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Client-centered care (or person centered care) is an approach to speech therapy that aims to treat the “whole” person. Its a collaborative approach that includes the person and their family or support network in all aspects of speech therapy. This approach strives to hold the client as an equal partner in the every aspect of speech therapy.
"Person-centered speech therapy creates a foundation for care that is inquisitive, thoughtful and therefore individualized to you."
The Disease Model
Previous models, such as the disease model, focused on the condition that caused the communication impairment. For this reason, approaches tended to be very prescriptive. Under this model, people were often lumped into categories based on the disease that caused their communication or swallow impairment. There was emphasis on test results in determining speech therapy goals, with little, if any, input from the individual or their family. Speech pathologists were not in the habit of seeking input from patients or asking them how they would like to measure success. The balance of control tipped toward the speech language pathologist who could then make the determination of when goals were achieved and when to discharge, typically based on numbers. Historically, we weren’t very good about checking in with the individual to fully understand if they felt they had met their goals before terminating therapy.
Person-Centered Speech Therapy
Fortunately, there has been a shift in medicine from the narrow view of treating a disease to treating a person as an individual who has a disease. With a person-centered approach, the clinician collaborates with the patient and families in all aspects of speech therapy. The speech therapist understands that your situation is unique and your voice is equally important.
Practicing person-centered care creates a foundation for care that is inquisitive, thoughtful and therefore individualized to you. This approach incorporates available support systems, considers family dynamics, social dynamics, resources and obstacles. The outcome is a speech therapy plan that is inclusive, unique and personalized and consequently, likely to have better outcomes.
What does Person-Centered Speech Therapy look like?
Because each individual is different and each speech language pathologist has their own style and approach, speech therapy can look very different between two individuals with similar conditions. But, I provide some examples of how Amplify Speech Therapy has implemented the person-centered approach for clients to give some clarity.
Speech therapy goals that are Individualized
The best way to explain how speech therapy goals can be individualized is to compare the traditional approach with a person-centered approach.
A disease model goal:
Mr. Jones will improve writing skills by writing 2-3 word responses to paragraphs at 80% accuracy over 2 sessions.
A person-centered goal:
Mr. Jones will improve writing accuracy to write his to-do lists, write events and times in a daily planner and take phone messages for his wife with 80% accuracy over 2 consecutive weeks.
A disease model goal:
Ms. Perez will label everyday common objects with 75% accuracy given minimal phonemic (sound) cues.
A person-centered goal:
Ms. Perez will improve accuracy of personalized list of everyday objects and family member names from photographs with minimal phonemic cues for 75% accuracy.
Goals written under the disease model prioritized the speech pathologist's need to collect data and frequently over-utilized workbooks that have random reading and writing material, similar to what you would find in a school textbook.
To address the above examples of person-centered goals, the speech pathologist will have to rely on the family and caregivers. For example, someone who is having trouble naming objects because of expressive aphasia may not be able to tell me which words they have trouble saying or which words would give them the most success. Family input helps a speech pathologist curate a list of words that are meaningful.
Workbooks decide that common objects are things like ball, scissors, razor, lamp, pencil. These words may not be important to Ms. Perez and therefore won't give her immediate success in her day to day life. Examples of a personalized word list may include a pet name, cat treat, pain medicine, cane, or "cell" the word they've always used for mobile phone. Personalized word lists, like personalized goals should be built around the client's lived experience. And being mindful about one's lived experience in developing speech therapy goals has the potential to boost speech therapy outcomes.
Speech Therapy Materials
Speech therapy materials that are worksheets pulled from a workbook aren't always applicable to one's real life needs. Reading paragraphs and answering questions about Jane going to a baseball game may not be meaningful unless your name is Jane or you coach your kid’s baseball league.
An example of person-centered therapy material for a client who is the primary cook in the family and has a goal of hosting dinner parties again would be using his favorite recipes. These recipes could be used to work on real life math problems, such as how to double or halve these recipes.
Developing personalized material doesn't always require more time and work from the SLP. One simple way to use material that is meaningful to the individual is to use their own material. I've used song lyrics to help a song writer improve his speech intelligibility after a brain injury. In working with a professor, we pulled material from his lectures to target specific words and word combinations that were difficult to say clearly. I have used photographs that a family member sent me of bears and deer on their property and had the client with aphasia build sentences to tell the story behind that encounter. It's so much more fun than using a black and white line-drawing to try to elicit conversation.
Person-centered care is more meaningful to the client, but it also gives them early success in being able to communicate the things that are important to them. Occasionally, this approach may require more time and effort from the speech pathologist, but as a speech pathologist, I get the added bonus of learning from my clients. For example, I recently learned all about Scottish cuisine because we built therapy around a client's heritage and interests.
Family and Caregiver Involvement in Speech Therapy
It is important to emphasize that collaborative speech therapy includes the family and caregivers. They provide valuable insight in identifying strengths and weaknesses every step of the way from initial testing, identifying speech goals, and providing support for creating therapy material (as in the wildlife photos or word lists mentioned above).
Speech therapy typically lasts for 1 hour or less, often once or twice a week. Its important to consider how much more time the family and caregivers are spending with the client. They are allies in speech therapy and are an important part of the person-centered approach.
When a person-centered approach means less speech therapy
A speech pathologist may identify concerns in voice, cognition and swallowing in a person with Parkinson's. But if they have no interest in working on swallowing, creating goals for swallow exercises or strategies, a person-centered approach values the client's goals. As long as they fully understand the concerns and make a conscious decision, part of the collaboration in speech therapy is giving the voice and the right to say "no" to a goal or even to therapy.
Home visits offer an individualized approach
Another way that Amplify Speech Therapy is person-centered is by offering home visits. Visits in a clinic or therapy office remove the person from their natural setting. When the SLP comes to the home, we are surrounded by all of their familiar objects. We don’t have to rely on a picture of a sofa to elicit vocabulary, when we can use the very sofa they have sat in for the past 5+ years. We incorporate pets and family photos to work on family members' names. In dysphagia therapy we can use familiar foods rather than being limited to pantry items, such as crackers and applesauce. In cognitive therapy, we maximize success because we are surrounded by what is familiar and can make realistic modifications to routines already in place.
Is your speech therapy meaningful?
Person-centered speech therapy can be applied to all areas of rehabilitation (or preservation): language, voice, speech clarity, cognition, and swallowing.
When speech therapy is personalized it has some inherent benefits. It is meaningful and therefore has sticking power. It is more motivating because the client is working on something they know will have a positive impact on their day-to-day life and success. Goals are crafted around real-life events, so naturally are integrated more quickly into one’s life. This can translate into more rapid progress.
Treating the whole person means seeing the whole person. If you are not sure if your speech therapy is offering person-centered care, you can ask yourself these questions:
Do you feel seen and heard, not as a diagnosis or a condition, but as a complex and unique individual with a life story.
Were you asked to contribute to developing your speech goals? Do you know what your therapy goals are?
Do the exercises and materials feel meaningful and applicable to your life?
Are you given the opportunity to learn the reasons behind the therapy goals and exercises?
Are family members and caregivers included in therapy? Are they included in updates and planning?
If you answered "no" to any of these questions, ask your speech therapist to include you in these decisions and approaches. Advocate for more personalized material and inclusion of your family. If you are putting the work into speech therapy, make sure the speech therapy is working for you!