It’s a habit we are all guilty of as therapists. We throw around these words that parents don’t always understand, and then barely have the time to accurately explain ourselves. A disconnect can emerge in this process, with opportunities missed due to misconceptions or misunderstandings. One of these concepts that often gets caught in the jumble is something called a “co-treat.”
This term is short for “co-treatment”, or when more than one discipline works with a child at the same time. Could be physical therapy and speech therapy, or occupational therapy and speech therapy. I’ve even seen occupational therapy and physical therapy done together.
A parent’s typical first thought when they hear that their child “would be good for a co-treat” is usually something along these lines:
“That doesn’t seem fair!”
“They would be cheated out of therapy time!”
“That just means you both do half of a job, right?”
Ok, ok, hold on to those thoughts, because yes, sometimes a co-treat isn’t appropriate, and many times it isn’t done well. However, there are a lot of good things about a co-treat that are often lost in an immediate rejection of the idea. I hate feeling like I’m trying to give parents an up-sale to the heated leather seats and moon roof of therapy services. So let’s first look at a few reasons why a co-treat might be recommended.
Why co-treats are recommended.
When one discipline compliments another.
I put this one first because it’s pretty much the only good reason to recommend a co-treat. You want to be able to say that two services together were truly better than each one apart. (Wow, that totally sounds like a line from some cheesy therapy romance …) I promise you, in many situations it is the best option for a child’s progress. Allow me to give you an example:
Say you have a child with severe sensory processing issues. Most of the time, the speech therapist can’t get anything out of them unless they are engaged in a sensory activity. As much as we OT’s try to give them suggestions for their sessions, there is nothing like being there to help the child’s nervous system adapt on the spot.
In this scenario, the child might do a language activity as they go back and forth in a tunnel. They might use functional language to request ideal sensory strategies. They might become so organized within the session that they are able to show a whole new skill set. Both therapists are working together to achieve their goals simultaneously, with one discipline promoting another. It’s a beautiful thing when it’s done well.
When a child has specific behaviors that impede therapy.
There have been times when a child has had violent outbursts or severe behaviors that require a few extra hands. Neither therapist may feel comfortable with the idea of treating the child alone, so they ask for a co-treat. Since the idea behind it isn’t necessarily to meld two therapies together, I don’t really recommend this one. If the behavior is so bad that a therapist needs another hand, I would recommend a behaviorist or other specialist be involved in the case to address the root of the issue.
When time constraints limit therapy time.
Sometimes parents just don’t have the time to get a child every service that is recommended. And yes, it happens when parents aren’t that interested or invested in therapy, and they might only willing to do services if they are together, or within a tiny time frame. So if that parent only has an hour a week, sometimes it is better to get two services at the same time rather than just one. In this situation a co-treat might not be ideal because the child probably isn’t a great candidate to work on two skills simultaneously. However, it still happens when therapists are desperate to get the child what they need in a short amount of time.
And yes, on the more depressing and less ethical flip side of that, sometimes a clinic might recommend a co-treat for the wrong reason of billing for more services in a short period of time. I’d like to think that this rarely happens, but eh, who knows anymore.
The logistics of a co-treat.
The billing stuff:
I’m not going to go in depth about billing procedures, because I might get myself in trouble since I’m not quite certain of how procedures may vary from state to state. However, I can tell you that I’ve seen it done one of two ways.
-Sometimes services are billed completely separate as if they occurred at two different times.
-Sometimes the therapists split the time that they treated the child. (i.e. it’s an hour co-treat, so each discipline only bills a half an hour).
In my opinion, I’m not quite sure how two people can bill for the same time that they are with a child. (Even if they were pretty amazing at it and were always working on their goals.) However, It definitely depends on the policies of the insurance they are billing, because some insurances even have limitations for the number of services a child can receive in a day.
Parents, it would be up to you to double check your policies and make sure that it is being billed properly. Don’t be “double billed” for time that shouldn’t be happening. However, if the clinic you attend only deals with private pay situations, they can pretty much make you pay anything they want. Regardless, it’s worth looking into the billing procedures.
The ethical stuff:
Watch out, because often a co-treat is done WRONG. When it is done well, it is not simply a “my turn – your turn” back and forth with activities of a different focus. This sort of set-up drives me crazy. A co-treat should be an integration of both disciplines working together.
As I mentioned earlier, if the speech therapist has cards they are working on, instead of having them do an OT motor activity, then sitting for 10 minutes to do cards, integrate the cards into a motor activity! Hop on them, bring them back on a scooter board, bring them through a tunnel. Both people should be actively working on goals at the same time.
Also, it seems weird to point this out, but I hear it all the time. No, I can’t just “do PT” or “do speech” with a child too. We each have individualized training and licenses that permit us to complete a certain set of interventions. Even though we may often overlap in many areas, I can never claim to be anything other than an OT.
The benefits of a (well done) co-treat.
Sometimes incorporating two therapy services together can be magic. The child might enjoy and participate more in the session when both are working together. Sorry to my speech friends, but sometimes just being in the OT gym or incorporating OT tasks can make some of their speech activities more exciting and/or motivating. Also, I love the idea of knowing what the child’s speech goals are so I can hold the child to an appropriate set of standards when I am communicating with them.
Honestly, sometimes just having the time to talk and collaborate with another professional yields ideas that you never would have thought of alone. I’ve seen some co-treat gold that never would have happened without two people working together. And yes, sometimes individually you might not have a stellar session with a child, but with another professional at the helm as well, it might just come together.
Even if you are strongly against this concept as a parent, if your therapists recommended it, maybe try it at least once to see how it works. I’ve been so frustrated when a parent immediately shuts down the idea without even hearing us out or giving it a try.
If you see a synergy and progress that you didn’t see before, then you’ll know it was worth the test. If you see a lazy back and forth, then hey, at least you know that too. Also, even if it seems to be a good idea, but doesn’t sit well with you for every session, ask to try it once a month or so, just to touch base and see how things progress.
Just like in all therapy, there is a little bit of art thrown into the science. And a well orchestrated co-treat is just that, art. If you have two therapists that can do it well, you might be pleasantly surprised by the results.