Thursday, September 25

Bump in the Road

I always hesitate to write when what I have to say is not positive. Not because I want to provide an image that everything is always sunny in our world, but because one of the downfalls of having a public blog is not knowing who is reading. So, in large part, Drew's Dad and I have chosen to keep our more problematic situations and debates between us, instead of sharing it with the cyber world.

Having said that, we have been going through a rather rough patch with Drew's cochlear implant services. We have been so fortunate to be surrounded by such wonderful doctors, audiologists and therapists throughout the past two years. But recent transitions have not been going well, and Drew's Dad and I are now facing some difficult decisions.

We learned back in May that Drew's primary therapist was moving. Her husband accepted a job offer on the east coast. We were devastated to learn of her departure. (In fact, I don't even know if I wished her luck when she told me the news I was so upset!) Drew responded so well with her. She had this nature about her that echoed a quite confidence. She knew when to talk a lot to Drew and when to let him quietly investigate the task. She provided invaluable guidance for our family. She worked so well with Drew's audiologist, providing detailed information on how Drew was responding in therapy, and potential areas for adjustment to his MAPs. Her personality just clicked with our family, and we felt like we were not only loosing Drew's therapist, but a wonderful advocate and friend.

The search thus began for a new therapist. Our old one departed in July, and we actually missed our last appointment with her, due to Drew's bout with Roseola. There was no replacement immediately in place, so we took nearly a two month hiatus from therapy. While I was not thrilled with this, Drew enjoyed the summer months, and it made coordinating all of his therapy with the fact that his sister did not have school much easier.

Now we find ourselves working with the new therapist. While she is an extraordinarily nice woman, she is not providing the level of service we are accustom to. So, I am left questioning our situation. What should a therapy session look like? How much interaction should take place between the therapist and child? The therapist and parent? What "homework" should be given? Do you learn something new at each therapy session? The list goes on.

Part of me knows that we were very blessed to have someone as talented as our previous therapist, so I know that I can not hold anyone to her standard. But I have concerns after our appointments this month about the way the sessions are being conducted, and I certainly have not learned anything new. Maybe it will get better, but I feel so helpless right now. While Drew is doing so well, we have worked so hard to get him to this point, I don't want to lose momentum now. The difference in language between a two year old and three year old is outrageous, so this transition is not happening at a good time. In addition, Drew's Dad and I both work full time, so taking him elsewhere for services would be challenging. We will do anything we have to for Drew, but I feel like we shouldn't have to do that.

My question to you is, what are your therapy sessions like? Do you see "lesson plans"? Do you leave with a focus or homework to do for the next week? What can we do to help make this transition better? How long should I give this transition period before I change therapists? Any comments you have would be greatly appreciated.


elizabeth said...

I'm so sorry to hear that y'all are going through a tough time. I recently attended a great seminar put on by an audiologist and two therapists from Hearts for Hearing (a clinic in Oklahoma)and they gave some great advice on strategies, parent coaching techniques, and other aspects of AVT. They didn't outline a sample session, but some of the things they discussed might help you better evaluate your situation. All of my notes from this seminar are at in posts titled "Play It By Ear!" Day 1 and 2, respectively.

Good luck!

diber said...

That's really sad and frustrating. I know I would feel really awful if we lost our therapist.

We see a therapist from the hospital once a week, and last winter I felt we needed one more therapy session from the school district. I so heart Hospital Therapist. She totally rocks. But the person they gave us from the district did not work. I could tell from the beginning that this was not going to work. I gave her three sessions. I felt like after three times I should have a good feeling about how she ran her sessions and her rapport with my son. I didn't feel like I had time to "mess around" with therapists.

Yes, absolutely you should be able to "see" the lesson plan. I also think that I should be able to see the trajectory of the sessions. For instance, do you see how the session fits in with the overall picture. Our therapist uses the AuSPlan and lent me a copy to read it, so that I know what's going on and where we're going.

Yes, we do leave with homework for the week. Like, "focus on turn-taking and articulating these consonants...." I usually try to repeat some of the games or songs the therapist did in our play at home.

Our sessions usually follow a similar pattern. 1) test Ling sounds, 2) work on listening and articulating through repeated syllables (like "baboo" or "madoh" or "teemabee"), 3) then she does a few age-appropriate activities that work on articulation, vocabulary building, and listening.

I hope you get to the bottom of this. I remember how awful I felt when we tried out the other therapist that didn't work for our family. I'm sure she was a good therapist, but you also have to take into consideration how a therapist "clicks" with you. It's also hard not to feel a little freaked out when you feel the neuroplasticity clock ticking. I hope you find a new therapist that works for you.

Kel said...

That is so difficult! It is so wonderful to have a great therapist, and when you aren't feeling the vibe, that really throws everything off. Personally, I would give it a few more sessions, and if you still aren't feeling it I would look into a new therapist. Just as much as the therapy for Drew and lessons for your family, an important piece is leaving YOU feeling confident and empowered.

Anonymous said...

Well our sessions look vastly different from Drew's I'm sure, just as a result of Ethan's severe apraxia etc. However, I can very highly recommend Laura at Columbus Speech and Hearing. (email me for her last name and contact info if you want it) I heard about her initially from a parent on Ci Circle who also loved her. She has experience working with the AV group in Akron and she also worked at the renowned Ohio Valley Voices in Cincinnati. Ethan loved her and so did I. She was always very positive and upbeat and debriefed each session so articulately, giving me things each week to focus on at home. So if you decide to switch therapists I can't say enough great things about her.

tammy said...

