be inspiring and strengthening.
However, every now and then I run into a therapist who goes beyond politically correctness to say that she stopped giving home programs because parents simply don’t do them. “I don’t want to lose face” is the medical reasoning often provided to justify this practice. Losing face is a nice and short way to say lose trust or ‘cry wolf’. It is also very difficult to challenge such an argument. Especially when voiced by a veteran therapist who has seen her coaching sheets end up in the trash once too many.
There is no argument that home program assignment is a complicated task that needs to be handled with delicate care. There is also no argument with the need to customize and adapt the home program not only to the child’s therapeutic needs but also to the caregivers and family capacity to perform such a program. However, there is a compelling case that giving up on any and all home program assignment is not a good idea. We cannot expect generalization of intervention without some home program. Kids (and adults) are treated so they could carryover what they learn and absorb in session into everyday routines. This element of therapy – carryover – needs to be treated in a professional manner just like diagnosis and intervention. It is an integral part of therapy and not an added bonus. Yet it seems to fall short in terms of amount of research, publications and education compared to its fellow elements of diagnosis and intervention.
The concept of just right which was elaborated on in a previous blog can be a good basis for home program assignment: just right carryover!
The just right approach states that if something is too easy and not challenging enough it tends to have diminished effect on motivation. It is in the human nature to chase the challenge or piqued curiosity. It is the therapist’s job to identify what might work best for every caregiver. For one that may be a clearly articulated target and for other it’s a new framing for looking at things.
The just right approach also states that if we up the ante too much we risk losing the client. If the challenge is too big it could easily frustrate. If the road laid by the therapist in front of the caregiver seems too long or too steep for the overwhelmed caregiver, he/she will be reluctant to take the first step. In those situations, it might work better to break the road into digestible segments.
Managing the carryover is just like managing in-session interventions or doing evaluations every few months. It is a path the family needs to walk through, guided by their therapist. Coaching them through this path is an essential part of therapy just like hands-on treatment. Observing what assignment to start with and how to evolve the carryover just-right challenge week after week. Adapting the carryover based on measured outcomes reported by family and observed by therapist. Keeping in mind the road ahead, even if sharing it with the family one piece at a time. All this and more is what managing carryover is all about.
- Giving up on homework assignment altogether is not an option.
- Carryover needs to be tailored to kid’s therapeutic needs and family’s adherence capacity.
- Just right approach can be used to set and adapt the carryover plan.
- Carryover plan is a process that needs to be managed just like diagnosis and in-session work.
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.