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The benefits of getting support in the child’s natural environment

Updated: Jan 13, 2021

The type of support that I give children in their home environment or on trips in the community is very different to the therapy room. At home I attempt to help you solve a problem that you encounter when supporting your child to complete a task or activity they find difficult. During a home visit, I do not work directly with your child but observe the ways you and your child complete the task, supporting and modelling other ways of approaching challenging activities.

Inviting a therapist into your home space can be very difficult for some parents. Therefore, it is helpful to set a clear goal for such a visit. This will help to manage expectations and ensure that I come prepared. It also allows us to focus on solving one difficult activity at a time, one that you consider a high priority.

I find that my support at home is most effective after I have seen your child for a block of 6 sessions in the therapy room. During these sessions your child's trust in me will grow, making them more receptive to me modelling a strategy to manage the behaviour.

In my experience, we achieve better outcomes if we work together and communicate about which of the suggestions has worked for you. If I suggest something that is difficult for you and your child to do, it is imperative that you share it with me so I can suggest a more suitable approach. In some cases, depending on the task and your needs, I may videotape the situation and we will analyse it together during a follow-up session.

Typical activities parents have asked me to support at home include

· Using the toilet

· Eating

· Bath time

· Taking a bus

· Walking in the street

Here are two case studies of children I supported at home and in the community:

The case of C, a 4-year-old boy with a diagnosis of Autism who disliked washing his hair and had a meltdown before every bath time.

I visited C and his mother at home to observe bath time. During the visit, I videotaped the preparation for bath time and C in the bath. As the family had another young boy and his mother was home alone, we agreed that I would leave at the end of bath time and we would meet again in order to analyse the reasons C has meltdowns and how we can support him.

Having observed the situation, I realised that the main difficulty was that C was unsure about what would happen. He did not know whether, once he is in the bath, it will be washing hair day or not. Upon watching the video and reflecting on the situation with C’s mother we also understood that he was not sure whether bath time was going to happen at all. This lack of clarity caused C anxiety that led to his melt downs.

We decided that C’s mother would try to introduce pictures to support C’s understanding and to ensure that he knows beforehand if he was going to wash his hair. The initial improvement was that C enjoyed bath time and that his melt downs only happened on days when he needed to wash his hair. We then explored different strategies to help him tolerate washing his hair as well. Observing the situation allowed me to support C and his mother with a clear action plan that was tailored to C’s difficulties rather than giving generic advice about bath time.

The case of F, a 4 year old boy with a diagnosis of Autism whose mother wanted to stop using the buggy and instead encourage him to walk independently. F was unable to speak and therefore could not articulate where he would like to go.

When I observed him walking on the street, I thought that the main difficulty for him was not knowing where he was going and how long it would take. In other words, because F did not know where he was going, there was nothing motivating him to walk. Since he was not used to walking, he protested by sitting down on the pavement. In addition, he had no way of expressing that he was tired, hungry or wanted to do something else the way other children his age did. Walking in the street can be very challenging and overwhelming for children with Autism. It is therefore important that when we start teaching a child to walk instead of using the buggy, we choose motivating trips. With F, we decided to start working on walking to the park. The first trip was difficult as F stopped a few times and sat down on the pavement. I reassured his mother that it was part of learning and showed her how to support F to stand up again. We decided to take a photo of the playground once we arrive, which we would use in the following trips to help F understand where he was going. We chose a photo of an activity in the playground that F liked the most, namely swinging.

In addition, I realised that another hurdle to overcome was that F’s mother was worried about walking with F in the street, since he was unpredictable and sometimes would suddenly drop himself on to the road. Moreover, F’s mother thought that she may not be able to convince F to carry on walking when they were out and therefore it might be difficult to return home. In this case it was important to support F and his mother for longer. They needed another adult to accompany them a few times until they felt confident to complete the journey alone. We then thought about other journeys that F might enjoy and slowly built up towards walking more frequently and for longer distances.

These are some examples of how I would be able to support you and your child at home and in the community. If you have any questions, please do not hesitate to contact me.

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