It’s fair to say there’s a lot more than meets the eye when it comes to scheduling and maintaining productivity in a pediatric therapy clinic. In the name of transparency, let’s discuss a few things that both families and therapists have to consider when making a therapy schedule work.
Finding a weekly appointment time can be challenging:
Therapy is a commitment, and not necessarily a light one, as it typically requires a weekly appointment for an extended period of time. Making sure caregivers can get a child to and from said appointment all while juggling work, extra-curriculars, homework, and sibling schedules can be difficult.
After the initial evaluation, I typically ask when an “ideal” weekly appointment would be. I need to stop doing that, because I often find myself immediately following up with, “yeah, I don’t have that.”
After-school appointments are hard to come by due to their popularity. Often, people will resolve to start their therapy sessions at a less ideal time, with the hope of getting first dibs on a coveted after-school appointment as soon as it opens up. Others might instead opt for a week-to-week schedule, calling in to see what cancellations the therapist has for the week.
I have to note that lately I’m seeing less therapists even offering those after-school hours due to the fact that they have to pick up their own kids or might only work part-time. Some clinics mandate that therapists offer certain later hours, or the extremely rare Saturday time, but these are still difficult to come by.
Many children end up getting pulled from school for therapy:
Therapist schedules are usually slammed first thing in the morning or late in the afternoon. Those awkward middle-of-the-day appointments are great for younger children who aren’t in school yet, or maybe children in feeding therapy that need sessions around meal times.
However, I’ll throw out that I have had some really great sessions with school-age kids mid-day if their parents can swing the hassle of getting them in and out of school. Depending on the child, sometimes missing an hour out of the middle of the day is least disruptive to their academic schedule, and they might be able to return to school with more focus and better regulation.
Others find that missing the last 20 minutes of the day or arriving a few minutes late in the morning is beneficial as well. A talk with the child’s teacher can reveal what part of the day (if any) is easiest to miss once a week.
Some schools are incredibly open to this idea of children missing a bit of their day for an appointment, while others are very particular about students being pulled out, coming late, or leaving early.
I’ve had parents ask if it was “worth it” for their child to miss part of their school day to come to therapy, and I can understand their concern. I’m obviously a bit biased, but receiving direct 1:1 services in the clinic should be beneficial to the child’s overall skill development, and should support the skills they need in the classroom. We just want to make sure it works out so they aren’t missing other important resources in their school day.
5:00 is a dreaded appointment time for everyone:
With only so many after-school hours in the day, the last resort is adding an appointment at or after 5:00.
I’d love to hear if others out there have had consistently good luck with these later appointment times. In my experience, the child is often exhausted, the therapist is exhausted, and the session can turn into a battle of wills. Some older children have done well in this time slot, but overall, it’s a tough time for many children to try to do therapy. These later times should be reserved for those children that can still receive maximum benefit from the timing of the session, which might just be a matter of trial and error.
Transitions between appointments can be tricky:
I promise you that no one can make a mess like a pediatric therapist. It’s almost as if you look around the room after about 45 minutes and think, “how did this happen?” It seemed like such a good idea to bust out that sensory bin at the time, but now the rice has wedged itself into every available crevice of the room and my next patient is walking in the door.
While trying to clean up between patients can throw off the schedule, therapists might also find themselves jumping from a session with a 6 month old baby to a session with a teenager, so switching gears can take a moment. Some might also be running in the door from a home health visit in the community, or unexpectedly locked in an intense conversation with a parent at the tail end of a session. All I can say is that your therapist will try their very best to stay on the established schedule.
Running behind for one patient sets the whole day off:
When you are scheduled back to back, those run-overs make it difficult to catch back up. Sometimes a parent is late in picking up, or a conversation just goes long. In order to give everyone their fair session, it often means running behind most of the day if the therapist is the one starting late.
However, I think it’s important to throw out that if a caregiver brings a child to a session 15 minutes late, this does not mean the session automatically extends 15 minutes late as well, unless the therapist specifically states they can see the child longer than their scheduled appointment time. This miscommunication has happened on multiple occasions in a back to back scheduling scenario, which leads to unexpected setbacks.
Cancellations can make or break a day:
Maybe it’s just me, but it feels like cancellations are an “all or nothing” part of my day. Either everyone comes, or 75% of my day cancels like a domino effect. Some clinics have strict cancellation policies which require that missed sessions are rescheduled, or perhaps a fee is assessed for “no-shows” or last minute cancellations.
To be honest, these policies often work well to keep people accountable for their scheduled sessions. (Not just for our sustainability as a practice, but if you miss a lot of sessions, it’s hard to prove medical necessity to insurance providers.) Although on the negative side, it also leads to a lot of sick kids coming to therapy. There’s nothing worse than little Johnny coughing in your face saying, “I didn’t go to school today because I was sick!” So I encourage people to cancel when necessary, with the intent of making up the session if possible.
And also, while talking about cancellations, I know things often come up last minute when it comes to children, but the more notice you give your therapist that you can’t be there, the more opportunity they have to offer your time to someone on a waiting list.
Un-billable time has to be limited:
In an ideal world, every evaluation would have a sit-down meeting with a parent afterwards to go through the entire write-up. This doesn’t always happen. Why? Productivity. I’ve seen various expectations of productivity in different clinics, which I’d say average around 75-80%. That means only around 20% of my day can be spent outside of billable treatment hours for things like paperwork, phone calls, parent meetings, treatment planning, set-up, etc. Therapists often find themselves doing a lot of things on their personal time to keep up with the work flow. So if it takes a while for a therapist to type up an extra note or communicate with another therapist, it likely has to do with finding that elusive “extra” time.
Therapists understand the commitment involved in bringing a child to therapy, and regardless of the challenges that can arise from scheduling, seeing the progress from week to week hopefully makes those sessions worth the extra effort!