Early Intervention Strategies for Success

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  • EI Research to Practice Brief #1: Provider Perspectives on Changing their Practices(current)
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TheBoy With Idea Light Bulb Over Head practice of early intervention (EI) is always evolving and changing as new evidence comes to light about how to support children and families. This brief summarizes a research study that examined perceptions and experiences of EI providers as they implemented a new service delivery approach. It is followed by strategies you can use to evolve your practices based on the findings in the study.

Research: What Do We Know?

Salisbury, C. L., Woods, J., & Copeland, C. (2010). Provider perspectives on adopting and using collaborative consultation in natural environmentsts. Topics in Early Childhood Special Education, 30(3), 132-147. (PDF, New Window)

Salisbury, Woods, & Copeland (2010) conducted a case study of six early intervention (EI) providers as they adopted the collaborative consultation approach. Collaborative consultation focuses on increasing caregivers’ capacity to support the needs of their children using strategies such as modeling, coaching, joint problem solving, reflection and feedback, and prompting with children and families during natural routines. For more information about collaborative consultation, read Collaborative Consultation in Natural Environments: Strategies to Enhance Family-Centered Supports and Services (PDF, New Window) by Woods, Wilcox, Friedman, & Murch (2011).

This study included providers from the four most common EI disciplines: occupational therapy, physical therapy, speech language pathology, and developmental therapy (or special instruction). Information was gathered from the providers through a survey, interviews and focus groups to understand their perceptions about and experiences with adopting and using the collaborative consultation approach during their visits with families.

Findings

Five types of support were identified that affected providers’ abilities to learn about the approach and implement it in their work, including:

  1. Reflection on one’s own practice
  2. Viewing their work environment as a “learning community”
  3. Having a broad definition of training
  4. Having organizational support
  5. Actual experience with the approach

Support at all levels of the organization was important, from the individual staff level up to the managerial and organizational levels.

Providers reported a commitment to adopting these valuable practices while also describing challenges. They found that it was easier to use these practices when families had specific requests for support, understood the approach and worked in the home. They also noted that using the approach was impacted negatively by other providers who had not adopted it (i.e., who were still using toy bags).  They noted that changing practices was hard for both the provider and the family when both were used to interacting using more traditional practices. Implementing these practices was successful when providers perceived that they had appropriate training, had time to practice using the approach, and received support from their team and their organization.

Practice: How Can You Use What You Know?

We know thaSign: Theory Into Practicet changing intervention practices is closely tied to your perceptions about the change as well as the support you receive. It also takes lots of practice and reflection to compare what you know and have always done with what you are learning. Based on this article, keep these strategies in mind as you evolve your practice:

Be aware of your own attitudes – how you think drives what you do. Be open to change.

Understand that changing practices is challenging and success is more likely with appropriate support – Changing practices is a personal and an organizational issue. Providers need understanding and support at all levels.

Initiate a change in practice with new families – It might be easier to try out new practices with new families, rather than changing how you work with a family you have supported for a while using a different approach.

Explain your practices to families – Help families understand why you are using new strategies and how these strategies will help them and their child. You will likely learn alot from them about what is effective and how best to implement the new practices.

Reflect on your changing practices – Reflection needs to be an active process. Think about what you do on each visit, why you did it, and how you could improve it. Ask a peer to tag along and provide feedback. Videotape a visit then critique it. Reflect with your team and support each other as you discuss successes and challenges. Put reflection time on your staff meeting agenda and do it with every meeting.

Seek out training – Attend a conference or workshop. Participate in or lead a staff development activity. Read an article or book about the practice. Taking an online module or course. Find a more experienced mentor.

Create a learning environmentSupervisors need to make time for staff reflection, practice and training. Make the change a shared priority and encourage staff to learn from and with each other.

What other strategies have you used to change and grow your practices?

27 comments on “EI Research to Practice Brief #1: Provider Perspectives on Changing their Practices

  • Sarah Nichols says:

    I like the strategy suggested for changing practices with new families because then they don’t really know it is new and if you fumble a little they won’t know the difference. However one thing that I have done (in addition to trying new things with new families) is try the new strategy/approach with a few families that I had been working with for a while and feel really comfortable with…and then I could let them know that things might look and feel a little different today and that I would love to get their input afterwards on what they liked and didn’t like about the new approach. More often than not the families told me they liked the new strategies I was implementing and were able to give me some good feedback since they knew the “old” way I was doing things and could express what they really liked about what was new. Sometimes they could even give me pointers on how to do something better the next time.

    Reply
    • This is a fantastic idea, Sarah! When you have that kind of honest working partnership with families where they feel like they can give you feedback too, I think that both you and the family benefit. I’ve found that when families understands what you want to try and why, and that they will also have a “say” in the process, they are often happy to support your efforts too!

