Why FOCUS Asks Parents to Stay in the Waiting Room During Evals, Sessions
FOCUS Therapy in Fort Myers conducts a range of in-depth evaluations for children who have been referred for speech, occupational, physical, or ABA therapies as well as ADOS testing. During our evaluations and therapy sessions, we rarely allow families to directly participate – but we have evidence-based reasons for our position.
During evaluations, we want to ensure every child receives an assessment that is as accurate as possible because that is what is going to allow us to:
- Determine whether the child needs therapy.
- Calculate the frequency/level of therapy that might be recommended.
- Make a strong case to the relevant insurer(s) about the medical necessity of the therapy.
Parents, when present in the room during FOCUS evaluations, can unwittingly stand in the way of those goals. Why? Mainly because children rely on their caregivers when things get tough – to help them, to comfort them, to make it better. When a child is struggling in a certain area, such as communication or independence with self-care skills, our clinicians need to independently observe the particulars.
Parent input is a key aspect of our evaluations, but we need to see for ourselves, too. Jennifer Voltz-Ronco, MS-CCC/SLP and FOCUS Therapy Owner/Founder, explained that when a child is accompanied by a parent during the direct observation portion of the assessment, parents often interfere without intending to do so or even realizing it.
“For example, in speech evaluations, parents might talk to the child or give clues to help their child ‘get the right answer’,” Voltz-Ronco explained. “We might ask the child to point to an object out of an array of 3-4 items by saying, ‘Show me the cup.’ Standardized testing requires that we be very specific in how we present these items – and with the requirement that we wait. And while we wait, we’re looking to see how long it takes them to process the directive and what they do. Will they look at us to see if we’re looking at the object? Will they point to it or make a face if they’re unsure? They might associate a cup to mealtime and instead point to a cookie. If the child looks to our face to get a clue, that would indicate social awareness and joint attention – key pre-linguistic communication skills. If there is a delay in their response, there may be an auditory processing issue. If they grab the first thing in reach, they may have impulsivity issues. Watching a child while they’re thinking tells us so much. But parents in the room might think the evaluator presumes the child doesn’t know the answer, so they interject. They say to the child, ‘You know what a cup is, like the blue sippie cup you have at home.’ Unfortunately, what that does is give the child numerous opportunities to hear the word, ‘cup,’ and in many standardized tests, we aren’t allowed to repeat the word or give a description or synonym. So with that, we lose the opportunity to see what we needed to see, and must in turn score the response incorrectly – which impacts the overall results.”
She went on to explain that often the key responses FOCUS therapists are looking for aren’t necessarily what an untrained observer may presume.
What’s more, some children can become what we call “prompt dependent.” That means the child looks to the parent to prompt them (to take an action, answer a question, etc.) – even if they don’t necessarily need the prompt. Many of our team members are parents ourselves, so we wholeheartedly understand how difficult it is to wait for your child to “do it themselves.” It is actually instinctual to intervene when we see or sense our child needs help. But during these evaluations, this intervention – however slight – can actually prove more of a hindrance when what we’re seeking are accurate results.
We DO Want Parents Involved in Their Child’s Therapy Journey
Although it is important for parents to remain outside the room during evaluations, this does not mean we lack transparency or that we don’t want parents involved at all in the therapy process. In fact, we get the best results from therapy when parents are fully engaged!
But we discourage direct engagement during the evaluation process and therapy sessions because we want to ensure our findings are accurate and that your child gets the true level of support they need.
While we want parents to be involved in consultation, goal-setting, education, and carryover, we strongly advise parents against sitting in during therapy sessions for the following reasons:
- HIPAA privacy regulations. Our FOCUS Fort Myers clinics are designed for child-directed play therapy. Kids often want to “play” (i.e., have their therapy) among other kids in our group treatment areas. Having parents in these spaces can be a violation of other children’s medical privacy rights.
- Some parents seek advice during sessions. Reaching out for insight and consultation is not a bad thing. We are happy to do this with parents before and after – because we’re all on the same team, and we want to be on the same page! But our therapists must devote as much attention/energy as possible directly to the child during the session.
- The best therapy results stem from 1-1 treatment. Kids naturally retreat to caregivers when things get hard. When they’re 1-1 with their therapist, they’re much more willing to try new things. It also helps build trust between the child and their new, super-fun therapist!
Our promise to parents is that we will always reinforce with positive praise. We never push children to do things that are beyond their capabilities. This is more than merely a job to us. We care about these kids and want them to reach their goals – and to have FUN while they’re doing it!
All this said, there may be limited circumstances (typically when a child is under the age of 18 months) when a child will refuse to separate from a parent without a full-on meltdown. In those cases, we may have to improvise. However, if a child is willing to transition (which is more likely when parents encourage it), that’s preferable during evaluations.
Why is FOCUS Therapy Underscoring This Now?
Parent trust in our team is paramount to what we do. Our goal, like that of parents and caregivers, is to help each child grow into a happy, healthy, well-rounded, independent person who can do all the things others their same age can do. Empowering parents to give their kids the tools they need to be successful is key to that. One of those tools is helping children understand that brief times of separation are Ok.
Although we have had this policy for years, we underscore it now because we’ve seen a slight shift in the past year. Some kids are having a tougher time separating. Some parents are expressing greater reticence to allow independent assessment and evaluations. Our theory is this is traceable to the increased social isolation we all experienced during the pandemic. The impact on young children and families was felt more acutely for them than for others, as it occurred during critical stages of early childhood development.
In the past, when preschool children 18 months and older were dropped off for an assessment or therapy, there may have been some difficulty. But for the most part, caregivers reassured them they were safe and it was Ok – and the kids quickly moved on. They learned being here and “playing” is actually a lot of fun – something to look forward to! (It’s exactly the same with daycare, staying overnight with grandparents, a new babysitter, etc.) Learning to self-regulate through that initial separation is an important social-emotional development for children – a healthy one that helps them build confidence, gain independence, and allows them to try new things – even when they seem tough at first. But when daycares closed and babysitters stopped coming around and grandparents were social-distancing, lots of kids missed out on this key developmental skill.
It’s been our experience that when parents display confidence and trust in our team, the kids pick up on that and separations tend to go more smoothly – even if it takes some time at first. If parents are not ready yet for a 1-1 model of therapy for their child, they might want to first explore Early Steps, which is specifically available to Florida kids under 3. The Early Steps model involves working alongside parents to coach them, helping kids develop age-appropriate skills. (Many of our patients receive both Early Steps services as well as private therapy.) After a child turns 3, there is the federally-funded FDLRS program, which is where kids continue receiving early intervention services, but in a school setting. It should be noted that parents are not allowed to sit in on FDLRS sessions either, as the expectation is that kids will be able to separate from their caregiver by the age of 3.
We know that there are understandably some additional challenges on this front that families weren’t faced with even a few years ago. Our team is committed to helping each child/family work through whatever obstacles must be overcome for kids to reach their maximum potential. Our hope is parents see that as well, and continue working with us to help create a therapy environment where every child can thrive!
If you have additional questions, our FOCUS Therapy team is happy to provide whatever insight we can.
Contact us online or by calling (239) 313-5049. FOCUS Therapy offers evaluations and services related to pediatric speech therapy, occupational therapy, physical therapy, ABA therapy, and ADOS testing in Fort Myers and throughout Southwest Florida.
Florida Early Steps Program – Video Explainer – Florida Department of Health
More Blog Entries:
How ABA Therapy Can Help Fort Myers Kids, Dec. 27, 2021, Fort Myers Pediatric Therapy Clinic Blog