Speech and Language Therapy in Natural Environments

     I have provided speech therapy for preschoolers in a variety of settings.  I have seen them in their pre-schools, in their homes and in clinic settings.  Of these settings, the clinic does not meet the criteria of natural environment. I no longer work in that setting with any child.  A natural environment is defined in IDEA Part C Regulations at 34 CFR Part 303 as: "To the maximum extent appropriate to the needs of the child, early intervention services must be provided in natural environments, including the home and community settings in which children without disabilities participate." (34 CFR 303.12 (b)). See the IDEA Regulations for Natural Environment for details.       All of my early intervention (birth-3 yrs) therapy sessions currently occur in the child's home.  The therapy in this setting allows the most opportunity for progress for several reasons.  In this setting I can include parents, siblings, friends and other caregivers in the sessions. I require at least one person to be an active participant during each session. I am not there to give the parents a break. I can provide support and models in the context of typical relationships and play.  I can adapt my plan to accomodate activities and routines to support full participation and learning. 
     As I tell parents, I am only in their home for a total of about 1 hour each week.  My job is not to provide therapy to the child to catch them up developmentally all by myself.  They will make minimal progress and may not catch up with only my effort one hour per week.  My job is to educate the family through explaining and modeling, so that they can provide the same quality speech and language stimulation techniques throughout the child's day when I am not there. I am a resource for them.  I am available to them for the hour each week to share my knowledge and help them provide the best interactions they can.  I have them be active participants in the sessions and demonstrate to me that they have an understanding of the techniques that I use.
     Another benefit to this natural environment setting is that I can help parents learn how to teach vocabulary that is relevant to their child.  We use toys and activities that are in the home. I teach basic signs to the parents as I teach them to the child. We use a variety of items in several ways to stimulate speech and language development. I provide ideas and activities for parents to use. I make suggestions to them of experiences to try to encorporate into their child's life. There are times that I bring some of my own materials although it is usually best to use what is in the home.  I will address this in my next post since this topic deserves its own space. 
     At the ages of 3-5, I feel it is still most beneficial to see the child in the home with parents present to provide consistency in the way cues and models  are presented to the child.  At this age, they are often working on speech sound development and correction as well as language skill development.  I see many children at this age in their preschool classrooms.  I see the most progress from these children if there is also parent and teacher involvement.  Since the teachers are with these children for large parts of their day, I am sure to share what I am doing with these day care providers as well as progress reports and home activities sent to parents. I provide homework for children working on speech sounds so that the parents learn to help remind them of their sounds.
     Parent involvement is necessary and crucial in order for children with delayed speech and language skills to make consistent and substantial progress in the shortest time possible. This can be most effectively accomplished through provision of therapy in natural environments.