How?

• You can see how the children function in the classroom. With your input, this can allow the team to make changes to better support the student. You can see what language your students need.
• Children learn skills better in the environment they are going to use it.
• You can practice skills/goals in the activities that they do in their classroom.
• If your school environment is play-based, you can use your play therapy skills to target specific goals.

Ideas to Help You Plan

First, find out what your teacher’s plan is. Is there a theme? What activities will they use at the table, in free play, during circle, etc.? Think about what language skills you need to be successful in those activities. If a child is putting puzzles together, the vocabulary you would need would be the names of objects on the picture, verbs such as turn and flip, and parts of objects. What stories are read in class that week?

Are you going to do circle? If you are, look at your most popular goals and pick one. Then try to incorporate that into your circle activity. Remember circle should be short. Books, songs, and movement activities are usually effective. If you are not doing circle, find out what will happen. If you can, take what happened (e.g., a book that was read) and use that as inspiration for your table/play activity. This will help reinforce vocabulary and skills that the classroom staff are using. For more ideas in circle activities, check this out.

What are the toys available in the classroom? How can you use those toys to work on your goals? Can you adapt the toys to address your goals? What are your student’s interests, and how can you use those?

Lastly, it may seem silly, but have fun with the students. The more you have fun, the more the students will have fun. Looking for an example of planning ideas?  Go here.  Let me what you like best when doing preschool push-in therapy.

Visual Schedule

Visuals schedules help students organize their day or part of their day. They provide structure and take the guesswork out of their day. While schedules are usually in most classrooms, they are particularly crucial for children with language disorders or cognitive delays. Visual schedules are essential if a student has a different schedule from the rest of the class or for kids who struggle with change.

First/Then Boards

Now I don’t prescribe to the idea that First-Then Boards have to be something a child doesn’t like and then a reward. We tend to bribe students, especially students needing supports, way too much.  We need to change how school is organized so that school meets the needs of all students.

Back to visual supports, I tend to use them to break down schedules or activities into smaller units. First-Then boards can help children focus on the task at hand by giving them an idea about what is going to happen next. If you are using First/Then boards to break down schedules,  many people are starting to use First/Next language.

Choice Boards

Choice boards do exactly what it says in the title; they help children make choices. They can help with making choices for the order of activities during therapy. Choice boards are most frequently used to help children with what toys to play with or centers the kids can go to. These visual supports can also be used to help children pick regulation tools, who they are going pick, what they could eat, and more.

Visual Strips to Help with Routines

These visuals help learn routines, learn the sequence of the routines, or help remind a child of all the steps in a routine. Think washing hands after going to the bathroom. These visuals help students to do a task more independently. Visuals work really well for getting dressed, washing hands, and going to the bathroom.

Break Cards

These are for students who are learning or have learned when they need a regulation break. These visual supports help students self-advocate and not just leave, ask to go to the bathroom, or disrupt class whenever they need a break from class. These are definitely not magic bullets and tend to take a while for students to learn to use appropriately.

Note: If you are truly trying to support regulation with break cards, then having a regulation break should be seen as a tool and not as a reward. Changing how we view breaks will help provide students the supports they need and will help the students be and feel more successful at school

Wait Cards

Shocking (not really), but children have trouble with waiting. Using wait cards can help students know that an activity isn’t going to immediately happen. I like to use the “not now, soon, and go” to include on the wait card. This provides even more info about when the activity will happen.

Feelings Cards

This can be contentious. These cards help children identify how they and others are feeling. It is important to model how you and others are feeling. Make sure that you use a variety of emotions, including ones that people often classify as positive (e.g., happy) and negative (e.g., mad). I also tend to include states of being pictures (e.g., tired and sick). Remember, we are not happy all the time, and we shouldn’t expect our students to be happy all the time.

It is also important to note that neurodivergent children can process emotions differently. They may not feel emotions the same way as neurotypical children. For example, when nervous, they may not feel a tightening of the stomach or their stomach may not “tighten.” Emotions are complicated and teaching about emotions is just as complicated.

Using more standardized visuals for the ones described above can really help reduce prep time or increase the speed at which students have access to these tools. They can also bridge the gap for when individualized visuals can be created. Now, these are not all the types of visuals you might need, but they are visuals that should be in every school. Also, depending on the student, you may need to personalize these visuals.

If you are interested in learning more about visual supports and visuals that should be available at school, click here or on the photo. If you have any questions about visuals, you can check out other blog posts in this series (go here) or contact me, and I’d be happy to chat.

