How to plan towards a carryover empowered discharge (from therapy)?
Every good thing comes to an end. In the case of pediatric therapy, we can say that therapy comes to a good end when individualized goals are met and caregivers are empowered to carryover the interventions and coping strategies into the child’s daily routines.
For most disabilities, this does not mean the child no longer has any difficulties. It rather means that a realistic and agreed upon goal has been reached, and the child with the supporting caregivers, all have a good understanding and sense of competence about what needs to be done in order to carryover the interventions into everyday life.
So if we know the end game is not only to achieve the pre-defined goal with the child, but also to see the caregivers off with a backpack full of tools, a competent song in their hearts and strong seed of change in the child’s routine, we need to plan for that!
Discharge planning starts on evaluation
This means that discharge planning has to do with caregivers’ ability to carryover interventions after therapy is over, just as much as (if not more than) it has to do with evaluation of child’s ability to participate in current activities. AOTA defined that occupational therapy typically includes individualized evaluation, customized intervention and outcomes evaluation. Caregivers’ ability to carryover once the therapy has ended can also be examined through these steps.
Hospitals say that discharge planning starts on admission – in occupational therapy, as well as other therapies, this means that discharge planning starts on evaluation. Evaluation not only of child but also of caregivers. Therapists evaluate child’s abilities to participate, as well as caregivers’ ability to carryover interventions in the post therapy era. Just like therapists work with child and family to determine goals for child performance and behavior, they should work to determine goals for carryover. These goals can include identifying who can take part in such carryover program and to what extent (parents, teachers, babysitters…), how much ‘load’ can each caregiver take, how much training will each caregiver need to achieve this goal, how motivated is each caregiver, can that motivation be influenced and how.
Similarly, throughout the therapeutic process of customized intervention and measured outcomes, a plan needs to be devised and implemented to get caregivers ready for discharge. Based on the evaluation, therapist can take actions vis-à-vis caregivers, such as: assigning ‘homework’ in a growing scale to support caregivers’ education and habituation, test different assumptions regarding various caregivers’ ability to share the load, schedule coaching sessions that focus only on caregivers (and invite all relevant ones), work with individual caregivers on their motivation and more.
Scientific approach to discharge planning
It helps to approach discharge planning more scientifically:
- Set goals for carryover empowerment in partnership with the caregivers. What should each caregiver be able to do upon discharge?
- Plan the learning curve for each caregiver. Make sure it fits the caregiver’s learning pace and goals.
- Measure caregivers’ learning progress from time to time and adapt the educational plan accordingly.
- Identify caregivers’ hurdles and strengths, and try using coaching and strengths based approach.
- Prepare the discharge of caregivers’ carryover program, just like you’re preparing the farewell from the child.
This sort of discharge planning cannot wait for when discharge is on the horizon. Opportunity for lasting impact stems from planning carryover empowered discharge from day one. Managing the caregivers’ process is as important as the hands-on intervention with the child, if not more. Remember to always work towards a carryover empowered discharge!
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.