Keeping adult clients motivated at home during physical distancing [repost from ASHA Leader]

As published April 7, 2020 in the ASHA Leader, the monthly newsmagazine for and about audiologists, speech-language pathologists, and speech, language and hearing scientists. Written by Emily Dubas De Oliveira.

We’re in the midst of unprecedented physical distancing to stay safe and reduce exposure to COVID-19. With remote working, school closures, and virtual learning, everyone is forced to abandon previous daily routines and create new ones at home.

This disruption is affecting our speech-language clients and their families across the health care continuum. For those of us working in hospital outpatient settings in hospitals, the challenge is providing clients at home with enough consistent and intensive practice during a critical time in their recovery.

When adult clients are at home, they can be easily distracted and caught up in other activities and tasks—and without a routine, appointments, or getting out of the house, motivation to practice strategies can be very challenging.

So whether we’re seeing our patients in-person or virtually right now, what can we do to help our adult clients stay motivated during this time? I’ve updated a previous post, 10 Ways to Motivate and Empower Clients to Practice, with new considerations and tips to recommend to our clients while they’re spending more time at home to set them up for success during home practice.

Explore telepractice or e-visit options

If you are interested in starting telepractice during this time, ASHA offers a range of resources and guidance:

• 5 steps to getting started with telepractice
• Payment and Coverage Considerations for Telepractice Services During Coronavirus/COVID-19
• COVID-19: Tracking of State Laws and Regulations for Telepractice and Temporary Practice
• SIG 18- Telepractice
• Proving Outpatient Telepractice Services to Medicare Beneficiaries

Make a schedule

I like to spend part of the session creating a rough weekly plan—we write obligations like appointments and transportation time, for example—then schedule “to-do” list items, such as homework. This exercise also helps clients think critically about what day, time, and duration they have available to practice at home.

One of the most challenging issues with being home all day is the lack of routine. So building a schedule is even more important to keep clients on track. Using their calendar or daily planner, clients can write down how they’re going to spend their day—and that includes when they’re going to practice their speech-language exercises.

Get creative

Practice doesn’t mean it has to feel like work. In fact, research on neuroplasticity highlights the importance of motivation and salience in facilitating neuroplastic changes. So in other words, the exercises need to be meaningful to the client, and this can keep clients motivated.

Encourage your clients to tell you what they enjoy doing, and then help them think of how they can adapt that activity to challenge themselves in their goal areas. For example, if your client is working on reading comprehension and likes to cook, you might make it a goal to cook three new recipes this week.

Set realistic goals

Using SMART goals can help your patients evaluate if they can complete the homework. These might include:

• “I will practice my speaking and listening skills by calling three people I haven’t talked to in a while this week.”
• “I will write 10 texts or emails to family or friends this week.”
• “I will use my memory strategies to remember three commitments this week.”

Provide rationale

Understanding the “why” can motivate people. (Why should I do this? Why should I care?) A quick conversation might work for some clients, whereas others want to conduct their own research. I remember giving one patient an article on memory. By the next session, he returned with a binder full of articles! Additionally, connecting homework to the person’s treatment goals help explain why it’s personally relevant. Finally, I encourage patients to write their own rationale in a notebook. That way, they can reference it in the future if they need a motivation reboot.

Build accountability

If the intrinsic motivation approach isn’t working, external pressure motivates many people. Try creating more accountability in sessions for these types of clients. I worked with one patient who told his brother when he planned to do homework and when he completed it. The idea that someone else was waiting to hear from him got him started.

A great way to build accountability (and get creative) while clients are home right now is scheduling phone calls or video chats with family or friends. Clients now have external motivation to keep their commitment. And phone calls/video chats are a great way to work on a variety of different goals (working on communication skills during the conversation, on memory by remembering to make the phone call, on attention by focusing during the conversation and ignoring the distractions).

Measure progress

Measuring progress accomplishes two things: It compares current and past performance and creates accountability. I sometimes use paper-based methods for patients to measure progress—to-do lists, planners, writing down SMART goals—but technology also makes tracking accomplishments easy. Many programs help monitor homework, along with apps that can measure performance or allow for you to remotely monitor your clients’ work, even when they’re at home.

Link new habits to old ones

Encourage the client to link a new habit—like homework—with an old one. For example, one client’s routine was to clean every morning. She also found she works best in a clean environment, so she started doing homework immediately after her cleaning routine.

Identify the optimal work environment

Some people receive motivation from being surrounded by others who are also working. Other people work better alone.

In this time of physical distancing, working with your clients to figure out the most optimal environment in the house can be helpful. If your client needs complete quiet, what room would allow for this? How can we reduce environmental distractions? Or perhaps your client does better around other people who are working. Perhaps sitting at the kitchen table where other family members are working might be better.

Reward yourself

Ask your client to identify a fun activity to do after finishing their homework: watch a TV show, take a walk, read a book, grab a cup of coffee, whatever they enjoy.

Modify the homework

Some feel stifled by rules. These clients might feel relieved when you reframe their assignments as “homework-in-progress.” Clients are more likely to try a practice activity if they aren’t rigid and you are willing to modify them. I typically have them try two or three times, and if it’s not working, we can change it.

Use a timer

Getting started is often the hardest part. A timer can be a great motivation checker. For example, one patient would set a timer for 10 minutes, thinking “I will work for 10 minutes, and if I’m still not motivated, I can stop.” Often when the timer ends, she would be in the groove and motivated to keep going.

Use social networks

Social media can help your clients connect with others to feel less isolated. There are many groups for different disorders out there. Encourage your clients to learn how others are staying motivated and what they’re doing at home

What strategies work for you in motivating clients to practice at home? Share in the comment section below.

Emily Dubas De Oliveira, MS, CCC-SLP is a clinical manager at The Learning Corp, and also treats patients with acquired neurological conditions at Spaulding Rehabilitation Hospital. She is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; and 15, Gerontology. emily.deoliveira@constanttherapy.com

>> Original article is here.