“There is something you should understand about the way I work. When you need me but do not want me, then I must stay. When you want me but no longer need me, then I have to go. It’s rather sad, really, but there it is. ” ~ Nanny McPhee
I remember the first time I saw that movie (which was first a book I still have yet to read :-)), a few years back, and I thought – that’s a good quote, I’ll have to remember that. I then of course promptly forgot it. It wasn’t until about two years ago that I found myself recalling that quote as I was describing to someone what I needed out of my Assessment process at the North Dakota School for the Blind, a process that enters full swing for the first two months of fall – so right now! Welcome fall! – every year: “I need a tool that determines not just if what I do is effective, but if what I do is MORE effective than services the client is already receiving, so I can determine how much they NEED me.” Ding ding ding!
In the end, I wasn’t able to find a tool like that, so I created one. And thus, the Nanny McPhee quote re-entered my world. The way my job at NDSB is set up, I see upwards of 40 students around the state, some of whom live 5+ hours away from me, so seeing everyone on a weekly, or even monthly basis isn’t possible. It didn’t feel right for me to say “You live too far away, I can’t see you,” and yet until Nanny McPhee popped back into my head I didn’t have the tools to give any other reason for limiting how often I provided services, let alone terminating them, and so I bottlenecked – I was seeing more clients than I had hours to document, my data collection suffered, and ultimately the quality of my clients’ services did too. But not anymore.
This fall marks the 2nd year since the creation of my own Assessment tool – which I’ll be sharing as part of the Clinical Practice Forum at this year’s American Music Therapy Association (AMTA)’s conference in Jacksonville this November! – and every year I find new ways to make the tool stronger and more effective to do the following three things:
1. Assigning a numerical ratio to the students’ needs between my services and other disciplines: no longer do I just document what the student needs from me, I can note what percentage of their needs specifically depend on me, and which of their needs can be left to other capable professionals.
2. Determining how often a student receives services: as I mentioned before, in my rural state, the students I serve get seen once a month, if their needs call for it (and if the weather cooperates, though we’re looking into teletherapy options for the future, but that’s a whole other ballgame!). My assessment is set up in such a way that one percentage range of need equals a certain number of visits per year, and another range equals a higher or lesser number, thus all my services become consultative and not fully direct. Yes, I still work with my student, and they remain the center of my goals and priorities, but their education team becomes an equally crucial part of therapy, receiving adaptations and tools from me to utilize between my visits, with the eventual goal being that, sometime in the future, the student won’t need me anymore. Which leads me to…
3. Termination of services. This is a criteria that took me the longest to not only develop, but to work into the language of my assessment. Students qualifying for the lowest level of service multiple years in a row will be terminated, no if’s and’s or but’s. I know they want my services, I know they enjoy them, and I enjoy providing them. I love all of my students and would love to work with all of them 24 hours a day if sleep, nutrition, hygiene, and a general sense of sanity weren’t requirements for me to keep functioning. I want more than anything to be able to serve every student that wants me. But that’s when I have to go.
“It’s rather sad, but there it is…”
This is the first fall where I’ve had to tell families their child won’t be receiving services anymore after this school year ends, and it is very sad, but by and large I’m finding that people understand. All good things must come to an end. And that isn’t me honking my own horn as the “good thing.” It’s the music and therapy tools my training has given me, that are the “good” I know must move on to serve other students. But, I always know they leave traces. It’s like another of Nanny McPhee’s quotes: “You are the story.” Nothing really ends because I leave, life goes on, and my students grow up to do great things. I’m now in that point of my career where I’m starting to see students I worked with as infants transitioning to preschool, preschoolers transitioning to kindergarten, highschoolers graduating. And as sad as I always am to see them go, I am fascinated by watching them grow. And that’s a pretty fantastic feeling to take off into the sunset as I disappear into the snow…