By Erin Naugle, M.A. CCC-SLP, Stefanie Peck, M.A. CCC-SLP; Jason Drusbacky, OTR/L, Deborah Finley, M.A. CCC-SLP, and Maria Kucmanic, OTR/L
At The Center for LifeSkills, we see children for individual treatment sessions, but sometimes a co-treat therapy session is indicated to help maximize the child’s progress toward their therapy goals.
But what does co-treatment mean?
Working together for more meaningful therapy
A co-treat therapy session is a session that is conducted by two or more therapists from different disciplines (e.g., speech-language and occupational therapy) to target similar goals. The therapists work together to create treatment activities that can target corresponding goals.
For example, two-year-old David has delayed speech and fine motor skills. He doesn’t say many words and has trouble getting and grasping simple toys. Together, his therapists would create a motivating activity to have David request “more blocks” using signs or words and then pick up or stack the blocks. This allows him to work on two goals simultaneously instead of just one within the same activity. David will get more opportunities to practice during the one therapy session. It might seem that during an hour-long session he is only getting 30 minutes of speech and 30 minutes of OT, but it doesn’t wind up working that way. In this example, David is actually practicing both therapies during the whole session, maximizing the time and also making the work more meaningful.
Another reason for a co-treat session is to help the child be organized and attentive for therapy. Research has shown that movement increases expressive output. In a co-treatment, a child might swing and receive vestibular input, which will help with communication. Or, the child can crawl through a long tunnel, providing input to the joints, and follow that with naming vocabulary words. The speech-language task becomes more effective because the child’s body is awake and aware.
Therapy sessions sometimes take place “back to back.” For example, Matthew would have an OT session to get his body “ready” to be able to focus and attend during speech. The OT would use the session to focus on sensory integration strategies to improve self-regulation so that Matthew is at an alertness level conducive to learning during his speech therapy session. Our therapists have often found that their clients are better able to focus and attend on difficult speech goals after they have had occupational therapy.
Case Study 1 – Gabby (*name changed)
Excited to begin her session, 3-year-old Gabby independently ran down the hall and into the treatment room. She patiently waited for therapists to join her and giggled as they opened the rice bin. She enjoyed digging, pouring rice on her feet and filling containers. She pulled farm animals out of the rice and for the first time she was able to repeat “sheep,” “dog,” and “moo,” and allowed the therapist to touch her lips to help produce the “m” sound.
Looking back to a year ago. Gabby began therapy services at 23 months of age. After an early diagnosis of autism, her parents sought out individual OT and SLP therapies. During individual evaluations, Gabby demonstrated difficulty attending to back-to-back sessions, transitioning between sessions, and tolerating the sensory demands of being in therapy for longer than 30 minutes. Gabby was unable to transition from waiting room to therapy gym without all lights dimmed and doors closed to prevent a meltdown. The therapists decided that a co-treat would be the environment that would be most beneficial for her to be successful in therapy.
As Gabby’s sessions progressed, she began to walk back to therapy without requiring doors closed and lights off. The therapy sessions initially lasted only 25-30 minutes to increase her tolerance. She displayed great difficulty transitioning in between each activity and was often unable to be redirected. Over the next few months, Gabby began to tolerate touch prompting due to the OT providing a variety of sensory input at the beginning of sessions. Her attention to preferred activities has improved to 5 or more minutes following movement time prior to beginning any tasks that require sitting.
Because of this increase in attention, she has shown significant improvement in fine motor skills, vocabulary, following directions, and sound production. These improvements were possible due to constant collaboration within the treatment sessions by both occupational and speech therapists. Gabby now demonstrates increased mastery of age appropriate skills.
Case Study 2 – Johnny (*name changed)
“Johnny just said a six-word sentence,” emailed his mom. The speech therapist is pleased to hear about Johnny’s progress. Five months ago, Johnny had a few words and had become very frustrated when his family did not understand his messages.
Johnny is a happy, busy, “on-the-go” 28-month-old boy. He loves to climb onto the back of the couch and jump off. He loves to run and crash into wall. This sweet little boy has no fear! Johnny was very excited when his speech therapy sessions began. He quickly became aware of sounds and his attempts to use speech increased.
After a month of therapy, the speech therapist began to see that Johnny was so busy “seeking” deep input into his body that he could not focus on learning speech and language. Mom agreed to an evaluation with an occupational therapist. The OT explained to Johnny’s mom that he would benefit from strategies and activities to assist him in visual processing and sensory regulation. Johnny’s parents jumped in quickly and created a space for him at home so that he could participate in the sensory activities completed in his weekly occupational therapy sessions. He loves his new ball pit, weighted blanket and mini trampoline.
As a result of intervention from OT, Johnny is focusing better in his speech sessions and making progress in both therapies.
Why co-treatment can lead to better outcomes
Collaboration between therapists is crucial to any child’s progress toward therapy goals, but sometimes, a co-treat session is even more powerful. Occasionally, families initially feel that their child is receiving less therapy, but in actuality, the higher intensity of a co-treat session pays off in progress much more quickly than therapies on two separate days. Of course, all children are different and progress at different rates, but a co-treat is one way that we at The Center for LifeSkills feel we can maximize a child’s rate of progress.