22 Speak Out
December 2014
Speech Pathology Australia
BRANCH news
northern territory
Following a decade
of clinical work in the United
States and Kenya I recently
moved “home” to Australia,
choosing Darwin as the place
to alight.
I work for Carpentaria
Disability Services providing
Early Intervention Services,
where we use a relationship-
attachment model of service
provision. What attracted
me to this way of working is
the way children and their
caregivers are repositioned
in the therapeutic model,
away from clients who we
do something to, to clients
we work with. By helping
parents shape their role in the
interaction they become the
“agents of change” for their
child (Geller & Foley, 2009).
In taking up this model, I’ve
noticed the following changes
in my practice:
•
Because the children
we see come with
complicated stories,
diagnoses and
patterns of care, the
team spends a lot of
time in consultation,
clinical supervision,
and meetings ‘behind
the scenes’ about the
families.
•
I rarely engage with
the child directly! The
parent serves as the
play partner while I
coach the parents on
things to say and do to
support their interaction.
Because we want the
parent to have the play
experience with their
child, we don’t model
very often. If I model
the interaction, I risk the
caregiver thinking “well I
can’t do that, that’s too
hard.” Parents are more
likely to sit and play and
talk with their child if they
have had experience and
success doing so in the
clinic.
•
Speech pathologists
often talk about
‘following a child’s lead’
but in my experience
we tend to be quite
directive. When I actually
follow a child’s lead, for
as long as that takes, I
see the child’s play more
clearly – I see patterns,
the number of repetitions
needed to consolidate
learning and the depth of
the child’s engagement
with a single activity. I
frequently want to show
the child new or different
ways, disrupting their
natural play patterns and
often shutting down their
natural engagement with
the activity.
•
I have a knee-jerk
tendency to fix things
before they occur (e.g.
move something out
of the way, put a toy
in within reach of the
child, loosen a lid).
However, I often jump
in too fast, undermining
a parent’s responsibility
and capacity to find a
solution, or robbing a
child of a chance to try
something, and then
find a better way so they
have success.
•
We can shape a child’s
play and learning by
providing a well set-up
room. By giving children
various toys and play
scenarios I set the scene
for working on the goals
I have agreed on with
the parents, without
“leading” the child.
•
Transdisciplinary teaming
requires role release
which is time intense
and requires lots of
communication and skill
development between
therapists. Further, the
ultimate role release is to
the parent.
Working within a relationship-
attachment model has
reinvigorated my thinking
about clinical service and the
role we play in families’ lives,
and reminds me that there
is always more to learn as
clinical service providers.
Bea Staley
Speech Pathologist
Reference:
Geller, E. &
Foley, G. (2009). Expanding
the “ports of entry”
for speech-language
pathologists.
American
Journal of Speech-Language
Pathology
,
18
, 4–21.
Parents as agents
of change and other
realisations
‘When I actually
follow a child’s
lead, for as long
as that takes, I
see the child’s
play more clearly
– I see patterns,
the number of
repetitions needed
to consolidate
learning and the
depth of the child’s
engagement with
a single activity.’
Bea Staley at
Carpentaria
Disability
Services.
