About one year ago now, I started hearing some new buzz words swirling around the Early Intervention Program in my home state of Wisconsin–words like evidence-based practices and coaching, natural learning environments and primary provider. As a pediatric speech-language pathologist, I was a bit intrigued. Mostly though, I was rather annoyed and quite a bit skeptical. After all, I had been trained to look analytically at a child’s speech or language, come up with a plan to fix it, and implement that plan systematically and objectively. Suddenly, it seemed, I was being asked to take a step way back. To work through parents rather than through the child, and to train parents to be speech therapists. And I found it absurd to expect parents to learn in a few short months what I had learned in six years of higher education.
Because I’m the curious type, though, I started asking lots of questions and doing lots of research. I’ll be honest and say that my primary motivation was to prove that this approach was wrong. I dug through the research on speech and language outcomes for early intervention, looking for the “evidence” that was being touted about so loudly. I found research to support the clinician-directed ABA intervention and language facilitation in play with which I was very familiar and some research to show that parent-led intervention could improve child language and phonology as well. Yet I found not one large, well-controlled study that proved beyond a shadow of a doubt that this “new” approach—the one that called for coaching parents to responsively engage their children in the context of natural learning opportunities–was any better than what we were already doing.
A funny thing happened along the way, though. The more I read, the more I began to realize something else. In focusing so narrowly on speech sounds, vocabulary development, and two-word phrases, I was omitting a huge body of research about child development. I started to see that so much of what was being asked of us as early intervention professionals had less to do with speech and language outcomes per se, and more to do with infant and toddler mental health. I began reading research that suggested that most significant factor in a young child’s development was not the amount of time that child spent in therapy, but rather the degree to which that child’s parent was responsive and engaged. And I began to understand that my single biggest source of power as an early interventionist was not to be found in playing on the floor with the child myself, but in helping that child’s parents become more responsive and engaged with him.
This isn’t to say, of course, that I suddenly began to think that there was no value in interacting directly with a child. This is far from true. Interacting directly with children helps us to discover what does and does not work with that child and allows us to model strategies for parents. There is every place for this in our early intervention practices. But this past year, I began to understand that I needed to be much more intentional about when and how I interacted with children. I also needed to be much more careful about building up parent competence in enhancing their own child’s development, rather than giving the appearance that a child’s development was dependent on me. After all, as a weekly early intervention visitor, I was with that child less than 2% of all his waking hours. It seems so silly that I ever assumed that I was the agent of change in a young child’s life, but I did. This past year, it finally dawned on me that early intervention wasn’t about me and what I did with the child…it was about that child’s parents and what they did with him. And if I couldn’t effect change in that, I simply wasn’t doing my job.
One year later, I’ve realized that these evidence-based practices aren’t about me training parents to be speech-language therapists at all. Children under the age of three don’t need their parents to be speech therapists. They need them to be parents. I’m not being asked to give up my role. I’m being asked to take all the information I have about child development, mesh it with what I’ve learned about infant and toddler mental health, and find ways to intricately weave those practices into the fabric of that child’s relationship with his parents. I’m being asked to get into that child’s life, to know his daily routines—no matter what they are–and to work within those. I’m being asked to start where the parents are, not where the child is. It’s complicated, it’s complex, and it’s messy. And it’s my job.