By Consulting Speech Pathologist, Dodie Newman, MA, CCC
What is Compensatory Skills Training?
Compensatory Skills Training is training that focuses on learning a wide range of coping strategies, also known as “workarounds,” for dealing with various cognitive challenges such as:
- short-term memory problems
- difficulty following oral directions
- scheduling tasks and appointments
- difficulty setting priorities
- controlling emotional episodes and others
Learning to Cope and Compensate
Individuals who are born with cognitive differences or who have experienced a medical or traumatic event that causes brain injury are usually capable of learning strategies and using assistive technology for handling these situations.
To master the strategies they need, they need the opportunity and enough time to reinforce their new habits in different environments. This is where either a professional cognitive therapist or a para-professional compensatory skills trainer can play an important role.
In essence, learning compensatory strategies makes it possible for an individual to use external means, like assistive technology, to allow them to function more independently and compensate for their cognitive challenges.
Why Compensatory Skills Training Matters
Individuals who experience memory challenges need to learn when and how to capture information they can find and use, as this is neither obvious nor natural, following a medical event causing a cognitive disability.
They need to learn how to request the time they need to make notes, whether the means is writing, typing, dictating or recording notes. And they need to know where to look for the information they have captured, when they need it, sometimes many weeks after the fact.
Without appropriate compensatory skills training, an individual with cognitive challenges may not know when or with how much detail (context) to write a note. They can even become discouraged about making notes at all, if they experience repeated disappointment when they cannot find what they are looking for.
Writing notes in planners and journals may work for some. Typing notes in software programs may work for others. Note taking software and apps may work too. And recordings and “smart pens” can be effective. However, in the absence of learning how their misfiring brain may be tripping them up, making notes to compensate for memory challenges may not be as effective as it needs to be.
Without compensatory skills training, note taking is often ineffective.
Following Oral Directions
For individuals who wish to succeed in school or at work, following oral instructions can be very challenging.
Instructions with multiple steps can be forgotten immediately, remembered incorrectly after short period of time, or “mis” remembered over time. Instructions that are written down may not have enough detail, or can easily be lost or misplaced. Compensatory skills training can address this challenge.
During the course of compensatory skills training, individuals can be taught how to make cue cards identifying the steps they need to take to complete multi-step tasks and procedures. They learn how to do trial runs. They learn how to color code information so they can find and use it. And they learn communication strategies such as “Clarify and Verify” so they can be confident they understood instructions correctly.
Scheduling Tasks and Appointments
Calendars, day planners and many of the popular note-taking apps and scheduling options are often the go-to technology for individuals with memory challenges. However, in isolation, or in the absence of compensatory skills training, they are seldom sufficient.
With compensatory skills training, an individual learns how to schedule a task or appointment so that it has meaning when the time comes to take action. Without this knowledge and skill, even the best scheduling technologies are either useless or, at best, not as useful as they need to be.
As a practicing cognitive therapist with over thirty years’ experience working with individuals with a wide range of cognitive challenges, I can assure you that thousands of dollars are spent regularly on planners, calendars and apps, in the hopes that simply scheduling tasks and appointments will “save the day” for individuals with cognitive disabilities. It may for some, but it may not for many.
Notebooks and calendars may be necessary, but in the absence of compensatory skills training, they are seldom sufficient.
Scheduling, calendaring, and structure are usually necessary, but that does not mean they are sufficient. It is equally important to teach the individual with cognitive challenges how their memory problems can trip them up. This is an essential component of compensatory skills training.
It is not unlike teaching someone how to build something. A hammer and nails may be necessary, but in the absence of appropriate instruction and practice, the effort may not yield the desired result.
Setting priorities, making decisions, solving problems and exercising appropriate judgment are all components of the compensatory skills training process. This includes strategies such as using visual cues to be able to see one’s options. And learning skills for knowing how to take action to solve a fundamental problem instead of reacting to its “symptoms.”
These are all components of what is called “executive function,” and it is an area that many individuals with cognitive challenges need to learn about.
Controlling Emotional Episodes
Individuals with cognitive challenges often experience stressors that individuals with ordinary cognition (so-called “neuro-typicals”) seldom experience — chronic confusion, crushing cognitive fatigue, extremely painful periods of frustration and overwhelm. Even when memory, scheduling or other tasks of life are under control, the emotional burdens experienced by many individuals with cognitive challenges, can become “deal breakers” if they are in school or at work.
Compensatory skills training can help individuals both avoid some of these states and also cope effectively when they happen.
Compensatory skills training is important because when a person with cognitive impairment does not regain “normal” function in a particular area, such as short-term memory, they can regain function in day-to-day life if they learn compensatory skills.
In conjunction with appropriate tools – in the form of either “low-tech” or “high-tech” assistive technology for cognition, they can learn to function with greater independence, efficiency and reduced frustration.
External tools such as notes, planners, routines cues, checklists, alarms, and other technologies provide external cues that the person’s internal brain cannot generate.
Training and repetitive practice of these compensatory skills are necessary so the person can comfortably and consistently use these tools. Lack of adequate training and practice will likely result in limited carryover of these strategies thus poor outcome.
It is not unlike an ice skater who needs to practice Figure 8’s repeatedly to insure proper execution without hesitation. When the time comes to perform, “muscle memory” kicks in and the result is a beautiful, consistent performance.
Cognitive Therapy Services – Service Cuts
Unfortunately due to insurance and budgetary limitations over the past several decades, the kind of extended compensatory skills training patients used to receive, rarely occurs in our health care environment. Overall, cognitive rehabilitation services have been greatly reduced for the general population. In-patient and outpatient length of stays have been shortened extensively, resulting in limited cognitive and other therapeutic services.
Often times, patients are seen by professional cognitive therapists very early in their recovery, when medical and cognitive challenges are greater. While compensatory strategies are often introduced at this early stage, because treatment time is limited, practice and carryover of these strategies often do not carry over.
The solution may need to be making use of alternatives that exist outside a formal rehabilitation setting. Job coaches can be trained to teach individuals how to compensate on the job.
Special education teachers and school system occupational therapists understand compensatory skills training. Some life skills trainers do too.
You may be able to find skills trainers with special training. They may be in a good position to provide pre-vocational compensatory skills training as para-professionals who are certified as Brain Injury Specialists by the Academy of Brain Injury Specialists, which is administered by the Brain Injury Association of America. And some certified ATPs (Assistive Technology Professionals) have expertise and experience working with individuals with cognitive challenges.
Achieving or restoring “ordinary” cognitive function in the presence of brain injury or other cognitive impairment, is a complicated process. That said, the right mix of tools, skills training, time and supports can level the playing field.
Dodie Newman, MA, CCC
Speech Language Pathologist