      Reply
  • yvonnie hutchison says:

    Yes, I agree with Sarah in her above comment. I have had similar experiences.
    I like the terminology used in this case study (Collaborative consultation) because it captures coaching as a strategy that is part of a early intervention visit. I have found that some families/EI professionals shut down when they hear “coaching” being mentioned. I know it’s just words, collaborative consultation, but I think it captures the family’s contribution as an EI team member.

    Reply
    • Collaborative consultation is a great phrase to use. It’s also an approach that includes coaching so they go together quite well. Check out the link in the post to the collaborative consultation article for more info. Unfortunately, I’ve heard the word “coaching” being used in ways that are not descriptive of the actual strategy – things like if you coach that means you can’t interact with or do any “hands-on” intervention, which is not correct. I love the idea that using coaching is just one tool in your intervention tool box to use as we collaborate with families. It’s all about really understanding how to use good, evidence-based practices – whether you call them coaching or collaborative consultation!

      Reply
  • Belkis Negron,PT says:

    I have been using the term reflection with the families. I also use video taping extensively as a tool to explore the strategies and to “see” areas of concern and of progress towards achieving goals. It is also very useful for peer review and for self reflection with the team.

    Reply
    • Two great ideas! I think helping families reflect on what they already do or could do is such an important key to collaborative consultation. I haven’t used videotaping much but I think it has such wonderful possibilities. We have a video of you, Belkis, on the EIPD Tools of the Trade page, talking about using parent’s cell cameras. If anyone wants to check it out, it’s here: http://www.eipd.vcu.edu/tools_trade.html

      Reply
  • Subarna Dharia says:

    As a pediatrician who has worked with early intervention for years, I feel very strongly that the ideals it imparts, like being mindful of the family’s wants and needs, addressing the whole child, and just making parents feel like a crucial part of the team are not exclusive to EI providers, but to anyone who works with children, including Pediatricians. I try to impart this information to the pediatric residents that rotate through our program. Thanks for your blog!

    Reply
    • I’m so happy to hear that, Subarna! I completely agree that these good practices are important in any position where you have the opportunity to support a child and family. That’s wonderful to hear that you share them with residents. There seems to be more movement, from what I’ve read, to thinking about the pediatrician’s role as considering the child in the context of the whole family which is exciting. Thanks for joining the discussion!

      I have a question for you – do pediatric residents typically receive much training in family-centered practices?

      Reply
      • Subarna Dharia says:

        This is variable throughout different residency programs, but I do believe there is more emphasis on this as of late. I do evaluate our residents based on their family and team interactions during their rotation.

        Reply
        • I’m really glad to hear that there is increasing emphasis on this. As you know, it’s so important to building that relationship with the physician that will last well beyond the child’s experience with the EI program!

          Reply
  • rupalp says:

    I found it easier to implement strategies with new families versus modifying my and/or introducing a new approach with families that I had worked with awhile. However, I understand that with a large caseload this may not not work for other providers.

    Reply
    • Yes, I’ve heard that from other people as well. Sometimes starting fresh is the best way to go. With families you’ve been working with, sometimes you can make smaller changes too. It can help to talk to the family about what you’re changing and why. Sometimes they can provide you with feedback too that can help you grow too!

      Reply
  • Allison says:

    I feel I am always reflecting on what I do in the home. I especially love getting brand new families that are also new to the “therapy world”. It really gives me the opportunity to really implement the coaching model and set the expectation of family participation. I, too, am always using my video camera not only to show progress to the family but also to have insight from other disciplines for more suggestions.

    Reply
  • Kathrny Von Schuch, PT, DPT says:

    As a Early Interventionist who has practiced in two different states that do not follow the “coaching” model, I can see a big difference in the families that I work with in using these approaches in VA now. Parents now feel empowered by their ability to collaborate with the therapists they are working with to help their child. I can see a change in their responses from session to session in their ability to recall what they worked on with their child, what worked and what didn’t, as well as their own ability to problem solve when we are not there. Video, as other posts have noted, is a great and readily accessible tool that we all have today and I think it is a great tool to integrate into the session. It has taken me some time to adjust my own practices from when I first started here in December, but fortunately there has been a lot of wonderful resources and therapists who have helped me to integrate this therapeutic model into my treatment strategies.

