We’ve all been there before. You’re 20 minutes into a treatment session and desperately wondering if this technique will bring results, if this is the session when you finally see the progress everyone’s expecting. The questions race through your mind. What’s going on? Am I ineffective? Am I choosing the wrong area to address? It’s my cueing; it must be my lackluster cueing. Or maybe he’s just tired/cranky/hungry/distracted. Next session will produce better results. Or will it?
As speech-language pathologists, we take seriously our ethical responsibility to make certain we evaluate the effectiveness of our interventions, and we expect our clients to benefit from our services. There may come a time in your practice when you find it necessary to determine whether or not continued treatment remains appropriate for a particular client. And what a conundrum it is.
Let me be clear. I’m in no way suggesting each and every patient failing to produce /s/ with 80-percent accuracy across three sessions should get dismissed due to lack of progress. We expect peaks and valleys in every treatment journey. We also reasonably expect our clients to master skills at their own pace. However, some situations require closer examination to make sure we uphold our ethical responsibilities and serve our clients in the best possible way.
As SLPs, we all want the best outcomes for our clients. And it may feel like you’re throwing in the towel if you dare to utter the dismissal word, especially if that word gets met with opposition or anger. Continuing to treat clients who don’t showing substantiation of intervention benefit, however, leads to a slippery ethical slope.
If you find yourself wondering whether or not treatment is making a lick of difference, perhaps it’s time to devise a different plan:
D—What’s the duration of interventions with little or no perceived benefit? If you provided treatment using myriad techniques for 9 to 12 months with little to no positive results, consider dismissal.
E—Is there a clinician who has more expertise in this particular area who can mentor me? Or who is better equipped to treat this client?
V—Are there variables at play—behavioral, medical, social, motoric—negatively affecting a client’s ability to benefit fully from treatment? I suggest you begin by considering medical, social, behavioral, and motoric factors, though you might need to dig deeper. People can only allocate their internal resources to so many tasks simultaneously. Perhaps a break from treatment allows your client to focus on a more pressing issue now, keeping in mind they can return.
I—Consider the intellectual/cognitive functioning of your patient and how it correlates to his or her current communication abilities and goals.
S—Is my treatment setting conducive to the advancement and generalization of skills targeted? At times, a simple change in setting may bring dramatic differences in outcomes.
E—Am I employing evidence-based practice? Did I introduce different intervention strategies and allow my client to adjust to each variation in implementation?
Dismissal, discharge, exit or graduation. Whatever you call it, it remains a highly sensitive topic among clients and caregivers. Taking the time to closely evaluate your treatment journey should give you the confidence to stand by whatever decision you make. Just remember:
V-Variables at play
E-Employing evidence-based practice
Amanda Rhodes Fyfe, MS, CCC-SLP, is a pediatric speech-language pathologist with experience treating in a variety of environments, including private practice, hospital, and educational settings. She currently serves students in the Mansfield Independent School District. firstname.lastname@example.org