Therapy and how it works--The FAST Answer

I've been there--Felt that--panic....something is wrong with my child.

I call for help and there seems to be no reassurances and I am left with more questions than I had when I started.

The preschool teacher says that things just "don't seem right" with MaryJane.  She just isn't playing with the other children, she isn't participating in class and she sits by herself.

You look on line and come up with possible reasons.  You find articles, call the author and want an answer--fast.  But all that person does is talk in generalities and you wind up feeling angry.

I think the issue is not understanding the process of therapeutic help.

The person on the other end of the phone is a stranger. He or she does not know you or your child.  They need to meet you and your child.  That is first.  This usually takes place in the form of an evaluation or a screening.

A screening is more superficial than an evaluation, but can reveal a lot of information in the hands of a skilled practitioner.  It should look at sensory, perceptual, fine and gross motor, task and interactive abilities and language.  Depending upon the process it can unitize standardized and/or criterion referenced tests and measures that produce a profile of the child's current functional abilities.

And evaluation is more in depth and looks more closely at the above issues and should involve the comparative  results of 4-7 standardized tests as well as clinical observations.  In some cases characteristics of suggested potential diagnoses can be made.  However, only a medical doctor or PhD psychologist can make those determinations.

To put it simply...there just is no FAST ANSWER.

As an occupational therapist for over 36 years I hear the panic in the parent's voice, the fear of knowing and desire to get "it" done.  I wish I could answer you over the phone.  I wish I had those powers. I wish I could tell you that in 3 sessions your child will be OK.  I wish I could with just a few words wipe away your anxiety.  I cannot. And any "professional" that tries to give you those answers and/or assurances without knowing your child should be suspect.

Below is a list of what to expect when you call for therapeutic help:

1. Phone interview
2. Setting an appointment
3. Providing forms to be filled out prior to the first visit (screening or evaluation)
4. The first meeting (screening or evaluation)
5. Your receiving the written report (within 2 weeks of the assessment)  (a written report is essential because insurance companies will ask for as justification for payment, pediatrician will want it, schools may require it for accommodations, etc.)
6. Discussion of the report with the therapist 
7. Initiation of treatment if that is the decision to go forward (Keep in mind there is no formula by which the therapist can determine the length of treatment.  This is not an anti-biotic one takes for 10 days.  This is process that changes neurological functions and that does not happen "overnight".)

What you should expect:

1. Therapist accessibility by phone or email as needed (This is time sensitive and meetings in excess of specific limits may be charged for.)
2. Some therapists allow for parent participation in the treatment sessions.  I think this is a good idea so that there is better carryover at home.
3. The therapist keeping progress notes for sessions
4. Written receipts after each session
5. ICD-9 and CPT codes defined for doctors and insurance companies
6. Verbal progress reports and semi-annual or quarterly written progress notes as needed.
7. Therapist accessibility to needed conferences (be expected to pay for the professional time to do this).
8. As treatment progresses, the parents should be working in concert with the therapist as to the direction of therapy.  Both the family and the therapist should be co-supporting each other.

All this takes TIME.  The length of time depends upon many factors but mainly the receptivity of the child.  If the therapist pushes too hard, the child will resist and tune out.  If the therapist does not challenge the child the child will become disinterested and not engage.  It is a delicate balancing act.

Changes usually happen first in therapy, then at home and then in school and other task demand/out of comfort zone situations. 

The may be no FAST ANSWERS, but with patience there can be many GOOD ANSWERS.