Before Rebecca Guagliardo heads off to work, she checks to make sure she has all the necessary supplies.
Sometimes, her necessities include toy dinosaurs; other days she needs trains. Bubbles are almost always on her list. These children’s toys may seem simple, but for a speech therapist such as Guagliardo, they are invaluable tools to help a child in therapy.
Guagliardo is one of the nearly 300 licensed therapists who are contracted by the state to work within the Lake County Health Department’s Early Intervention Program. The program works with children from newborns to age 3 to identify, address and, when possible, overcome any developmental delays in five categories: physical, cognitive, communication, social and emotional and adaptive.
Guagliardo joined the program in 1999 and said she immediately was moved and inspired by the impact her work can have on a child’s life and the bonds forged with the families she helps. More than 20 years after working with her first client – a 15-month-old “delightful little person” – Guagliardo said she still receives regular updates from his mother on his achievements in life.
“It just really impressed upon me what a difference early intervention makes,” she said. “His family took every suggestion that was given and just did above and beyond what they had to do, and it changed him tremendously. It just made me realize that a little bit of suggestion on my part could change things.”
Families are typically referred to the program by their pediatricians after the physician’s assessment of the child’s progress at standard wellness checkups during the child’s first years of life. Once a referral is made, a service coordinator reaches out to the family to walk them through the intake process and arrange an evaluation.
Early Intervention Program Coordinator Donna Musser said at any given time there are about 800 open cases within the system – a combination of families going through the intake process and families who are working with therapists, including speech, occupational, physical and developmental.
“The [therapists] are some of the most wonderful, caring individuals providing these services,” Musser said. “It is amazing to work with them and to have the relationship we have with them. We have a lot of children whose families are real concerned; every family who comes in. Even families whose children are not showing a delay are concerned about autism because it’s all over the world right now. And more times than not, that’s not what’s going on – not even close to what’s going on.”
There are several criteria a child can meet to be eligible for the program. The first category of eligibility is a list of diagnosed conditions, including Down syndrome, cerebral palsy and one of many conditions that would predicate a “high probability of developmental delay.” The second category is based on the evaluation conducted by Early Intervention therapists. Musser said the majority of children enrolled in the program fall into this category.
“[A child must] have at least 30 percent delay in any one of the five developmental areas: communication, motor – fine and gross – cognitive development, social and emotional development and adaptive,” she said. “And if it’s a communication 30 percent, it’s based on total communication – receptive and expressive language.”
Once a child qualifies for the program, an Individualize Family Service Plan is written detailing the goals the therapists would like a child to reach in each area where a delay was found, and the family is processed into the system. At that point, therapists such as Guagliardo are asked to take on the child’s case.
While Guagliardo, like many therapists, follows the service plan as a map to reach certain goals, the route she takes to attain these goals depends mostly on the child and what motivates him or her.
“In my initial phone call or text to the family, I try to find out things that would be motivating to the child and build that in,” she said. “One of my therapy friends – mom and dad are really involved and prior to me coming they prep the person and they do a lot of jumping and [playing]. Then I come and maybe we’ll do an activity and then we do jumping. Or we’ll do an activity and we’ll go outside and swing. We try to incorporate as much of what the child likes in what we’re doing to keep him motivated. Therapy techniques are embedded within the play.”
Both Musser and Guagliardo stress the importance of family involvement and how crucial it is to the progress and success of a child in therapy.
“The key is the family,” Musser said. “We’re only here to tell you what might help; what will give your child that extra push, what will help move him in the right direction. But us being in your home once a week or twice a week – if we need to be there that often, then we should move in with you. It really is that day-to-day, 24/7 that you do with your child that’s gonna make that difference.”
Guagliardo said even the simplest, seemingly unrelated tasks such as “messy play” with pudding or applesauce can have major impacts on speech development.
“It is amazing,” she said. “You don’t think about all the wonderful things you do as a parent that are really facilitating their brain growth. You figure all the development that occurs in the first three years, brain development-wise, is a strong reason to do early intervention.”
Musser adds tummy time plays a crucial role in a child’s speech development; the muscles a child strengthens during tummy time are the same muscles he or she will need when trying to posture for and vocalize words.
“That’s the number one reason we get referral,” she said. “So families are surprised that their children may have weak muscles or may have some other things going on and they never really realize that tummy time was so important. Because those muscles haven’t strengthened the way they should.”
As a child nears the program’s third-year ceiling, Musser said, her team begins working with the family to facilitate the transition into preschool. Parents are encouraged to reach out to their school district and tour the facility to familiarize themselves with their child’s future classrooms and teachers. With parental consent, the early intervention program will release their child’s evaluations to the school so they can review the child’s progress through the program and determine whether any additional evaluations by the district are needed.
Musser said the program does outreach work within the county to stress the value of early intervention and the importance of screenings or evaluations if a parent has questions about a child’s developmental stage. But again, Musser said, it all boils down to family involvement.
“At the very young ages, it is so important just to talk to your child,” she said. “Even when your child is very young and you don’t think they understand anything. Talk to them, make faces at them. Make silly noises and encourage your child to do it back.”
For Guagliardo, the most rewarding part of her job is when one of her “therapy friends” is able to vocalize his or her thoughts or feelings.
“I love when somebody is able to tell me what they want to do,” she said. “I love when they come and they can say clearly something they’ve been working on for so long. There’s a huge sense of accomplishment for the child when they know that what they said was heard by other people.”