I was asked recently about how to make activities easier or harder for clients. When you’re training to be an SLT or indeed working as a newly qualified SLT, this can be one of the hardest parts of the job as you often have to make adjustments on the spot. With experience this gets easier but even the most seasoned SLT will have moments where they realise a re-think is required. The bottom line is, there is no magic list of incremental steps, knowing how to step therapy activities up and down is the very essence of the specialist skills that we learn when we become SLTs. That’s what all that theory is for and one of the reasons why “Speech & Language Therapist” is a protected professional title! Having said that, understanding a few key points is helpful when doing your planning especially while you are training or in your probationary year.
Before we continue…
First and foremost, 2 important things to remember are:
- If a task is clearly way too hard for a child, you can just stop doing it! Better to stop and do something easier than to continue with something that sends a message of failure. If you have no easier therapy task, there is nothing wrong with just playing a game together to regain the child’s trust and build rapport.
- There is absolutely nothing wrong with throwing an easy task into a therapy session. It gives the child experience of success and helps them feel comfortable. So if you do find yourself with too easy a task and no way to step it up, don’t panic!
The importance of thorough and ongoing assessment
To my mind, the most important part of being able to step activities up or down for a client is to have a very clear understanding of what their individual strengths and weaknesses are. That is why doing a detailed and comprehensive assessment is always my first port of call with any client. If that takes 2 or 3 or even 4 sessions, then so be it! Therapy will always be more effective when it is based on a clear set of assessment findings.
Of course, no assessment is foolproof and an assessment only gives you a snapshot of the child’s skills on a particular day. With that in mind, constant observation of the child during therapy sessions is also essential. Their strengths and weaknesses may vary depending on external factors like the amount of sleep they had last night, the time of day, whether they’re coming down with something, perhaps they’re excited about an upcoming event and so forth. You may find that they may learn the new skill you are teaching either more quickly or slowly than you anticipated and you need to account for this too.
Obviously it best practice to plan your therapy ahead but I would advise against over-planning. By ‘over-planning’, I mean doing something like sitting down and writing a detailed plan of exactly what you are going to do in each session of a 6 week block. By all means, have an overall outline plan for the 6 weeks based on your assessment and therapy aims but I’d advise adding specifics into your individual session plans no more than one or maybe 2 sessions ahead. That means that you have your overall ‘map’ of what you are doing in the block to keep your therapy focused but you have the flexibility to alter your weekly plans session to session based on the child’s performance each time. Here’s an example of a plan that I have actually used from the start of a 6-week block.
Something I have not shown here is how to step up or down these activities. That’s because I know this child really well and have various tricks up my sleeve based on my previous experience as an SLT and with this child in particular. And here’s the rub! As I said at the start, I cannot give a definitive list of what to do to make things easier or harder for clients because that list will be different and individual for each child. However, I can share the key things I take into consideration when planning and working out how to step activities up or down. These are:
- What CAN the child do? Are there stronger areas of their language/speech processing that we can use to support weaker areas?
- What is the child likely to find more difficult but still achievable?
- What scaffolds can I use to support learning of more difficult skills? (Modelling, visual supports, signing and so on) How will I fade out the use of these scaffolds?
- What things are going to be outside of the child’s current skill set developmentally?
- What things are going to be outside of the child’s skill set based on their disorder?
- Given each activity I have planned for the next session, how can I make each activity one step easier or harder based on what I know of the child and the answers to questions 1-5?
Obviously keeping accurate notes of your sessions comes into its own here because you can then use the information you recorded to see how the child did, which supports worked and which supports you can try fading out next session.
I hope that this is helpful for those of you having trouble with stepping up and down. You are not alone! If you have questions about specific clients, do feel free to email me at firstname.lastname@example.org I will get back to you as soon as I can but do bear in mind it can take a couple of weeks!