I agree with Mahoney, Robinson and Perales (2004), “….the time has come to stop talking about parent involvement and to commit to learning how such involvement can be accomplished across a range of family constellations, circumstances, and values.” When I first start working with a family I explain that there shouldn’t be a “therapy” hour, rather the family should have lots of ideas on how to “work” with their child by incorporating strategies into activities they are already doing throughout their day. The following are a few tips that will assist the early interventionist in learning how to embed strategies into a family’s natural routines.
Start with a routine-based interview.
The early interventionist could use a formalized, extensive routine-based interview like McWilliam’s RBI (2004). I tend to do a less formal interview: I ask the family to tell me about a typical day (starting from when the child wakes up until they go to bed for the night). If the family hasn’t mentioned it during their accounting of a typical day, I ask about specific activities they do: shopping, walks, visits to friends, parks, library, day care, etc.
Incorporate family goals into strategies
This is important for a couple of reasons. First, because the family’s goals help shape the child’s IFSP outcomes. Second, when our approach is compatible with family routines and priorities, the result is collaboration among all team members (Blythe, 2012). Lynne Blythe, local system manager of the Infant and Toddler Connection of Rappahannock-Rapidan suggests an equation: Family identified routines + prioritized outcomes = Collaboration + Cooperation “Take away any factor and the equation becomes unbalanced” (Blythe, 2012). Sometimes this requires the early interventionist to explain how the strategy is a precursor to an outcome skill.
Set up the environment
While changes to the actual family activity should be avoided, sometimes it is necessary to modify the environment where the activities take place. For example, let’s say a family’s outcome is for their child to use words and start walking like their cousin’s same aged child. This child’s toys are always on the floor for easy access during playtime. Moving the toys up on top of the coffee table encourages the child to either use his words to request a toy or to pull up to stand to reach the toy, or both!
Follow the family’s and the child’s lead
I recently had a child with a diagnosis of Spina Bifida who was resistant to walking with her reverse walker. I suggested making the walker a fun activity by adding a basket to carry a favorite toy. The Mom put the child’s favorite bear in the sling seat and encouraged the child to push the walker from behind like a stroller. Was it the correct way to use the walker? Technically speaking, no, but for our purposes, heck yeah it was! As a pediatric physical therapist I’m trained to break developmental activities up into sequences. First a child crawls, then cruises then walks. First a child must be comfortable on an even surface with an assistive device before you introduce uneven surfaces. As an early interventionist I have learned to keep that training in mind, but follow the family’s lead. This same child refused to walk more than a few feet with her walker inside. Admittedly, I was running out of ideas. That weekend I received a video from the Mom of her daughter walking – outside, in gravel!
This is the fun part! For instance, going for a walk provides numerous opportunities to incorporate multiple developmental strategies: squatting to pick up rocks or flowers, marching, going up on toes to reach for leaves, labeling objects and colors, experiencing different textures on hands and feet, etc. Can you use a favorite toy in a new way? Can the siblings be models for the strategy during the naturally occurring activity? As an early interventionist you’ll have to think on your feet and outside the proverbial box!
“Interventions fail to be implemented and sustained when they do not fit the daily routine of the family…when the intervention cannot be incorporated into the daily routine, or when the intervention is not compatible with the goals, values, beliefs of the parents” (Bernheimer & Keogh, 1995, p.424). I am just one pediatric physical therapist. As early interventionists we learn the most from each other. What are some specific examples of how you have incorporated interventions into the daily routines of your early intervention families?
References available upon request.