Typically, the school-based therapist will not be starting with a blank slate when looking to start work with a school-based program. “You walk into a building where a program is in place; you are replacing someone or are an addition,” says Roseanne Clausen, CCC-SLP, manager for special projects in the school for the American Speech-Language-Hearing Association (ASHA).

If the therapist is joining an existing program as an addition, rather than a replacement, there are likely to be “kids with significant needs,” says Clausen. Otherwise, “you are inheriting a case load and perceptions of how people operate.” 

In order to handle these challenges effectively and make changes where appropriate, the therapist needs people, space and materials, Clausen says.

People

One of the therapist’s first jobs, Clausen says, is “building partnerships,” a task that is particularly important if the new therapist plans to make a break with the way the former therapist conducted business. “Administrators need to know how the program is organized and why,” she says. “If they viewed your predecessor as someone who worked in a small room with stacks of material, you will be out in the cold.”

Next, she recommends cementing an alliance with the custodian, who will be essential “to get things in and out of the room.” This is a critical job if the therapist is attempting to change the perception of the little room with the unobtrusive professional tucked away.

Therapists must also form relationships with the teacher. In the case of an SLP like Clausen, she says the therapist must be in the classroom to hear the teacher’s lessons and observe the students’ responses. Then, the therapists can make suggestions about scaling down vocabulary or otherwise helping students accommodate their learning needs.

Parents are another key constituency to have on the therapist’s team. “They need to know what we do so they can do reinforcement at home, or it will delay [the child’s] progress,” Clausen says.

Finally, the student is the most important person with whom to form a relationship. “They need to see you with a partner, especially with adolescents,” says Clausen. The student is much more likely to confide in a partner about daily struggles, such as difficulty understanding the slang their friends use. These admissions help the therapist to determine what needs to be learned to be successful, says Clausen.

Space

“We have a notorious history of the broom closet,” says Clausen of outdated perceptions of therapists, especially SLPs, as the professional sitting unobtrusively in a small room. This perception of the therapist as “Lone Ranger” is not just a result of the beliefs of others, says Clausen. “We own part of that.”

“Now, we are very available,” Clausen says. As part of their work in reaching out to form relationships with others in the school, the therapist is spending increasing amounts of time in the classroom, the gymnasium and on the playground. Not only does this make the therapist much more visible, it also helps to ward off the claustrophobia that can come if the therapist’s designated space is decidedly closet-like.

Materials

Finally, Clausen says that the therapist must have the requisite materials in order to deal with students effectively. Although this toolkit may vary slightly from therapy profession to therapy profession, she had some specific suggestions from her experience as an SLP.

First, basic tools like computers “allow us to do our job more efficiently.” Along with this, a full set of classroom materials that the students may encounter in their studies, including textbooks, will help the therapist support the classroom mission and see where the student is experiencing breakdowns.

Finally, toys and games – Clausen is a fan of using puppetry – will help the therapist work with students individually and can also open the door to activities that can be done in the classroom with the entire class.   

Focus on Individuals and Families

Kim Dennis, MD, is associate medical director at Timberline Knolls, a Chicago-area residential treatment center for young women, ages 12 and older, suffering from eating disorders, substance abuse, dual-diagnosis and other emotional disorders. Her work demonstrates the need to balance the needs of individuals with the power of the group.

“I’m adamant about having individual treatment plans, [because] everyone’s genes and bodies are different,” she says. With individual physical make-ups, each person will respond to treatment differently. But it is not just genetics that are highly individual.

Dennis conducts “a very thorough initial assessment” of all of her patients, including family history, what has been tried before, what the child feels has been successful and what the family thinks has worked. She also asks probing questions about the parents’ behavior and the child’s home life.

“It is not uncommon for unmanageability in adolescents to mirror problems in the marriage,” she says as an example. Other problems at home that can impact the child include use of medications by the parent or use of alcohol or uncontrolled substances. “We find out about these things because we ask. It may not be seen by the family as relevant, but it is,” Dennis says.

The Power of the Group

Not only does Dennis see the value in individual therapy, she also believes group therapy plays a valuable role in “normalizing and reducing stigma” that her patients may feel about their disorders, their need for medications or their participation in therapy. The value, she says, is in “a connection with something larger than oneself, particularly when the problem is something that isolates the kid.” This is especially true when the patients can see where their peers have emerged successful from the process. “It is nice to have others with experience, strength and hope,” she says.

For therapists in all disciplines and contexts who deal with this young population, Dennis recommends plugging into the culture and relaxing. “Definitely learn something about popular culture; read Star magazine,” she says. She particularly enjoys seeing herself reflected in the youth she works with, and she recommends this as one of the best benefits for therapists. “Be willing to have fun,” she says.

    – Jennifer Patterson Lorenzetti is an Ohio-based freelance technology writer and the owner of Hilltop Communications. Questions and comments can be directed to editorial@therapytimes.com.