Monday, September 5, 2011

Parts of a Whole

Here in Chesterfield County, they do things a little differently from what we're used to in terms of Early Intervention and therapies. I've talked about this just a bit before. There is more of a "transdisciplinary" approach, recognizing that areas of speech, motor development, and the like occur together, not separately. Obviously, I get this. When "just" a speech therapist comes, for example, it's not like the child doesn't engage in climbing or doing a puzzle. During PT, it's not like they don't talk. So there is clearly overlap and it's important that everyone recognizes that.

But as with medicine, there's a reason specialists exist. PCPs are great, but there are times when a more focused eye of expertise and knowledge is needed. You wouldn't have a family doc perform a GI surgery; you'd go to a GI. Specialists, because of their focus, have a certain perspective that a more generalized approach can't offer.

So I say if a child has speech needs, speech therapy is probably a good idea. If they have gross motor needs, PT is probably a good idea. Etc. This is the medical model put in a different domain, but that's how Bob and I have decided to look at things. Obviously there are downsides to this approach, but seeing that most of the world is *not* this compartmentalized and specific, I think it can be helpful.

Children's Hospital here is full with speech appointments until December! So we are starting the process of getting Dean evaluated for speech through the school system if we can't get it through EI. PT through EI is awesome. And we're working towards him starting preschool of *some* kind in... gulp ... January. My baby Dean. Most definitely not a baby anymore.

"Preschool" could look any one of a thousand ways at Dean's age and with his needs, so we'll see. But I think he's ready and he would love the opportunity to participate in school somehow. He's always so eager to join Cole at school (who starts again next week!) and sits right down on the individual mats at storytime at the Children's Museum. Looking for God to give us wisdom about how Dean and all of our boys will thrive at school. Love these kids.


horace said...

Hey Ali. I can see where you are going with this post and it may be that different approaches work with different kids. We finally weaned Olivia off her feeding tube with a developmental psychologist from Germany bc no one here does anything but behavioral feeding therapy (which was a disaster for our child) and we are at a place of thinking the whole system of PT, OT, once a week therapy blah blah is just so stupid - so limited and so our country's pathetic attempt at helping families. Our experience was finding one smart, out of the box dude from Germany who was willing to basically stay in our house for two weeks, believing our kid could eat and boom - she is eating mac and cheese and hot dogs. I don't know. I think the whole "therapy" system is so pathologizing and silly, but truly I get that our experience may be different. The people from EI were so well-intentioned, but just not very smart, nuanced or able to see the big picture in any significant way. And even our experience of outpatient feeding therapy only served to set Olivia back and make us all depressed. As a therapist, obviously I believe in therapy. I guess I don't believe in specialization. I am a huge believer in being a really good generalist, but its an interesting issue, so thought I would respond.

Ali Foley Shenk said...

YAY for eating!!!!! I'm so glad for you guys. :)

And I totally see what you're saying. What I should have said (and maybe I'll go back and edit to clarify) was that this is what we think is best for Dean. He thrived under the more specialist model because he does really well with being taught VERY specific skills and ideas. But I can absolutely, absolutely see how this would not be the case for everybody. I think for us it was exciting to figure out exactly *why* the more general perspective was not helpful for him.

No matter how you slice it, I'm so glad that you found someone for Olivia to help!! Thanks for sharing.

Barbara said...

My grandson Cody is now in Preschool for speech therapy (in Indiana). He is 3. Before that he had a speech therapist from the state through Early Intervention. He also sees a speech therapist through the doctor's office now. My daughter has done whatever it takes to get him the help that he needs. I'm sure you will do that too for Dean. I learned some things about speech therapy from the conference I went to about VCFS - that Oral Motor therapy does not work (just in case someone suggests it to you), because in all the studies it did not help the child to actually speak. Cody gets help with articulation, which is what he needs - right now everything sounds like 'mamamama' to the untrained ear (gramma's), and we only understand him based on context. I realize Dean has different issues, but I thought I would share what I know here. Hope all is well with you - I am starting my new job tomorrow. God Bless you all.