Perspectives On Co-Treatment

Co-treatment is the treatment approach of having two therapists, usually a physical or occupational therapist, and a speech/language pathologist, work with a child together. For some children, co-treatment is the most effective treatment approach. Co-treatment may occur for the entire session. It also may be done as an "overlap" session, where one discipline works with a child for the first 30 minutes individually, two therapists then work together for 30 minutes, and then the second therapist has 30 minutes alone with the child, for a total of 1-1/2 hours.

The need for co-treatment, or appropriateness of this approach varies from child to child, and also changes in the developmental process of each child. A child might benefit from co-treatment for a period of time, then move to individual sessions for a time.

Co-Treatment Is A Good Idea

• Allows us to incorporate goals in a holistic context, as they occur in development.
• Emphasizes how the goals of different disciplines relate to the total picture (i.e. sound production enhances movement; increased lip closure is seen with better head and trunk position; tongue movements mirror improved gross motor patterns).
• Enables us to teach parents how different goals are inter-related. We can then involve parents in how to incorporate those goals into daily home life without the piecemeal perspective of different therapies.
• Allows therapists to "brainstorm" together as we work with the child and family. The result is a stronger therapy program for the child.
• Enables the therapists to share treatment responsibilities. If one is absent, the other can still provide components from the other discipline.
• May allow both disciplines to work on diverse therapy goals within one hour, to accommodate a young or medically fragile child, with reduced tolerance.

Specific Advantages Of Co-Treatment

In co-treatment, one therapist can handle and position the child, and the other can work to facilitate communication and play. Children can be more active participants in their movement if they are motivated by an activity. While the motor therapist provides the support and facilitation needed to maintain, or to move in and out of a position, the communication therapist can be offering a toy or activity to promote the desired movement. In this way, both the motor goal of movement is equal and more challenging activities that require more motor and/or cognitive work can then be explored.

Communication activities, or use of augmentative communication devices are often best accomplished with active positioning by a motor therapist, to maximize a child's ability to move. There is often more vocalization with movement. A child also needs optimal positioning for best use of eyes for communication and play.

For children with sensory processing difficulties, it is often beneficial to have communication and motor therapists working together to incorporate sensory input into other therapy activities to promote behavioral state regulation, and motor planning. This then allows a child to be functioning in an optimal state to address other therapy goals.

Specific Disadvantages Of Co-Treatment

• Insurance companies may not want to pay for two therapies in one hour.
• Scheduling of two therapists may be difficult.
• A child may be stressed with two therapists working at the same time.
• A child might need 2 full hours of treatment, and be able to tolerate the increased activity demands.