    Reply
    • That is so exciting and inspiring to hear, Kathryn! We’ve had some requests (here on the blog and elsewhere) for insights into how PTs can implement coaching with families so I’d love to hear if you have any advice. I think the struggle has been with coaching families who have children with multiple significant disabilities and those with medical needs. I think that, sometimes, it’s an issue of beliefs about what a PT “should” do, but other times I think therapists want to use coaching practices but struggle to integrate them into their work. Any suggestions for PTs who might be finding it challenging to change their practices?

      Reply
    • Janet Hammond, MS/CCC-SLP says:

      I am so encouraged by Kathrny (Kathryn?)’s post. My team could do this if we find some way to jumpstart making these changes. We have been told to do the participation-based model, and given the Practice Beliefs, but no modeling in how to support families in implementing them successfully.

      My small team (only a single person from each discipline) is assigned a huge territory; the 5th poorest county in the US. We work with many marginalized families. I personally put 800 to 1,000 miles a week on my car. We do not get reimbursement for mileage or time spent driving, only family contact – so we have to put in long hours to make ends meet. It is challenging for us to change how we do things without some guidance or leadership.

      Maybe it would be helpful for busy teams to access a video library or at least a list You Tube links modeling successful PBI using daily routines. Once we get a taste, my team of awesome therapists will easily transition to participation-based interventionists.

      Reply
  • danielle@t4k says:

    I agree that starting new strategy with a new family is much easier. I have worked in EI for a long time and when I look back and think about how I have changed my therapy over the years working towards this collaborative consultation model it astounds me. Ten years ago I would have NEVER walked into a house without my toy bag!! That would have done me in!! I agree with what Kathryn says that this model “empowers” families to feel that they can help their child. I try with each new family to be less hands on and more of a coach by setting a specific goal for myself before that first session (i.e. this time I’m going to ask “what do you want to work on today?” or “I’m just going to watch you play”). I still have a lot of work to do in this area but it is such a joy to see the family using the strategies that I provided for them when they actually get the results we are looking for. When families thank me for what I have done I always put it back on them and remind them that it’s not what I did, I just coached them and they did the hard work.

    Reply
    • I love your strategy of setting a specific goal for YOURSELF before each session. That’s very different from thinking about what you need to get the child to do during the visit. The focus is on you in a very positive way and on your own growth as an interventionist. That’s how we change practices – by making that commitment to ourselves and purposefully thinking about and working towards it everyday!

      Reply
  • Carol Wesley MS,CCC-SLP says:

    If you think about it, the setting is your toy bag. I often find it makes sense to the grownups when I can say, “Because we have goals, I knew what I would be doing here today, I just didn’t know what I’d be doing it with!”

    Reply
    • What an interesting insight, Carol. I’ve never thought about the toy bag being our setting but you’re right, by bringing it we are trying to create a setting. What you say to parents really emphasizes the flexibility that’s required to provide good EI support!

      Reply
  • Laurie Cunningham says:

    I do love the term collaborative consultation. I’ve been successful with being very upfront with families who are coming from a different model – clearly defining roles and talking about how we can work together to make changes they want to see. We talk about how my time with them is so short and that my expectation is not that we will see big things happening during our session, but that big things will happen later that they can tell me about next time. It can be really difficult, especially when the medical community pushes a different kind of therapy model, but I am finding it easier and easier to work within this model with the family fully engaged.

    Reply
    • That’s wonderful to hear! I love how you describe your time with the family. I found that using Robin McWilliam’s quote – about how it’s not what we do during the visit that makes the difference in the child’s development, it’s what happens between visits that really matters – to be very useful with families. What do you all do in your locality to try to reach out to health care providers to help them understand how EI works? That’s an ongoing challenge in many places…

      Reply
  • Dylan_Rodgers says:

    Using new strategies can be very useful and in times of change difficulties can arise which shows why implementing these strategies with new families can be the most successful. Although if you are already working with a family, if you help explain the importance of trying these new strategies and how they can help in the development of their child could help them be more receptive to the change

    Reply
  • Lori says:

    Theory Into Practice is the stage I feel I am at all of the time. Fortunately I came from the multi disciplinary family centered natural environment training; I didn’t have to change my approach, just figure out how to “best reach the ideal”. It has been over a dozen years, & we are still working on collaborating with professionals & parents who are not yet used to this concept. Either way; theory tends to be based on the Ideals of practice. Will we ever be 100%? Not likely. But we have to strive for the ideal to get closest to it as possible; most importantly respecting, valuing & empowering families, not imposing our values as professionals but letting parents know that they have the potential to be the experts because they are the childs #1 teacher and guiding them along the way, as a team.

    Reply
    • So well said! I think that, when we are constantly striving for best practice, that we do stay in a theory to practice stage. Being mindful about that effort and actively striving for the goals you mention are what help us move from an awareness level to actually putting those ideals into practice.

      Reply

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