Think about the last location where you provided clinical services. Mine was a grocery store. The produce section is not the only place I provide services with my adult clients—I also address speech intelligibility and social communication goals at coffee shops, money management at banks, divided attention at soup kitchens, sequencing at golf courses, and reading comprehension during book club at the library.
These locations might seem unconventional, but they represent real-life community settings in which to help my clients—who mostly have acquired brain injuries or dementia—integrate back into their community and regain those life skills most important to them.
I admit, it’s more convenient to work in an office where materials are within arm’s reach. But when clients walk out of our offices, they need to transfer skills learned in a clinical setting into their natural environments. Rather than rely on my clients’ self-reported, perceived skill levels in their environments, I prefer to gather a realistic view of their abilities by going with them to real-world settings.
I see my clients gain three key benefits when I take them from the clinic into the community:
One size (does not) fit all: Community settings allow me to learn my clients’ values and preferences—a principle of evidenced-based practice. I discover these preferences during the assessment process by gathering details on daily routines, hobbies, vocational interests, educational goals, family responsibilities, and go-to places they like to spend time. I also note what barriers to participation in these activities they report. Clients’ responses guide an individualized, one-size-does-not-fit all, plan of care.
Empowerment: It’s no surprise that clients and their families feel empowered when collaborating with practitioners to create meaningful goals. Clients also feel more empowered when learning to use functional strategies in naturalistic contexts. Imagine how empowered a client might feel after successfully using a visual scanning strategy to find their bus route on a map. Or the confidence felt by a client who stutters asking a question in front of an entire pottery class. Feelings of empowerment can lead to higher satisfaction levels, increased confidence, and participation in—rather than avoidance of—preferred activities.
Generalization: Speech-language pathologists strive for their clients to be able to generalize skills learned in treatment to other settings. So it makes sense to plan for generalization of skills when first identifying the best strategies. Treatment conducted in the environment where we hope generalization will occur provides added value.
SLPs can monitor successes, challenges, and the level of assistance needed during functional tasks. For example, a client with severe memory impairments meeting a clinician at a grocery store might need prompting to take a picture of the door he entered or to cross items off the list once placed in the cart.
Things to consider when taking clients from clinic to community:
Reimbursement: Prior to giving sessions outside the clinic, make sure any applicable insurance reimbursement applies to those services.
HIPAA: Even in community settings, maintain the confidentiality and privacy of your clients at all times.
Emergency contact: Make sure to get an emergency contact for your client—especially if you plan to meet in the community.
Community-based sessions aren’t always a realistic option. However, we can also bring pieces of clients’ communities into the clinic. Get the names of clients’ preferred restaurants, shops, and libraries, for example. Visit those websites to learn information you can incorporate into sessions. If possible, use real restaurant menus, bus schedules, grocery store flyers, bank deposit and withdrawal slips, and museum brochures. Set up a coffee pot to simulate a coffee shop and ask co-workers to act as employees or other patrons. Bring hammers, scrap pieces of wood, and nails to complete a woodworking task. Or needles, thread, and fabric to sew.
The sky’s the limit! Let’s help our clients become active, engaged participants in their communities by trading our desks for a walk in their world.
April Gibbs Scott, PhD, CCC-SLP, founded and owns Carolina Premier Speech Therapy, a private practice serving adults in the greater Raleigh, North Carolina, area. She is also a Certified Brain-Injury Specialist who consults with families and businesses to integrate people with cognitive-communication disorders into their communities. firstname.lastname@example.org