Review of the Mobile Therapy Room in Winter

So far, this winter hasn’t brought any major extremes of weather (except excessive rain!!) but we have had a couple of cold snaps that have let me evaluate the performance of the mobile therapy room in winter conditions. Overall, I have been pleased with it and have found working inside to be comfortable and easy.

The cuddly slug draft excluder in actionI have certainly appreciated all the efforts we put in to insulation! The Celotex insulation board and bales of wool that are stuffed into all available spaces behind the panels mean that the van heats up quickly and stays warm with the odd top-up from the heater. The one problem I did find was that there is a tiny air gap between the back doors where the back step which was creating quite a nasty cold draft. That was easily solved with the addition of a cuddly slug-shaped draft excluder and the cunning use of a household sponge to well and truly plug the gap!

The Eberspacher heater that is fitted in the mobile therapy room has done a great job of keeping us all cosy on even the coldest days. I went for the D4 model which is quite a big heater. The reason I went for the D4 was that I wanted to be able to heat the workspace in the mobile therapy room quickly. On the coldest day I have had so far, the thermostat in the therapy area was reading a chilly -9C when I switched the heater on. Thankfully, within 15 minutes, it was up to a very pleasant +18C. Mission accomplished!

The mobile therapy room with the LED lights on in the dark.Lighting is a big consideration when you are working in Scotland through the depths of winter. Through December, it gets dark as early as 3-3.30pm on the dreichest (that’s grey and miserable for the non-Scots out there!) days. The mobile therapy room is fitted with 9 soft LED ceiling lights and I have found that these provide a gentle but bright light for working when it is dark outside. Because they are LEDs they don’t flicker or hum like fluorescent strip lights which was a key reason why I chose them. I’ve also found it handy to have LED strip lighting round the step recesses as that makes it easier to see where the step is in the dark.

In terms of winter safety features, my high visibility vests have proven a big hit. I think getting them on for heading out to the van just adds to the whole adventure! I have an adult sized one plus two paediatric sizes so that no-one is left out. So far, I haven’t needed to use my Snow Socks but it gives me great peace of mind to know they are there. Snow Socks are canvas wheel covers that are easier to put on than snow chains and give you extra grip when you need it in snowy conditions. I’ve used them on my car before and they’re remarkably effective.

One of the biggest challenges I’ve had over the winter has been keeping the mobile therapy room clean inside and out when the weather is wet and grotty. The way forward so far has been to remove shoes if necessary when we go in and to make sure I give it a clean each week which I do anyway.

So all in all, I can conclusively say that the mobile therapy room has consistently given me and my clients a safe, warm and comfortable working environment through the worst of the Scottish winter! Mission accomplished :-)

 

What goes into a speech therapy session?

As with so many things in life, the key to a really good speech therapy session is good planning and preparation so I thought I would write a post about how I plan and prepare for each session that I do.

The first thing any speech therapist will do when they see a child for the first time is assess them to figure out what the underlying difficulty is.  Assessments come in the form of standardised assessment and informal assessment. A standardised assessment is a published ‘test’ which compares a child to other children of the same age using standarised scores. Informal assessment is used either where a standardised test does not exist or will not work well for the client in question. It takes the form of activities planned by the speech therapist to elicit certain language structures or simply consists of observation of the child during play or other day to day activities. Once the initial assessment is done,  I will analyse the results and use these to guide what we will work on in subsequent therapy sessions.

Next, I come to the planning stages when I decide on our overall targets to work on over the block of sessions as well as what to work on in each individual session.  This is always based on the assessment of the specific difficulty in question and my first aim is to form a rough ‘road map’ for a block of therapy sessions.  At this initial planning stage you never know how quickly a child will pick up on different topics or strategies. Having a  good understanding of the underlying problem and a clear idea of which areas to work on and in what order it makes it easy to move on as needed to keep the client engaged.

Simple speech therapy S game

A simple speech therapy game working on S

Once I have my over all therapy road map I move onto the planning of individual sessions and this is where I use all my skills and experience as a speech therapist to tailor each activity to the specific needs of the child. Even though I may sometimes see children with exactly the same speech difficulty and consequently quite similar therapy road maps, each individual requires quite different activities as their personalities, interests and ages may be quite different.  For example, one child may work well with a board game where another would work much better with an interactive game like crocodile dentist.

