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Weekly 1:1 therapy is not the most effective form of therapeutic support.

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I say this as a clinician who has been practising for nearly 25 years, with a career in the private sector that predates NDIS by over a decade. I have supported families who could fund 1:1 therapy, not just once a week, but even 4-5 times a week if their child was not overloaded by that level of intensity.

When NDIA rolled out, unlike many professionals who had worked in systems where support sat in the range of ‘minimum’, I was confident that weekly 1:1 therapy was more effective than fortnightly or monthly. I was confident that for many clients, higher intensity led to faster progress and goal achievement.

When NDIS participants rolled through our doors from the old system, all they could say was – “Wow, you private practice people know how to get things done.” We worked in partnership with people. Choice and control is what private practice was always about. We were about best practice and best outcomes, without delays.

I’ll highlight here, because the scope of OT and SP is broad, that Spot is a practice that upholds Neuroaffirming and Trauma Informed values. That means we prioritize nervous system safety, and the most powerful tool in our kit is relationships. This is evidence based (not just a wok value).

When kids and families establish a trust based relationship with their provider, it opens the door to collaboration. It empowers people as the experts in their own lives. It ensures they can set meaningful goals. It creates the foundation for authentic interactions. Clients can rest in our care, and we can hold them safely in their zone of proximal development, so growth can unfold. We need high intensity therapy to develop those relationships. People can’t build that connection easily if you only see them 5 times in a whole school term. Watering down the dosage actually means providing therapy that we’re not expecting to be effective. It’s wasteful and dare I say, even harmful, as time and critical windows for development pass by with the false impression of that supports are in place.

I’ll admit, the first line of this blog was a bit of a hook (although I suspect seasoned therapists may have detected my loophole). I believe the most effective form of therapeutic support is multi-modal care. A direct therapeutic relationship with a child is important, but we need SO MUCH MORE.

Parent Coaching

I passionately believe in parent coaching, and feel we’re running on a false economy when that is not offered in conjunction to 1:1 care. Often it’s a way to super-power our direct therapy, but in some cases it’s essential if we are to see any real world progress at all. What is the point in setting self-advocacy goals, if self-advocacy attempts are not registered and honoured by the people around a child. How can we shift behaviour when it stems from unmet needs? How can we enhance motor skills, or speech and language development, if there is no one who can meet a child where they’re at in everyday life.

Training

While coaching is great, often, it is not enough. Parents, carers and educators benefit from training. At Spot we do this through our Training Hub; making high value content available on demand, to anyone in a child’s care team.

What else, and who else? Clinics are great; we can control the environment and use specialized equipment to support development & skill building (*although at Spot we work very hard to keep all our tools as mainstream & accessible as possible). But, we need to go where children are – their natural environments – home, school, ASC, even soccer training. When we go where children are, we also meet all the people in their lives. The more people we can ‘touch,’ the better. 

Group Therapy

Lastly; Group therapy. This is different to 1:1 therapy, and I don’t think it should be an ‘either/or’ to individual therapy. We glean so much from supporting people in situations where the social demands are different. What skills can they access when different variables shift? Do new strengths shine? Are we able to see a barrier to achievement of goals that we couldn’t see before? Groups have a unique therapeutic purpose and impact (& we have not even mentioned the value they hold for connection to people with similar lived experiences).

So, what can people expect at Spot? ALL of this, for everyone. This is what high quality care looks like – it’s not compartmentalized. It’s a radical and proactive commitment to excellent.

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Where will we land with the reforms?