I think about this a lot. A LOT. In fact, I probably spend waaay too much time thinking about this. But I think people’s jobs/lives/general awesomeness could be improved if the immediate environment was designed to actually help us out.
I started thinking about this back in undergrad when I worked for a daycare. One of my fellow “student teachers” (our Official Job Title) was studying early childhood education and had a real interest in how the daycare was laid out to benefit both the teachers and the children. She pointed out a few things to me. And then it was like a revolution: EVERYTHING EVER could be made simpler if the environment was altered to a purpose.
So that’s obviously an exaggeration. But that’s what it felt like.
I think about my out-patient surroundings a lot. Probably because I have the most control. (Sadly, a brand-new hospital is not going to be built just because I think there are some improvements to be made. Ha!) I also think about it a lot because it plays a large role in how I manage my kids in therapy.
1. To make a room seem smaller, put an object, like a table, in the middle of the room. (Yes, even a small table. I have one of those [wretched] tiny, square activity tables for children. I placed it in the center of my [hunormous] room to prevent one of my [rambunctious] children and it [magically] mentally cut off half the room in that child’s mind, making my job much easier. And much less exhausting.)
2. Lock them in that damn chair. (No, not a Rifton chair. Yet.) Seriously. Push that table and chair up against a wall if that’s what it takes. Don’t get me wrong, most of my caseload is three years old and younger and getting them to focus for a full session while sitting in a chair is unlikely (but not impossible), there can still be a time for sitting. And if that child must be corralled and cornered into a chair to accomplish that, then so be it.
3. Remove all visual distractions from behind you. Or, whatever the child is facing while
strapped into sitting in a chair. Unfortunately, this is not something I can really control in my current therapy room. Even when I have a kid strapped into sitting in her/his chair working on an activity, on the far opposite of my hunormous room, carefully guarded by my desk, a trashcan and two chairs (don’t ask) lies an open shelf with a few toys on it. This inevitably leads to pointing, requests, whining, and at times my herding them back into their chair. I mostly keep it clear or keep dysphagia materials on the top-most, easily seen shelf…but sometimes I slip up.
4. Get rid of that mirror hanging from your door. Who invented that? Someone who hated speech-language pathologists? Someone who has never encountered a small child? Some people may disagree, but I loathe them. I know mirrors have their place for articulation treatment, but why why why would you want one hanging on your wall when you can just as easily have a small one that you could pull out when you need it. I can’t tell you how many children will distract themselves by making faces and putting their mouth on it. Yuck!
5. Invest in some stop signs. Well, not real stop signs. (Disclaimer: I am not inciting anyone to go out and steal government property, i.e., your local stop signs.) Just make some. You can even be lazy and make them circle or square-shaped instead of the classic hexagon. I always try to put one on my door so that my kids have to request (at their language-appropriate level) to open the door before we leave. Put it at their eye level. (Fun fact: I cannot draw straight lines when using white-out to make the edges of my stop signs!)
6. Keep things out of sight. Or not. This ties in with number three. Most of my toys are actually in our shared toy/game room, but I also have some in a closed metal cabinet. They are out of sight and my kids can’t be, well, kids and try to distract themselves and me. Somethings I have laid out where they can see, either because I’m showing them what we are going to be doing, or so that they can see and not touch and practice requesting items.
7. Keep things out of reach. Or not. This also ties in with number six. Sometimes I want my kids to see things but have to make a request in order to get what they want. Other times I want them to pick one of the games I selected, and feel they have a measure of control in the session, so we can jump right into a good ol’ drill-play routine.
8. Be careful of your room size. Again, this depends on the age and temperament of your patient. With really small children where you might be doing more play based therapy, you obviously want room enough to play. On the other hand, you don’t want to spend half your time chasing them around and not actually doing any therapy. Obviously, we can’t all control our room size. I sure can’t. But I moved things around a lot in my room to try to make it do as much work for me as possible.
9. Clean hands! There should be hand-sanitizer containers either right outside or right inside the room. Keep everyone germ-free!!! Or close to germ-free! My problem? I’ve got to be more consistent having both myself and my kids use it first thing. Guess I need a STOP:
HAMMERTIME WASH YOUR HANDS sign for myself.
Those are ones I have worked through in the past year. There are probably more. I always wonder: are there studies for things like this? For therapy rooms/clinics and/or hospitals that show the proof of environmental modifications in aiding better outcomes for patients?