In all sessions, making it relevant, fun, enjoyable and interesting is the most important challenge. This often involves making materials of some sort and modifying the rules of toys, games  and activities so that they are relevant to the session. It is important to make sure that the difficulty of the game and the rewards of the game are tailored for each different client so that they stay engaged with the task, finding it neither too easy or too hard. I know I’ve got it right if they are looking forward to the next session!  For older children toys and games are often less suitable and this is where the interests and hobbies of the child or young adult are used to guide activities.

After the planning and making materials, the next thing I do is assemble all the materials into different boxes for each therapy session.  These fit neatly into my speech therapy cupboard so that I have all I need for the day whilst I am out and about in East Lothian and Edinburgh. In each of the boxes I always have to pack a back up plan just in case a session isn’t going as planned and I need to make the activity easier or harder to keep a child engaged.

Just before each session I also have to think about the work environment in the mobile therapy room.  Sometimes it needs to be very interactive, making full use of Velcro and magnets and sometimes it needs to be quite plain if a child is easily over stimulated or has a lack of focus.  The layout of the therapy room is important to make sure that you get the most out of the session.  Sometimes this involves working on the floor and sometimes working at tables. In addition I have to remember the obvious but easily forgotten things like making sure that the therapy room is warm enough and light enough for a good therapy session.

Once it gets to the actual session, hopefully everything will go like clock work and look to a casual observer like little more than structured play or an informal conversation. The more relaxed and natural the interaction in the session, the better as it gives me the best insight into the problem, what is being taken in and what needs to be done to move forwards.  It is really important for me to stay relaxed and playful on the outside but really focus my mind on observing the child so that I can pick up on all the subtle non verbal clues that give insight into the progress that is being made.  It’s always important to remember that sometimes activities do not work as well as you had hoped and if this happens there really is no point in flogging a dead horse! At this stage the most important thing is observation, thinking on your feet and reflection afterwards to see if there is anything else you can do differently next time.

Once the speech therapy session is over, it is essential for me to write up my notes promptly. My notes detail my observations (subjective as well as objective) from the session and are a continuous informal assessment.  The observations I make of the child’s response to the activities in the session are then used to guide the planning of the next session. My observations allow me to provide guidance and activities for parents to use at home and to other professionals such as teachers, other therapists or nursery staff.  Working outside of the session is the most important part of any child’s speech therapy support as this is where practise and the the generalisation of skills happens! After all, you wouldn’t expect to become a guitar virtuoso if you only practised for thirty minutes or an hour each week with your teacher!

Mobile Speech Therapy in Scotland.

When I got back from holiday in the North of Scotland I was surprised and pleased to see that I had a nice email from an overseas speech therapist asking about the mobile speech therapy room with a view doing something similar.  As a few people have asked about the mobile therapy room in the past, I thought it was a good excuse to put up a post about the speech therapy room and some of the practical thinking behind it. So here we go!

The mobile therapy room is a great environment for therapists and for clients alike. I felt it was really important to get the look and feel of the therapy room’s interior right.  It was extremely important to me that the room felt like a friendly therapy work space rather than a camper van or a dingy office. It had to be comfortable, easy to work in as well as safe and suitable for clients. A lot of thinking and planning had to be done by my husband (Van Conversion Department!!) and I to make sure that we achieved what I was after.

360 degree view inside the Mobile Speech Therapy Room – left click and drag to rotate the image.

The advantages of a mobile therapy room for therapists and clients.

For speech therapists, a mobile therapy room like mine is great as you have complete control over the therapy environment (not that I’m a control freak!). You can easily make the environment more or less stimulating to the senses depending on your client. This is really important with some children who are easily distracted or those who have sensory processing issues.  To this end, I made the walls in the therapy room Velcro friendly which is great for all sorts of activities including using symbols for communication, visual timetables and interactive use of visual supports. A fortunate extra that we didn’t think of in the first instance is that you get various metal walls in a van and, as you can now get printable magnetic sheets, you have additional options for displays and communication boards.

