Transitioning Out of Services
Lately I’ve been transitioning several children out of service - for some they’ve aged out of my competence, and for others, ABA therapy may not be the best service for them anymore.
I would encourage anyone (irregardless of service provider) to ask questions about this, and get familiar with the rationale. It could be heart-breaking for you, but it still may be the best thing.
For some of my kids, I’ve encouraged another type of service. For example, an SLP with a specialization, or an OT with a specialization. These other specializations may be a better fit for where the child is now; and that may not be a bad thing! I think it’s amazing when their skills are at a level where they can now fully participate in these types of skill- sessions and it won’t be impossible for them to listen, pay attention and learn.
Let me share a discharge story to illustrate my point:
Pre-(germ) we had a little girl who was in 5 day a week services. Just before (germ) hit - she was beginning to babble, and had recently started to watch our mouths move when we spoke. I was so so so looking forward to watching the language bubble up because you could just SEE it was on the surface - and she would have a lot to say! (Germ) hit and the family went oversees for almost 2 years. When they finally returned, she was 2 years older and speaking. Her language was fairly functional, but tough: lots and lots of omissions and substitutions. So until someone listened to her enough, she would be tough to understand. However, throughout her time away she had maintained the skills to pay attention, work on her skills, and be persistent. So, despite her being “older” than my traditional kids - we took her back. We spent 1 year working on her language, building up the background, encouraging her to continue working - and in that time we realized we had hit a wall. The wall of substitutions and omissions. Given that I (nor my staff) are not SLPs… the service she needs now is SLP. She knows she’s “saying” the same thing. She knows she’s “saying” it wrong. She can’t figure out how to fix it. And that is not within my competence. I had hoped she would start to figure it out, and while some things got clearer - the bigger pieces did not. So 6ish months ago I encouraged mom to get on every list for an SLP with a skill-set for omissions and substitutions - good at building sounds that are not there. Lo and behold just before we wrapped up service (more on that in a second) she got the call and began sessions. Now - we wrapped up services. You say: BUT WHY! Finally she’ll have the support from multiple service providers. Well yes. But also no. Her ability to speak more clearly hindered programming - she could not say the more complex words we were attempting to teach. And continuing to run trials when she isn’t capable will be heart-breaking for her. And we know she knows. So, in the meantime it is best that she attend perhaps 2 sessions a week of SLP with someone who can work on all those sounds. Parents are on board and happy to implement any suggestions. My hope (and gut instinct) is that once she is able to fix her pronounciation, her understanding will follow without explicit teaching of targets. However, irregardless, she will be too old for my competence by then. Maybe by now you’re thinking “but why didn’t you recommend SLP from the beginning - then you wouldn’t have hit the wall!” Well, when we first started services up again she would often look away from our mouths, she wasn’t interested in trying harder than she was, she engaged in yelling to get her way, and was “un-teachable” in the moment of frustration. So a lot, a lot, a lllooottt of teaching went into encouraging her to try. In fact, she was in virtual SLP sessions (before we resumed) that were ended because she would slam the laptop shut and would not engage. That is not the same child who is attending sessions today. The SLP calls her a “joy to work with”.
And that’s why sometimes, it may be for the best.
