Face to Face

Facilitated play:

• Multischeme steps (e.g., feeding baby, bathing baby, putting baby down for a nap )
• Temporal sequences (e.g., prepare food, eat food, clean up).
• Role play (e.g., chef and customer)
• Problem solving (e.g., repair flat tire on bus or broken railroad)

Discrete language games:

• Selecting/naming objects
• Describing semantic features

At a Distance

Leo was receiving direct therapy in the form Enhanced Milieu Teaching in play. It was determined that a home program paired with parent coaching would be the most appropriate at this time.

• Suggested home program with ideas for target areas and activities, delivered 1x week via email
• Weekly Zoom meeting with parent to discuss home program, success during the week, challenges, opportunities, and strategies
• Discussion of resources for ideas and activities (The Hanen Centre, Play Dough Recipe)

Face to Face

• Play kitchen
• Baby, bath, bassinet, bottle, blanket
• Puzzles
• Rice bin
• Barn + animals
• Books
• Playdough
• Veterinarian set
• Vehicles

At a Distance

• Weekly home program guide
• Toys and items already at home (Dolls, stuffed animals, Pretend food, play kitchen, utensils, Pretend grocery store, Vehicles & cardboard box to make roads, Books, Outdoor objects (bugs, rocks, leaves))
• Items and expectations within established routines (Mealtime, Bedtime, Getting dressed, Expressing choices/making requests)

Face to Face

• Recast and expand of utterances during play
• Cue/model student to use complete utterances for requests and turn taking
• Model play sequences and prompt for language (e.g., “We made a pizza! What should we do next?”)
• Prompt plural -s in the context of play (e.g., Here is one car. Here are two ____.”)
• Prompt basic spatial terms (e.g., The sheep is going in the barn. Where is the sheep going?)

At a Distance

• Specific examples and activities outlined in home program
• Coaching/demonstration over Zoom on how to utilize current interests to target goals
• Troubleshooting challenging moments that were ineffective
• Parent is encouraged to record play with child and share with clinician for feedback on strategies and techniques to support language and play

We have found that a coaching model has been effective for shaping routine activities at home to be more language focused and there is a shared enthusiasm between the clinician and parent to expand concepts previously learned in the therapy room to a more naturalistic environment. The renewed sense of connectedness with the parents has helped the clinician to think of new ways to capitalize on high interest activities in the child’s everyday life.

I was surprised by the volume of ideas generated between the clinician and parent in one session. To help narrow the focus each week, the student clinician and supervisor identified priorities from the weekly parent session and used these ideas to generate the next guide.

It is more challenging to track progress as it relates to the client’s use and understanding of language. We plan to develop methods to collect information from the parent as part of the home program. We anticipate this to be a simple weekly prompt for the parent to write down examples of utterances during play and routine activities.

There are opportunities to support and guide families when direct teletherapy is not the best option. Home programs paired with parent coaching have been successful in cases where a child may not attend to screen and more naturalistic environments are a preferred choice for targeting goals.