As well as having a very controllable therapy room, you have the advantage of being far less reliant on a school or nursery to find you a suitable work space when you visit. In my years working in the state sector, I have worked in some pretty bizarre corners of schools and nurseries. Many educational establishments are pushed for space and as an occasional (and sometimes frequent!!) visitor a speech & language therapist is bottom of the dibs list for a quiet room. Unfortunate as many of our clients have great problems paying attention, discriminating sounds and filtering sensory information in the best of circumstances! Certainly working in cupboards, corridors and cloak rooms is not helpful. When starting a private therapy business I wanted to make it as easy as possible to visit children in schools or nurseries to give the most thorough and appropriate therapy to a child. Having a mobile therapy room has really helped as I am less of a spatial inconvenience to a school (as long as there is a little space to squeeze into the car park!) and the extra help and support I can offer is often much better appreciated with the practicalities of accommodation dealt with.

For clients, there are numerous advantages of a mobile therapy room whether I’m seeing them at school, nursery or at home.  As described above, having my own workspace makes it much easier for me as an independent therapist to visit a child at school or nursery which can be more productive for some children as well as being more convenient for some parents. At clients’ homes, the mobile therapy room is useful because it provides a separate work area away from siblings, TVs, toys or other distractions.  I have to say as well that the mobile therapy room has been a huge hit with many of the children I see! For many of my younger clients, getting into it is a bit of an adventure and I find that this helps to put them into a good frame of mind for learning. 

Considerations about making a mobile speech therapy room.

If you are a therapist thinking of doing anything similar I have outlined below what I think are a few important considerations to bear in mind.

Access

Access to the mobile therapy room is something you have to consider with regard to your client group, parking and safe access. I opted for sliding doors on both sides of the vehicle as well as rear doors and a parking camera (helps to watch out for pedestrians when reversing).  The configuration I have opted for allows me to park close to a wall and still safely and easily get into or out of the van. This proves extremely useful in some school car parks which can be very tight for space. It also ensures that you always have access to the van from the pavement which I felt was really important when working with children.  Bear in mind that vans are generally designed with adults and deliveries in mind and the steps are therefore quite high.  I use an additional plastic step for small children so they can easily get into the van. You should also note that the position of the doors will affect how you lay out your room. To make the best use of the space in mine, I made covers for the side step wells so that I get full use of the floor space when the side doors are shut.

Planning and Van layout

The mobile speech therapy room on deliveryA new empty van can seem huge but it doesn’t take much to start filling it up! Space inside the therapy room is obviously essential and you need to think carefully about minimising wasted space without making the room seem cluttered or ending up with a huge van.  You also have to make sure it’s safe when you’re driving between appointments while ensuring that it’s quick and easy to set up and pack away your resources. I also decided that being able to stand up normally in the therapy room was important from a space point of view and also out of respect for my poor, abused back! Choosing quite a large vehicle meant that I have the space to work with a range of clients easily and that there is adequate room for parents or carers to join the sessions. With my empty van ready for action, It was time to make use of the living room floor and lots of paper to try out various layouts. Despite our best planning efforts, a lot of evolution took place as we built the van interior with various ideas changing as we went along. Internal boxes for each therapy sessionIn the end, we only made one cupboard to store equipment for each day. Inside it has space for up to 8 plastic Ikea boxes into which I can pack the materials for each of the sessions I have planned for the day.  There is also spare space for a few bigger items so that you can keep any distractions out of sight.  It was only late in the building process that a friend’s 11 year old son suggested sliding doors on the cupboard. My husband and I looked at each other with a look of “why didn’t we think of that?!”.  Sometimes the best ideas come from the most innocent minds! The sliding doors a great space saver, they don’t open when you are driving and they help keep the room neat.  The top of the cupboard makes a nice workspace that is ideal if you want to stand up to write up notes (being kind to your back again!). The work tables are mounted up against the bulkhead on adjustable height racks and can be set up as one table, no tables or 2 tables at any height.  This is great as it is really easy to configure the layout for all age ranges as you can see in the photos. The bulkhead is a really worthwhile feature as it separates out the cab area of the van from the therapy area which really clarifies the environment for both me and my clients.  It also provides an extra space for parents to sit and observe a session from if they so wish.

Easy to make the mobile therapy room safe to drive

Strap the chairs down, make sure the cupboard doors are closed and the mobile therapy room is made safe to drive.

Electrics and power.

