INITIAL CONSULTATION
At our first meeting, I evaluate your child in a setting created to assess and support his or her highest level of function. I observe your child’s strengths as well as vulnerabilities to determine the primary problem and to understand how they manage frustration and success. We always want to move from your child’s strengths to support their vulnerabilities. Parents are present and active during the entire session, ensuring observations are consistent their experiences outside the office.
A meeting is held at no additional charge with primary caregivers on the same day or evening or the next day to discuss findings and establish plan. Notes from the session are typically shared.
PARENT COACHING
Children between the ages of 0-5 years old work most easily within the context of his or her parents/primary caregivers. Treatment begins with the primary caregiver and the child, however I also coach babysitters, nannies and grandparents, aunts/uncles. This is an opportunity to deepen you and your child’s relationship for more complex play and learning. You will develop strategies that you can incorporate into your home environment.
Typically, notes are provided at the end of each session to review and reflect upon at home.
TEACHER TRAINING
Many schools contract with me to provide professional education and inservice seminars to teachers on teacher planning days. My inservice and consultative services support all domains of function within a classroom. This includes promoting socialization, executive function and play, necessary for the transition to upper grades. Sometimes children are referred for intervention because the activities within the classroom setting might not be developmentally appropriate, thus the child isn’t provided the just right support to function. Consultation with teacher can typically ameliorate this challenge.
ONLINE VIDEO COACHING
Once a child has been evaluated in-person within the office/playroom setting, parent coaching can be provided through online video call, when his or her family lives at a distance from our office. This is an excellent tool for families who live outside South Florida.
SCHOOL OBSERVATION/TEACHER CONSULTATION & TRAINING
It’s helpful to observe your child in their school setting to better understand how he or she functions in the classroom during both structured and unstructured activities (i.e. Centertime vs Playground). Through classroom observation, we can learn the concerns or observations of the teacher. We provide strategies to the teacher to support your child’s function at his or her highest level of classroom behavior.
TRAINING FOR THERAPISTS/CLINICIANS/
MEDICAL DOCTORS
Training is provided by Webinar or in person teaching/lecturing/discussion. Treatment videos are typically included during these learning sessions. The training I provide is presented in an integrated manner for all levels of learners from beginning to expert. I maintain a full practice and therefore my examples are relevant to daily practice. The information I teach is intended to be generalized to your session on the very next day. I fill out paperwork with goals, and assign appropriate readings and reference lists which are necessary for institutional CEUs.
FAQ’s
Q: Do you recommend treatment in an office or school setting?
A: Although it can be more convenient for children to be treated at school, the treatment plan is likely compromised because the occupational therapist doesn’t have all the necessary tools. They can only bring what fits in their bag, privacy is compromised, and ultimately, the school is not a therapeutic space. When working on concepts of affect regulation, frustration tolerance or mastery, a therapeutic office setting is necessary.
Q: I’m interesting in getting a second opinion on my child. Should I come see you?
A: There are times when your child has already been evaluated by an Occupational Therapist or another child specialist, but either the results were confusing, or progress was too difficult to measure. A second opinion can be helpful, and my goal is to be more comprehensive and clarify the primary challenges and/or diagnosis so that the treatment plan and goals can be re-prioritized. A parent meeting (after our initial session with your child) will give us the opportunity to review findings and clarify misunderstandings from previous opinion.
Q: I experienced challenges as a child but am now successful. Does that mean my child will also likely be successful without treatment?
A: The trajectory of development has shifted in our modern society. Children are in structured situations at a younger age and for more hours than in previous time. Technology has also had its effects on relationships, language, and thinking. There are less opportunities for movement within a given day. These changes are critical and compromise appropriate progression in development. Parent coaching is a method for you to become informed and more mindful of specific strategies that you can use with your children to support their development.
Q: What are the effects of COVID lockdowns on early childhood development?
A: There were diminished opportunities for exposure to a multitude of relationships and experiences for an extended period. This includes an emphasis on distancing ourselves from others. Thus, children had less experience with boundaries and managing boundaries. We had limited experience with people on the elevator as well as store clerks. There was the encouragement of Instacart rather than having children accompany you to experience the supermarket, CVS, and Target. This limited their exposure to others as well as to familiarize themselves with others as well as the process of waiting in line or understanding of how our community functions. The emphasis was on children keeping their distance from other children. Thus, they might have difficulties managing the intrusiveness from another peer or unfamiliar or familiar adult. The children are now too comfortable playing by themselves. This lends itself to a parallel play type of interaction with peers which is equivalent to 18 months of age. The interactions are intermittent at best and don’t allow for collaboration, building upon the ideas of others, social problem solving, and incidental language. This makes it critically important to ensure that everyone is well informed about developmental appropriateness and developmental expectations.
Q: How long does it take?
A: Intervention, regardless of format, can take anywhere from a single consultation to several years of twice weekly sessions. I like to reassess progress within six weeks of initiating intervention. At this point, we should all know that the intervention is effective, and you are comfortable with the treatment plan. We also make revisions that are necessary based upon what we have learned together. We might see progress but the child will likely regress if therapy is stopped at that time. It takes longer for new skills to become part of the child’s everyday behavioral repertoire.
When parents participate in our intervention, it is reassuring to see progress. Intervention can feel unnatural at first. When intervention produces progress for your child, you will develop trust in our therapeutic relationship and your own judgement.
Q: How long does my child receive treatment and what is the frequency?
A:Treatment is typically recommended on a twice per week basis, however it is ultimately based upon what the treatment plan indicates for the types of challenges your child exhibits. Intervention is a lot like going to the gym. Once a week is typically not enough because your body doesn’t remember what you learned. For children, their ability to remember and integrate the therapeutic experience requires more frequency. When parent coaching is involved, this is decided on a case-by-case situation. The sessions are 45 minutes. Intervention lasts as long as the treatment plan indicates which is decided by both you the parent and I within our working relationship. If something is feeling uncomfortable, it is important to communicate this to me.
When parents participate in our intervention, it is reassuring to see progress. Intervention can feel unnatural at first. When intervention produces progress for your child, you will develop trust in our therapeutic relationship and your own judgement.
Q: How is progress measured?
A: When addressing affect regulation, we look at: frequency, duration, and intensity. This is discussed in our parent meetings. Often, the first place that we will see improvement especially with preschoolers is in the school setting. When we see improvement in the clinical setting, then we know that this improvement is generalizable. Behavior is a solution to a problem. Therefore, since we are working on the underlying problems, we will likely see the behavior diminish. However, the underlying problems take time as it is a developmental process that evolves.