Early Intervention: How Questions Can Guide Your Practice

Question mark made of puzzle pieces

Photo by Horia Varlan

In my article “A Therapist’s Mantras for Early Intervention” on Pediastaff’s Blog, I mention the importance of asking questions in early intervention. We all ask a series of questions when we are completing an evaluation, then during treatment we often ask families how things are going to check in on a child’s progress, but there are so many more questions to ask that can help build a healthy parent-therapist relationship. These questions get to the heart of what’s going on and can truly impact the success of intervention.

By asking the right questions you can get to know a family for who they really are and allow them to see your genuine interest in their opinions and their child’s success. With appropriate questioning you can also establish communication with even the most shutdown of families, repair misunderstandings, and most importantly, encourage families to own the early intervention process as their own.

The following are the categories and sequence of questions I have found to be most useful in my own practice, to first build a foundation of trust and then allow for open and honest conversations as the therapeutic relationship grows. The first few categories may seem obvious, but if you stick with me, hopefully by the end you will have found an idea that you hadn’t thought of or tried before. Here goes…

1.  Ask questions that establish roles.

When first working with a family, it’s important to find out what ideas they have about how the intervention will work, what you will do when you come for a visit, and what their part as parents will be. I like to ask questions like these:

  • How would you like my help?
  • What do you hope to get out of working with me?
  • How would you like to take part in your child’s therapy?

The answers to these questions then provide an opportunity for you to discuss things like the importance of attendance, how your sessions will be set up to include them as the parents, and what therapy is and isn’t.

2. Ask questions that set goals.

The next category of questions gets more specific about what a family wants to see their child accomplish. You may have discussed some of this when completing the evaluation or other paperwork with the family, but due to time that has likely lapsed and changes that can happen quickly in a child’s development, it’s important at the beginning of therapy to re-establish those goals. I also like to focus parents very specifically on one thing we can start with that their child can likely accomplish right away so that parents are motivated to continue to work hard and set new goals. Questions to help set goals may sound like this:

  • What time of the day is particularly difficult for your child?
  • When do you get frustrated with your child’s difficulty communicating?
  • What’s one thing you think your child could do with a little help that would make a huge difference in his life?

Keep in mind that answers to the last question may still be broad behaviors like, “pay attention”, “talk more”, “listen better”, or “have better behavior”. It helps to take those answers and explain how a specific behavior, like taking a turn during an interaction, attending to an activity, pointing to make a request, imitating gross motor movements, or looking at an adult to ask for help can be the first steps to helping their child get to the overall goal. Once parents know what specific behavior they are looking for, they know when their child’s accomplished it, and they can see progress happening. Establishing those successes early on goes a long way in earning a parent’s trust for the long-term.

3. Questions that build routines.

Questions that build routines help parents figure out how they are going to implement these new behaviors and strategies you have introduced. Without a plan, a set day, time of day, activity, and specific behavior, it is unlikely that a parent will follow-through on your interventions for the simple fact that change is hard. With a specific plan, established by the family itself, it makes it much more possible to integrate these new behaviors into daily life. Examples of these questions include:

  • What times of the day do you think would be good to help your child practice taking turns?
  • Out of the toys here in this room, what toy do you think you’d like to use this week to help your child practice pointing?
  • What kind of activity would you enjoy doing with your child where he can imitate your movements?
  • Can you think of several times during the day you can make sure your child hears you saying the word “up”?

4. Questions that gather feedback.

This one is easy. To gather feedback you can simply ask, “How’d it go?”

5. Questions that spark action.

The questions that spark action are where the real relationship building happens. This is where you can encourage parents in their successes and help them to solve problems and overcome obstacles. It’s easy enough to guide parents through what therapy is all about, help them set goals, plan activities and then drop the ball. And, yes, just asking, “So, how’d it go?” with no follow-up questions still counts as dropping the ball. We’ve all done it because we’re frustrated that a parent didn’t follow through and we can’t seem to politely muster another question, or we can sense the parent is shutdown and we don’t want to push too hard. BUT the question after the “How’d it go?” is where you get the 411. Those questions are tricky, take special care, and go something like this:

  • So _________ pointed to what he wanted when you were working with him on the puzzle. Wow! How did that feel when he did that for the first time?
  • I know you said you didn’t have a chance to work on the word “up” this past week. Do you think you’ll have a chance this week or would it be easier to work on something different?
  • I know we had a difficult conversation last week after you got the diagnosis from your doctor. How are you feeling about all of that now?
  • I know _______ didn’t want to imitate your movements when you sang “Old McDonald”. What do you think made it difficult for him to participate?
  • Since _______ didn’t want to take a turn with stacking the blocks, would you like to practice it together today so that we can see if we can find a way to make it easier for him to participate?

Depending on the answers to these last questions, you may also need to go back to the previous questions to make sure you and the family are still on the same page as far as setting goals and building routines.

To sum it up…

And now I would love to hear what you think. What questions have you found to be helpful? How do you feel asking the tough questions? Other than asking questions, how do you keep the lines of communication open?

 

 

Kim Rowe, MA, CCC-SLP, is a speech-language pathologist working in early intervention in Savannah, GA. She is Hanen certified and passionate about family-centered services. When she’s not working, Kim enjoys writing at Little Stories, spending time with her husband, volunteering with her therapy dog Charlie, and listening to her daughter’s story unfold as she develops language.