In evidence-based early intervention, our primary aim is to coach, rather than to “do therapy” ourselves. We teach families how to help their children. The most challenging part of coaching can be finding effective ways to invite parents to participate and join in the interactions with their child.
Location, Location, Location
As therapists, it is natural for us to think about our relationship with the child in service. After all, we are teaching the child. That’s what we are trained to do. Right? Not exactly. We’re teaching the parent, so that the parent can teach the child. That changes the relationship. Our relationship with the parent, and the parent’s relationship with the child suddenly become much more important when we look at them through this lens. As coaches, we know that the interactions that the parent has with the child are primary and we work to keep those interactions at the forefront. I’ve learned to place myself behind a child rather than in front of him during an activity, or to create a triangle between myself, the mom, and the child. This breaks up the traditional child-therapist pair and gives the parent a space to join in. Locations other than the living room floor that can make this easier include the couch, a high chair, a table, or wherever the parent and child typically spend time together.
Start with Routines
Keep in mind that unless parents have been involved with coaching before, they’re probably expecting traditional therapy. All parents want to be involved and want to help their children, but they may not know how to step in and participate, especially during playtime. Coaching phrases like, “Do you want to try this?” or “Can I model that for you?” can feel awkward to deliver if you aren’t used to them. And we all know, if you feel awkward, it will be awkward.
Rather than starting with an activity that we initiate, we can set the stage for authentic parent involvement by observing the family’s natural routines first. I sometimes ask parents what they would be doing if I wasn’t there. Is it snack time? Does little Joey need a diaper change? This leads naturally into a mutual discussion about ways to increase interaction and language in everyday activities. If it is snack time and Joey heads for the refrigerator or brings us his cup, we have a perfect opportunity to introduce a word or sign for “eat” or “drink”, model and practice offering choices to build language, or encourage eye contact as a first way of requesting. Snack time, diaper changes, and dressing are activities that parents generally do so they are more likely to take the lead and give us a chance to support and encourage, rather than waiting for us to lead an activity.
When You Have to Play
If parents seem more inclined to hang back, say that their child normally plays by himself while they do other things, or are otherwise hesitant, we may have to fall back on some more traditional therapy or play activities. This is when we are most likely to lose parent interaction if we don’t keep it at the forefront. If we are looking at a book, rolling a ball, working on a puzzle, blowing bubbles, or doing any other traditional therapy activity, it is very easy to let the focus drift back to us and the child. I have to work to consciously keep the parent-child interaction at the forefront, rather than my interaction with Joey. If we are looking at a book and working on pointing out pictures, I stand or sit behind him and put the parent in front of us or next to Joey on the couch to ask those, “Where’s the…?” questions and help him point out the pictures. This tends to feel much more natural and I find it less intimidating for everyone. It also increases the chance that the next time Joey brings a book to his mom, she will point out a few pictures rather than reading complicated text because we’ve practiced this together.
If I’m rolling a ball or car back and forth, once Joey is into the game I roll or throw the ball to his mom and have her join the game that way. If Joey is having trouble getting into the game, I sit behind him and help him throw the ball to his mom, rather than encouraging him to throw the ball to me. I find that most parents want to participate with us, we just have to invite them in. The responsibility for not pushing parents out is with us, even when we are working with more traditional play activities.
Stepping Back in Trust
Once we have used location, positioning, routines, and a bit of creativity to get parents engaged and interacting with the child, this is when the magic happens. Once we have the parents involved, our job is to get out of the way. When I am in a visit, I feel this as a continual sense of stepping back from the parent-child dyad, maybe most during those times when I really want to get involved. If they are engaged in a social game or activity, the last thing I want to do is get in the way. I may give a suggestion of something to try, but I often stop myself from even doing that much.
Wait It Out
Instead, I tend to smile and nod encouragingly and wait. The last thing we want to do after the parent gets involved is to pull her back out of the activity again and put the attention on us rather than on Joey and the interaction. Generally, it lasts a few minutes and then the child is off to something else. This is my time to open a discussion, starting with, “Wow, he loved that game and he was really engaged with you.” From there we might reflect together and move to brainstorming strategies. If parents struggle with coming up with a strategy I might share some expertise with ideas like, “Next time you play that game with him, wait a little bit longer for him to look at you.” Having parents reflect first gives them an opportunity to think about how an activity went before I add to their thoughts. This encourages them to seek out and capitalize on opportunities for interaction during the time when I’m not in the home.
While it can be challenging to encourage parents to join in on the interactions during visits, paying attention to our words and actions can help us to create space for parents to actively participate rather than watching us play.
What strategies have you found for encouraging parents to join in during intervention visits?
Share your strategies in the comments below!
Stacy Zogheib has been a Developmental Specialist in Arizona since 2006. She has a Bachelor’s degree in Elementary and Special Education from Wittenberg University, and a Master’s degree in Early Childhood Education from Northern Arizona University. Stacy has a passion for supporting and empowering families with young children who have delays or disabilities. You can reach her at: stacypro@yahoo.com
This is a great article and so helpful for all pediatric therapists. We don’t learn this in school and it’s the hinge point that will make or break your sessions.
Great point, Kelsey! I like your “hinge point” analogy – so important to really understand what coaching from the outside means.
I agree that learning to step back is critical. I think that whatever our area of expertise, we so often feel that we have to do something, anything, when really what we need to do is get out of the way so that there is space for the parents.