Goodness-of-Fit: A Priority for Child, Family, and Therapist

by Susan Snell, MA, MS

For many parents, finding the "right" service providers for their child is a challenge. Most parents initially experience this process as they choose a pediatrician. For some, this is as simple as following the recommendation of a neighbor or going to the first practice listed in the managed care provider booklet. For others, this process includes careful investigation, interviews, and even a trial run before feeling comfortable with their choice.

The process is similar when parents seek other pediatric specialists. Many children see a speech/language pathologist or an occupational therapist on a weekly basis. Others go for vision therapy or nutritional consultation; some work with social workers or play therapists. The success of any treatment relies partly on "goodness-of-fit" between the therapist, the child‘s receptivity and capabilities, and the parents‘ expectations.

"Goodness-of-fit" is generally associated with the parent-child relationship, where similar temperaments and personal styles of relating make for a nice match between adult and baby. The concept is also applicable, however, to the relationship between therapist (or practice) and family.

Everyone wants the satisfaction of goodness-of-fit. Indeed, research shows that high levels of satisfaction are positively correlated with perceptions that one has some choice and control. To ensure a good fit with a therapist, assess your needs, be intentional about your choices, and follow your instincts. Here‘s how three families did it.

Goodness-of-Fit with a Multi-Disciplinary Team

Katie, age 5, is the youngest in a large family. In kindergarten, her IEP calls for occupational and speech/ language therapy, twice weekly. Both of Katie‘s parents work but have made her special needs a priority. They are knowledgeable about their rights and the services she requires. Placing their confidence in the therapists‘ professionalism, they depend on the school to manage their daughter‘s related services, to schedule routine conferences with Katie‘s teachers, and to notify them about her progress.

Katie‘s parents like the way the multi-disciplinary team coordinates her treatment. They are grateful that Katie‘s school gives her just what she needs.

Goodness-of-Fit with Parents in Charge

At two, Jason was identified as having some developmental delays. Now three, he attends a church preschool, three mornings a week. The preschool offers no services. Jason‘s parents, however, have the time, knowledge, and financial resources to seek appropriate therapies, which they select after consulting their health-care provider and pediatrician. Some services are covered, while others they finance themselves. Jason‘s parents have developed good relationships with a variety of professionals. They regularly attend all appointments and therapy sessions. They read current studies, investigate alternative approaches, and "chat" with other parents on the Internet, sharing information and resources. That‘s how they learned about the DDR. They feel that they are qualified to be Jason‘s case managers, coordinate his treatment, and make decisions about his school. With flexible work hours, they use their free time on a home program prescribed by his therapists.

These parents need service providers who appreciate a high level of parent involvement and can collaborate with families on a treatment plan.

Goodness-of-Fit by Combining School-Based and Outside Services

For three years, third-grader Serita has received language therapy and resource help for reading. Initially, Serita‘s language skills and attention improved, but for the last six months she has shown few gains. Classroom teachers have found her to be increasingly remote, rarely participating and regularly isolating herself from her peers.

Serita‘s parents realize that the treatment she currently gets needs a boost. Through their pediatrician, they find a private psychotherapist and a tutor, who seem to be a fine match for Serita. Indeed, the outside services, plus those she continues to receive at school, help her blossom. Her parents are relieved that by following their intuition, they made a positive and productive change.

While every family has differing needs, some generic criteria are useful. Here are some things to consider when deciding on services for your child:

Susan Snell is an Educational Consultant, St. Columba‘s Nursery School, Washington, DC, and Family Therapist, Fairfax, VA

[Initially published in New Developments: Volume 3, Number 4 - Summer, 1998]

All material in this web site is given for information purposes only and is not to be substituted for advice from your health care provider.


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