Spend Extra Time with the Child’s Team

Demonstrate how the visuals work. Go through the visuals you are introducing, talking about how to use them. If you have time, it can be helpful for the child’s team to be actively involved in making the visuals. This can be from picking which visuals to use to physically creating the visuals. This tends to give the team members better insight into the purpose of the visuals, and you will get better buy-in. Also, members of a child’s team who spend most of their time with the child will often have great insight into what visuals should be included and how they should look. Obviously, there are logistical challenges but doing as much as a team can produce better outcomes in the end. 

If you can spend time and use the visuals in real-time to model for the classroom staff, this can be very helpful. Once the child’s support team has a chance to use the visuals meet up with them. Go over anything that they have concerns about and answer any questions they may have. I usually recommend using the visuals for about three weeks before making any significant changes in the plan. This allows both the child and the child’s team to learn how to use the visuals. It also provides time for the visuals to become routine which will have better outcomes. During this time, you will need to spend more time checking in, problem-solving, and making minor changes to the plan. 

Pre-teach visuals before you need them.

Children learn new skills or coping mechanisms when they are calm and in a good space to learn. Visuals, especially ones to support classroom functioning and behaviour, need to be introduced when they don’t need them. Showing or using a visual that a child is unfamiliar with when a child is angry, upset, or dysregulated often leads to more anger and dysregulation. It’s like talking at a student when they are dysregulated; they will not understand what you are saying.  

If you are going to introduce visuals, introduce them when the child is not in that situation. For example, if you are going to teach a student to practice slow breathing when they feel angry, practice during a specific time (e.g., early in the morning). Then once a child is used to the routine, you can use it when they feel angry. In general, students respond better to visual strategies during times of stress, when they have learned the strategy in times of calm or the purpose of the visual.

Bake them into the students’ routines

In general, students respond well to routines. It makes the day more predictable, and it typically allows students to handle stressful or unpredictable events easier. Making visuals part of a child’s routine means that they will be used consistently, and visuals used consistently means that the visuals have a better opportunity to work. 

Think about what routines you have in a day; you have more than you think. What visuals would be easiest to introduce into the different routines? For example, schedules are most easily used first thing in the morning and then again after lunch. Break visuals are best presented during pre-scheduled breaks. Teaching how to wash your hands’ visuals should be used when washing your hands. 

Be Prepared to Confront Myths and Misconceptions Regarding Visuals

Just like the children we are supporting, the adults in the child’s life will also need to learn how to use the visuals. It can take more time than you may think. There are lots of preconceived notions about visuals. You may hear, “So and so doesn’t need visuals.” “Visuals are too much work.” “I don’t like the look of visuals,” aka “They’re not pretty.” “Visuals are too childish for this older student.” “We tried visuals for a week, and they didn’t work.” Some of these ideas can be very entrenched.

You are going to need to combat many of these ideas. Sometimes, it takes a long time. You may have to address these ideas/concerns over and over again. I also find demonstrating their use can be helpful. So if you are working with a child, make sure that you are using visuals. It may help break some of those myths, and it will teach the student how to use visuals and make more extensive implementation easier.  

If you want to learn more about visuals, click here. For more information on visuals, types, and how to use them, click here for an introductory book on the ins and outs of visuals.

What are your favourite tips for introducing visuals?

Benefits of Musical Books

1. They have built-in visuals. You don’t have to prep different visuals or as many visuals as other non-book activities.
2. They are predictable. This allows children to understand and learn different vocabulary and concepts from the book.
3. Children generally love them. You can play them again and again and again without the children getting bored. They may get lodged in your brain. The repetition is beneficial for children.
4. There are many that you can incorporate into many different themes.
5. Typically there are lots of options to do a smaller group or individual therapy.

Extension ideas for Preschool Push-In Therapy

1. Take the characters/animals/objects from the book and use them in sensory bins, with playdough, free play etc. This will allow the students many opportunities to practice those names in many different contexts. 
2. Use the characters/animals/objects in unrelated speech and language therapy activities. If you are working on prepositions, use the animals from the book. If you are working on describing, use pictures and characters from the book.   
3. Use the actions from the song as movement breaks. If the book has actions, have the students do them when they need a movement break. 
4. Use the characters/animals/objects in speech therapy. 

Favourite Musical Books for Preschool Push-In Therapy

1. Driving My Tractor by Jan Dobbins
2. Up, Up, Up by Susan Reed
3. The Shape Song Swingalong By Stevesongs
4. We All Go Traveling By By Sheena Roberts
5. Walking Through the Jungle By Debbie Harter and Fred Penner
6. The Animal Boogie by Debbie Harter and Fred Penner

If you are looking for more ideas for preschool push-in therapy, visit these blog posts (here and here).  Do you use musical books in push-in therapy?

