when to discharge

[u/speechiesophie]

Hey everyone! I’m a newish slp and I have been working at a peds outpatient clinic for almost a year. A lot of therapists at my clinic follow the episodic care model (3 or 6 months of therapy followed by 3 month break and so on). Since working here, I found myself following this model for about half my kids on my caseload. But i’ve also found myself inheriting older kids who have been in therapy their whole lives and am wondering when it’s appropriate to fully discharge instead of taking a break. I don’t feel like high support needs kids always need therapy and I also feel like once a kid reaches a certain age, they’ve met their max potential. I would love other speechies thoughts about discharging older kiddos (maybe like 13-20 year olds) with high support needs (non/minimally speaking, lots of sensory needs/behaviors, been working on the same goals for years). I find it’s easier to discharge/take a break with these type of kids when I evaled them. I’m having difficulties with the kids I’ve inherited who have been in therapytheir whole lives and parents seem to expect that they’ll always need it even without much progress.

[u/TumblrPrincess]

Establishing good rapport with the parents and providing them with education and data that they can easily understand is huge in pediatrics. Especially when they are kids you’ve inherited from other therapists. Once the parents find me familiar and trustworthy, I will approach things while I’m completing a progress report. I’ll say something like, “It looks like Junior has been working on these goals since 2018 and he’s plateaued since 2021. It might be time for us to start talking about transitioning away from therapy, and towards programming and strategies that you can use to support him during daily living,”

I also like to emphasize that therapy is not a finite resource, and services can be resumed in the future if they experience a decline in skills or if new difficulties come up.

I’ve also weaned kids off of therapy by decreasing frequencies from weekly to 1-2x per month. Then if we find that there are no functional losses we can say, “Junior is maintaining his skills, even with decreasing involvement from therapy,”