Easy to work in the dark in the vanMy husband and I spent a long time thinking about how best to do the electrics in the therapy room.  We thought the room had to be well lit, warm, easy to clean inside and not cause the van’s battery to go flat. To that end we went with 2 leisure batteries, a 240V inverter, 12V LED lighting and 12V power for the heater fan. If you’re building something similar, you’ll need to consider what you want to power, which appliance will use the most power and what your maximum current draw will be.  We felt that the lighting would be the most used electric item in the van in the winter (the heater’s very efficient!) and we wanted to minimise the amount of power this used.  By staying at 12V for the lighting and using warm LED’s we minimised how much power we used from the battery. The LED lights also do not flicke rand hum in the way that fluorescent tubes do so are less distracting for clients with sensory processing difficulties. For the inverter, we thought it was worth going for something powerful enough to provide enough current for a hoover, small kettle or perhaps a microwave. Although I have not needed these yet, It’s definitely worth planning for various eventualities.  A word of caution about the inverter though – we have learned that it is worth getting a pure sine wave inverter with a good amperage. Whilst this is an extra expense over a quasi sine wave or square wave inverter, it will be fully compatible with everything you may want to run.  I’m going to have to replace our inverter as I’ve found that I can’t run a variable speed fan from it (just as well we’ve had rubbish weather this summer!) and I’m sure there will be other devices that will have problems too.

Lighting

Skylights in the mobile therapy room

Skylights in the mobile therapy room

Having spent too long working in rooms with no or very small windows, I wanted as much natural light as possible in the mobile therapy room.  In addition to the side windows, I went for windows in the rear doors and 2 large roof skylights for natural lighting. This makes for a really light and airy feel inside the mobile therapy room. For the dark winter period, we installed 11 warm LED spot lights in the roof and which make the van a good work environment even if it’s dark outside.  We also added some door lighting strips along the side steps but, I have to confess, that was mainly because we liked the sticky backed LED strips you can buy! Looks good though!

Insulation & Heating

Insulating the walls in the mobile speech therapy roomIt’s really important to think about your local environment and climate when it comes to insulation & heating. You will need the ability to both heat and cool your van. We made sure we insulated the therapy room really well with a combination of Celotex and insulating lambs wool. The Celotex worked well on the floor and behind the large wall panels with wool stuffed into any gaps. For the roof, a thick layer of wool was the way forward. All this insulation helps keep things warm in the winter and cool in the summer but, as you can imagine, this alone is not enough to cope with a Scottish winter. For a bit of extra heat, I have a very efficient Eberspacher heater. These heaters use diesel from your fuel tank but are much more efficient than having the van engine turned on and using the van’s in built heating.  The Eberspacher is a heater designed for boats, buses and camper vans and comes in a variety of powers to suit whatever needs you have. I went for a reasonably powerful one so that I could heat the room up quickly if necessary. It certainly works, last winter it got the therapy room from a decidedly chilly -9C inside to a pleasant 18C in the space of 15 minutes. The main unit is fitted between the seats in the cab of the van with just the output vent opening into the back. In terms of noise, it’s pretty quiet with a little bit of clicking when it starts up then just the noise of the airflow. It is thermostat controlled so it will automatically switch itself on and off to reach the temperature you have set it to.

One additional advantage of the good insulation is it keeps the van nice and quiet inside regardless of the weather conditions outside.  Cooling has not been an issue so far (see Scottish weather for explanation!!) but I have made sun/privacy shades for the summer months and they certainly help to keep the temperature down when the sun is out. For a bit of airflow, I can open the windows in the back of the van and I have a tower fan to increase the airflow if needed.

Ergonomics

Like many SLTs and teachers, I have had time off work in the past with a bad back. It was therefore really important to me to make the mobile therapy room back-friendly. To that end I have a nice comfy seat with lumbar support for driving, the tables are adjustable, I have comfortable lightweight chairs and a kneeling stool for working at a low table or on the floor. We had a look at folding chairs from a space perspective but it was clear that the only way to go for me was standard upright chairs but these have a handy place to live in the corner of the speech therapy room and give somewhere for a parent to sit. For working at a low table or on the floor, I use a kneeling stool which is both incredibly comfortable and nice and compact making it easy to store. For small children I managed to get hold of a single classroom chair – not easy, be warned they’ll want to sell you 30 or charge you £50 delivery for one! I had to go a bit ‘zen’ to find a good kneeling stool as they’re surprisingly difficult to find. Mine is actually a Buddhist prayer stool made by a company called Blue Banyan.