Do activities together on teletherapy

As I have mentioned in a previous post on using food on teletherapy, you can make things on teletherapy. One idea is to make playdough, sensory bin, or calm down bottles. You would need to make sure that your family has all the ingredients. As well, they can use these ingredients for other purposes. For some families, the school was able to provide the materials. Making a sensory bin etc. together over teletherapy, you are still able to model language and set up the session to work on specific goals. A bonus is that you can show caregivers how to do this with their child(ren). Plus, they will have something to occupy their time throughout the week.

Another idea is to do a craft together. Again you need to know what the family has and are willing to use in a craft. I love to do free crafting with children. For younger children, it is developmentally appropriate. It allows them to develop their fine motor skills and explore their creativity. It can also work on fine motor skills for older children, and it a break from the stress of having to do something in a certain way as an adult. Unfortunately, this can and does happen. You can see more info on free crafting here.

Involve the parents

One of the great benefits of doing teletherapy at home has been more contact with caregivers. Especially for school children, this has been a blessing. Being able to talk and strategize and coach parents has been beneficial to both the parents and their children.

They have been able to use the skills they have learned or fine-tuned skills they already had. This has allowed us to problem solve and work on adding language to everyday functional activities. For example, talking about how to work on language skills when putting the laundry away, setting the table, or baking. Using short language activities throughout their week allows for positive change.

If you are interested in working on sending functional language skills at home, here are some handouts that you may find helpful.  If you provide your email address, you will be emailed the freebie on how to use child-directed art at school or at home.  Click Here.  What are your favourite functional teletherapy activities?

Do you set boundaries?

In short, yes! Do they look the same as boundaries you would set for another child the same age? Maybe, maybe not. Not a clear answer, I know. This leads to…

What boundaries do you set?

It’s essential to look at 

• The age of the child. Is it appropriate for a child that age?
• Developmental factors. Is it developmentally suitable for the child? 
• Are there any medical considerations?
• Is this a high stakes activity for the child? I typically don’t start with activities/objects that are particularly “high stakes” for the student. You need to think, “Is this hill, I’m willing to die on?”
• Is this a health and safety concern?
• Can I get everyone on board? This can be a tricky one. If the child has many people involved, that means many different opinions and approaches. The most innocuous object/approach can turn in to the biggest fight.  

I tend to start with less high stakes boundaries, something that it will help establish boundaries, but it is not soo high stakes that the child will a) be successful, and b) will not be so traumatizing for the child and the adults that it will not succeed. It is often easier to start small and go big than to start big and then have to go small.  

When do you start to set boundaries?

I believe that boundary setting should start as early as possible. The sooner a child learns about boundaries, the easier they are to impose, and the better a child usually is at accepting them. If you are setting boundaries at a later age, then I try to meet with the family, school staff, and outside agencies, if possible and set up a game plan. Looking at the questions above and getting a clear game plan usually makes this process more successful. Once we have a plan, then it is time to start.

How do you start?

Well, as stated above, the team tries to come up with a game plan. We look at where to start. What supports do we need to be successful? Often, there will need to be additional supports in place. Visuals are usually a crucial part of the puzzle. Having tools like first/then boards are essential. For more information on visuals, go here. Are there other activities that need to be ready? For example, if you are reducing screen time, then adding in a highly preferred non-screen activity would be advisable.  

I found that even with all the planning in the world, the first time or subsequent times, there will be challenges and hiccups. Being consistent and persistent, especially in the beginning, is vital. Also, if it is still not working, then going back and reworking the game plan is critical.

It’s a lot of work, but essential. Good luck!

Key tips to remember:

• Make them realistic and something you can follow through.
• Choose when to make to use. Is this a time of high stress? Then you may want to limit choices.
• Use visuals to help, including showing the child the items.
• Start small.  You can then you can add more.  Too many can be overwhelming.

Here is a video on how I use choices and why they can be powerful. Just click on the photo to take you to the video.

To find out how to use choice boards and other visuals that should be available at school, click here. Do you work on choices? When do you use them?

Being able to play is an integral part of language learning. Children learn how to relate to the world by reenacting events while playing. That is why you often see children playing “kitchen” or playing with dolls. You may even hear children reenacting events that had happened during the day. Ever hear a child reenact an argument they have heard. As such, it is an excellent way to teach new routines for children (click here fore more information).

Teaching routines is also essential for children, especially children who have language delays. They allow children to predict what is going to happen, which can reduce some anxiety children may feel. Ever go to a country where you don’t speak the language? You may feel more comfortable if you go to a restaurant and order a meal (the routine is relatively familiar) than having to take a bus (the routine may be very different).  

Because routines are consistent and predictable, it allows children many opportunities to practice. As a result, routines allow children to learn new vocabulary and how to relate to others in that specific situation.  

As such, teaching children what to expect by making a play routine out of a new event can be useful when getting ready to go to a new event — for example, teaching children what to expect when going trick or treating, what to expect when you are part of a wedding, what to expect when going on a vacation, what to expect when going to a sit down restaurant etc. For this post, I’m going to use trick or treating, as it is coming up. 