This is so hard and I fear this myself right now with having to leave such a great team. I truly believe that you have to click with your team. I don't have much tolerance for waiting around to see if it's going to work. Maybe you could even just interview a few others, before completely switching, to see if you feel that click.

Although Aiden is still an infant, this is how all of our sessions go:
1. Discuss new things going on with family & Aiden
2. Therapist reviews lesson plans and goals for session and asks if I am good with it or if I feel we need to review something else.
3. Ling check on HA's (using stethoscope)
4. Two to four teaching activities which she tells me about first, then models, then has me try, then provides feedback.
5. Discusses books & songs to go along with lesson
6. Gives our HW & reviews by asking me what I've learned, what strategies I'm taking home to work on, questions, etc. Our therapist writes all this down for us too (we're spoiled) and provides any reading material she feels would benefit us to go along with that weeks lesson.

Good luck Jenny ... and follow that mom gut instinct!

Kristen said...

I understand your frustration. You definitely need to go with your gut instinct. You don't want to have any regrets with Drew's language when he gets older.
Here is how Kevin's session works:
1. We discuss anything new he has been doing
2. She does oral-motor stuff to 'wake-up his mouth' and get his tongue moving. He has oral-motor issues...
3. She tells me what she is focusing on and why and works on that sound. We are mainly doing artic work now and not really that much listening work. She does do some of that, but she is more focused on artic. She usually engages Kevin in a 'game' to get him to do what she wants.
4. She leaves me with a list of things to work with him on. Usually words to practice and games to play.

Good luck. Drew is a star and will continue to be one!!!

leahlefler said...

How frustrating! We don't have any certified AVT's in our area, but our SLP is willing to work with us using that model (our entire area- the whole county- uses a TC approach). So we use a lot of things off the internet ( and ideas from blogs like yours) to supplement anything from the actual therapy times. We did get homework this week- we are to work on identification of body parts (eyes, nose and mouth) over the next week. Nolan is lagging in receptive language, so we're trying to "catch up" in this area(darn progressive losses)!

Landon's Mom said...

That has to be tough to switch in the middle of therapy but from what I've seen from your blog entries and videos of Drew, he has developed such a great language basis that I'm sure he'll do fine whatever you decide to do. We got lucky when Landon was first diagnosed to be get started with the only certified AVT in this state and she's been wonderful with him. I'll email you an idea of our sessions so I don't take up too much room under the comments.

Ben's Mom said...

I'm sorry to hear you have hit a bump in the road, but appreciate so much your candor and sharing of Drew's journey so that you can help to educate all of us. Drew is a star and you and his dad are an inspiration to so many. Even though Ben is an infant and not implanted yet, I'll say that our AVT center always prints out a lesson plan on what was covered that session and homework for us to do all week. I sign it and we each get a copy. Also goals are set and written down. We are still at the very basic level of pre-listening and sound awareness, but I am sure when he does begin to hear language that it will include much more detail in the lesson plan. Good luck with everything and trust your instincts.

Christian's Mommy said...

I know what you mean regarding the bumps in the road. We hit one this summer when we had a gap between going to school and seeing an SLP at Hopkins.

I LOVE the communication and the system that we have in place at Christian's school with his private SLP. Would you like me to send you a copy of his report, so you can see what is reported on? Shoot me an email.

Heidi said...

I recently discovered your blog...and let me say I absolutely appreciate you sharing your story. I am a WI mom to our Guatemalan Miracle. Our son is a CI candidate-we are in process. He also has cerebral palsy, along with many other issues, so we are familiar with therapies. We recently were told by our PT that our OT was let go. That was it, we never saw her again. Thus, we've had to transition to a new therapist. Don't be afraid to share your thoughts with the therapist. Chances are she's testing the water. There is only so much she can learn from your previous therapist's notes. I had to tell our new OT certain things, like its best to just observe him for a few minutes before you start handling him-especially if you are new person-and from then on, our sessions went much better. Politely share with her your feelings and that you aren't getting what you'd like. I would also ask for homework-we don't get written plans, but I write things down anyway. AJ's OT has now learned to speak up and say "work on this". Good Luck!
Mom to AJ in Wisconsin

Drew's Mom said...

Thank you all so much for your advice! I greatly appreciate it.

We have a meeting with the speech department tomorrow. I will let you know how it goes!

Megan said...

I know Luca loves his speak therapist when the next day after a session he is saying "Barbra" (for the first time ever) to himself in the car...

Luca's only 17 months now and I'm not sure what we'll do when he hits 3 years old and is out of the intervention program.

Val said...

I'm late I know and everyone has already given great advice. You should ALWAYS leave a therapy session with your head full of ideas that you can carry over at home. Therapy is not to be left at the door when you walk out (good thing you know that!) When the session starts I would start in with "this week we worked on .... and he did this as responses" just to let her know you've been working w/him. That gives her an idea of where he is in the process. Then during the session, ask something like "and how do we take that to the next level at home when he meets that goal?" see what kind of answer you get (she should be quick w/ideas if she's really good!) and then as it winds down, say "okay so I want to write down my goals/activities for the week, so let me get my pen/paper" so she can know that you are looking for the "homework". If she's just been holding back, trying to get to know you guys, she'll explode w/information. If not, well...I'd say mom and dad need a more challenging therapist.