 

 

 

Economics

So is it financially worth it? This is a really tough question to answer, however bear in mind that there is no point in going into speech therapy if you want to get rich! In my mind I have planned the mobile therapy room to have a 10 year life span but it has meant quite a lot of upfront cash costs as I couldn’t find a second hand vehicle that suited my needs.  Getting a new vehicle meant adding lots of extras from the factory options list as well as the additional extras kitting the van out once it arrived.  If you are starting a new business then it is definitely quite high risk to do something like this without an established client base. Having said that, the therapy room is quite an asset and can be used as a good selling point for your business. If you have an established business or larger speech therapy practice, then (depending on your geographical area) I think something like this could be a really useful and welcome addition to your service.  In the long term I think the mobile therapy room will pay for itself by helping Blethers to provide a service that well suits its clients but, as this is still early days, I can’t say for sure.  You definitely have to plan your days and sessions efficiently so you are not spending too much time driving around while still fulfilling the needs of your clients. There will almost always be a mixture of some clients who take more time to visit and some who are just around the corner.

You should also consider some of the other, harder to measure economic upsides though. The mobile therapy room makes for a really nice place to do your paperwork where you won’t get disturbed and I have had lovely peaceful sessions overlooking the bridges in the Firth of Forth and writing up notes watching the waves at Dunbar or the gannets at Bass Rock.  This is far more pleasant than any classroom or speech therapy office and it’s something you really can’t put a price on.

If you would like to know more any more specific information about the speech therapy room please feel free to contact me.

Is The Mobile Therapy Room Cool in Summer?

I use a mixture of strategies to keep the temperature cool and comfortable inside the mobile therapy room when it’s sunny. The side windows open to allow fresh air to circulate and I have an electric fan to help airflow. I also use the sunshades to reduce the amount of sunlight coming in and warming the air too much. I conducted a wee experiment over 2 sunny days and found that the sunshades alone take 10 degrees off the average temperature inside the mobile therapy room when it’s in full sun.

Even on the sunniest days, I find that this combination of strategies maintains a pleasant working temperature (high teens – low 20s) inside the mobile therapy room. Indeed it’s significantly cooler than some classrooms I’ve worked in!

The sun shades in action inside Edinburgh & Lothian's mobile therapy room

Can you see my child at school?

Yes I can, provided the school are happy for me to visit. The Mobile Therapy Room makes school visits very easy as there is no need for the school to find a room for me to work in. If you would like me to see your child in school without you being present, I will make sure that we arrange for me to give you feedback on how the session went and what you can do to help your child at home. We can do that however suits you best whether that’s by phone, email or in person.

Do you work with adults?

Yes I do work with adults, but only those who have developmental communication difficulties. I do not work with adults who have had strokes or head injuries or who stammer. Like autism and complex needs, these are highly specialist areas of speech & language therapy. You will find therapists with experience and training in these areas on the ASLTIP website.

Why do you need to contact my child’s NHS therapist?

Before we start working together, I will ask for your permission to contact any other speech & language therapist that your child sees. Apart from being simple good practice, contacting other SLTs involved with a child is necessary for a number of reasons. Your child will gain a lot more from their speech & language therapy support if the therapists they see work together. A close working relationship avoids unnecessary repetition and allows (with your permission) information to be shared so that the most effective care plan for your child can be agreed.

It is also necessary from the point of view of assessment. Speech and language therapists often use standardised assessments to compare a child’s skills to the normal range of ability for their age group. These assessments and their results become invalid if they are repeated too often so it is important to know what has been done already and for me to let your child’s other therapist know what I have done.

Does the mobile therapy room stay warm in winter?

Indeed it does! Staying warm in winter and cool in summer was a huge consideration while building the Mobile Therapy Room.  I spent a lot of time with my husband reading about camper van conversions, boat conversions and caravans to find the best insulation solution. In the end, we went for a combination of celotex insulation sheets and lambs wool behind all the wall and roof panels. As well as keeping the inside temperature fairly consistent, the insulation also provides sound proofing.

The therapy area is heated when necessary with an Eberspacher heater. The Eberspacher is a dedicated diesel powered heater that is used on small to medium sized sailing boats and in some camper vans. It is extremely efficient and, I discovered over the winter, can get the temperature from a decidedly chilly -8C to a more pleasant 20C within about 10 minutes.