How?

1. Gather the materials that you will need to play.  Find different costumes so that the child or children can use them to get dressed. Pull out out Halloween bags and something to represent candy. I have used very colourful paper scrunched up into small pieces.  

2. Get dressed in the costumes. Let the children pick what they want to wear. If you are at home, you can use their own costume. Don’t forget to get dressed yourself. Most likely, the costumes won’t fit you, but you can wear hats.

3. Gather your bag and pretend to knock on doors (I usually knock on a table) and say, “Trick or Treat!” If you are home, go to different rooms in your house. If you have another child or adult playing, you can have them hand out the treats. Then practice saying, “Thank you!” and move on to a new house. If you are working at a daycare or a preschool, this makes a great centre.  

4. Once the child is used to the trick or treating, then try to have them be one handing out candy, a role they may play if they do not go out or have already been out.

Do I only use dramatic play to help teach about these new events? No, but it is an integral part of the process. I also use stories about the event to help show the sequence of events.  If you are looking for some additional activities to help practice trick or treating, try this activity from Teachers Pay Teachers I have used it in addition to the dramatic play centre.  

Will this eliminate the nervousness and behaviors during the actual event of trick or treat? Probably not. There are different variables that we wouldn’t be able to reenact during the actual event, but it may help reduce it and allow the child to have a more enjoyable and successful event.

Establish a good working relationship with the classroom staff.  

When classroom teams work well together, it goes really well, but it can make for a very loooong and challenging year when there are issues between team members. This is especially true with pushed in therapy because you will be spending more time with the other classroom staff than if you are doing pull-out therapy. These can be long conversations, but they are essential to have before everyone is feeling frustrated and/or stressed.

At the beginning of the year, here are some critical questions to ask or topics to discuss:

• What are the views on dealing with behaviours? 
• What is talking with parents in the classroom going to look like?
• How do you like staff to share information with you and vice versa?
• What is your general philosophy towards therapy, and what is their experience in the past?
• What are your duties going to be in the classroom? 
• If you are not in the classroom the whole time, when will you be there, and what will that look like.  

Establish a routine.  

Whether you are working with the rest of the classroom staff to establish a routine for the whole class or not, you need to develop a routine when you are in the classroom. If you are leading a circle or part of circle, make sure that you have a routine. If you are doing adult-directed activities, make sure that you have a routine. This will allow the children to follow the activity and know when it is over. It will make your time with the students more productive and reduce any anxiety a preschooler may feel.

Make visuals your new best friend. 

You all know how important visuals are. While visuals are often essential in the older grades, they are imperative in a preschool classroom. For many students, this is their first time away from home, which is scary. On top of a language delay, they may not speak English at home or speak it sparingly. This makes it even more imperative to have pictures ready to start treating the language delays and introduce students to English.

Visuals will help with children’s fears (they will learn faster what to expect), increase familiarity with routines, and help students learn how to be in a group. The quicker you can make them and use them to establish the routine and the classroom expectations; the faster and better the classroom will run. One of the first steps is to have your visuals ready.

 Make sure you have a variety of visuals. It is important to have visuals prepared for all transitions that occur in the classroom. First/next boards, choice boards, schedules, self-help sequences are just a few types of visuals I make sure that I have ready for the beginning of the year. I typically have smaller ones to show individual students and more prominent visuals to show the whole group. It’s a lot, I know, but it is better to be over-prepared than under-prepared.

Make sure that you have a general AAC strategy ready for the classroom. 

Over the years, the number of children who start preschool not talking in my school has increased dramatically. These students may not have any AAC in place. If you are lucky, they may have been working on using PECS. My philosophy is that PECS is not enough to teach children to communicate. Having a general strategy for the whole class is very valuable to help introduce AAC to the children and their parents. It also starts the expectation of using aided language strategies on the first day, which establishes good habits for the staff and the students. 

Become familiar with the toys/centres in the classroom. 

I work at a play-based centre, so I tend to use the equipment in the classroom, especially for the young ones who have short attention spans and still learning to sit for adult-directed activities. What figurines do they have? Do they have a water or sand table? Do they have cars? Think about what goals/vocabulary you can use in the different areas or with the various toys. Especially at the start of the year, you will have better engagement and longer direct therapy time with preschoolers who have fun at a centre than trying to have the students run on your agenda.

These are just five times to make your preschool experience a positive one. To see more new push-in preschool SLPs, go here.  To find out how to use musical books in push-in therapy, go here. What are your favourite tips for SLPs going into a classroom?

Use themes 

Be intentional about the toys/equipment you use.  

Pick specific vocabulary to focus on

Play and interact with the children

Make it fun