Working with children in early intervention can feel like flying a kite. You create your game plan, you hope for perfect conditions and you cross your fingers that both the child (kite) and the family (string) feel like flying that day. What happens if it rains or is too windy? What if the kite and the string are simply unable to focus on flying that day?
As speech-language pathologists, we know not everything goes according to plan. Sometimes our backup plan needs a backup plan. And no matter how hard we try, some days speech-language treatment might be the furthest thing from the family’s mind. During family-centered sessions, it’s our job to involve and empower the family to work on goals at home. If a family experiences a crisis, however, babbling, improving language or transitioning to solid foods can take a back seat.
According to the U.S. Department of Human and Health Services, a crisis is identified by a family’s reaction to a stress-producing situation or event disrupting the family’s normal pattern. This can include a serious injury to the child or family member, Child Protective Services investigations, the child receiving a feeding tube, a house fire, persistent illness in a child, a family member or parent leaving the home, or unemployment. Families can also be dealing with the death of a child, a terminal illness diagnosis or children affected by abuse.
When working with families during or after a crisis, these five steps help them stay on track with treatment goals and also help them with their “new normal.” In addition, establishing or strengthening the rapport you have with a family boosts the successful outcomes of implementing these steps.
- Identify the crisis event. During this time, the family might grow distant. They might cancel sessions, appear less engaged or get easily frustrated. Once you identify the crisis event, try to understand the situation from their perspective. This attitude will help you better support them through new challenges.
- Empathize with the family. SLPs can forget that having the child effectively communicate, try new foods or pay attention during activities might not be the family’s most important task of the day or week. Acknowledging the family’s daily challenges allows us to be patient and provide encouragement and constructive feedback for improvement when addressing outcomes.
- Modify session plans or goals. Prior to the crisis, perhaps the family excelled at completing homework, practicing strategies or giving detailed reports. Sometimes, we might need to modify our treatment plan and identify what the family can handle during this stressful time. Short-term goals might—temporarily—become long-term goals. Sessions might occur less frequently. Letting the family find success in whatever they can accomplish at that time improves the child’s long-term success.
- Know when and where to draw the line. Working closely with families in their home and community allows them to trust us enough to ask questions that might fall outside of our scope of practice. It’s natural for people in crisis to feel dependent on a professional who offers help. For some families, weekly sessions are the only time they interact with someone they feel has information and power. It can be challenging, but we need to know when to refer the child or family to other health care professionals.
- Collaborate with professionals and community resources. When a family’s needs outweigh our skill set, we can create a network of other professionals in the community. Identify other professionals who might already work closely with client families and build relationships with them. This interprofessional collaboration will help support you as well as your clients. I’ll explore more on collaboration in the second installment of this series on working with families in crisis.
When families are in crisis, the rapport you build with them allows them to look to you for guidance, information and support about their child’s speech, language and feeding development. As SLPs, we can help children reach their full potential despite obstacles, but we have to empower parents to focus on their “kite” and fly into unlimited possibilities.
April Anderson, MA, CCC-SLP, a clinician at National Therapy Center in Washington, D.C., works with infants and toddlers, as well as with school-age children with feeding disorders. firstname.lastname@example.org