Today let’s think about what “routines-based” intervention really means. See if you can spot the similarities and differences between these two intervention activities:
Activity #1: Aimee is visiting with Josiah and his father, Martin. Josiah has an outcome on his IFSP to address his balance and coordination as he uses his walker to move about his home and his backyard. During the visit, Aimee suggests a new game. She asks Martin to sit about 5 feet across the room beside Josiah who is standing with his walker. Martin puts a ball in front of Josiah’s foot and helps him kick the ball. Then they tell Josiah to go get the ball and kick it again. Josiah walks about 2 feet then kicks the ball again, this time to his daddy. They play this new game for a few turns before Josiah loses interest and wants to go outside.
Activity #2: Martin carries Josiah and his walker out to the backyard and Aimee follows. Aimee isn’t sure what to do outdoors with Josiah so she asks Martin what they usually do. Martin explains that Josiah loves to play chase with his older brother after he gets home from school. Aimee asks Martin and Josiah to show her the game. Martin puts Josiah down in the grass with his walker and says “I’m gonna get you!” Josiah laughs and begins moving forward towards a big tree. Aimee is surprised to see that Josiah is trying to maneuver across the uneven ground. Martin pretends to chase Josiah who tries to move faster then tumbles to the ground. Martin asks Aimee how to help Josiah move across the grass. Aimee coaches Martin in how to get behind Josiah and help him shift his weight to pick up his feet. When Josiah gets to the tree to hide, he struggles with how to move his walker around it. Again, Aimee coaches Martin in how to help Josiah. As she watches, Aimee realizes that this game offers Josiah lots of opportunities to practice his balance and coordination.
What are the similarities?
Both activities are in the natural environment and address an IFSP outcome. The father is actively involved in the intervention visit. The service provider and father are working together and the child is engaged. These are all great things.
Here’s the big question: Which activity is really routines-based?
To answer the big question, let’s consider the differences between these activities.
What are the differences?
In Activity #1, Aimee is leading the activity and suggests the play routine. In Activity #2, the routine is one that the family already enjoys. McWilliam (2010) says that routines aren’t created by service providers. They are things that families do naturally for fun, to spend time together, or to accomplish things during their daily life. Activity #2 gets a thumbs up for being routines-based.
In Activity #1, the child’s interest is short-lived because the game is contrived. It’s not a bad game, but it’s not that fun for Josiah. It’s not based on his interests and it doesn’t sound very challenging. Activity #2 is much more interest-based because playing chase in the backyard is already motivating and familiar. The challenges are inherent in the game but Josiah doesn’t seem to mind them because he’s too busy having fun. Again, thumbs up for Activity #2.
Activity #1 offers Martin a new activity to try with Josiah, which also isn’t a bad thing. Activity #2, however, is a favorite game and is something the family does most days. Activity #2 is more likely to be repeated during the week and offers Josiah lots of opportunities to practice his new skills that his daddy is helping him learn. Aimee wouldn’t have found out about this great game if they had continued to follow her lead and stay on the living room floor. (PDF, New Window) Another plus for Activity #2.
Remember these Three Important Points
The differences between these two activities are so important to understand because they underlie the concept of routines-based intervention. Early intervention providers struggle to understand these differences, but if they keep these three important points in mind, they’ll be closer to providing more effective services:
1. Service providers don’t create the routines – families do. Join the child and family rather than creating a play routine. There’s nothing wrong with showing the family new strategies and games, but they are more likely to use what they learn successfully throughout the week if we coach them during what they are already doing.
2. Build intervention around what interests the child and parent. We often think we know best what children like to do or should be doing. Step back, observe, ask good questions, and find out what they do for fun, how they interact during caregiving activities, and what they would like to be able to do. Embedding strategies during these activities is really where the magic happens.
3. Family life doesn’t happen on the living room floor. This is a tough nut to crack in EI. We have to change our mindset about where and how intervention happens. Again, there’s nothing wrong with playing on the floor, but you might be much more effective if you ask the family what they would be doing if you weren’t there. Would they be playing on the floor? Or would they be doing something else? Ask if you can join them as they do that “something else.” Try it, you’ll be amazed.
What other similarities or differences do you see between these activities? How do you know when you’re providing routines-based intervention? Do you have a good example of a routines-based activity you joined that worked magic?
Reference: McWilliam, R. A. (2010). Routines-based early intervention: Supporting young children and their families. Baltimore, MD: Paul H. Brookes.
Dana, This is a darn good article! 🙂
You know, we here in Illinois are still working toward providing services in a family-centered, routines-based model. My own personal process in developing my skills and adopting this approach has been one that has taken time and has had many peaks and valleys. It is a process that takes patience and requires one to almost take a leap of faith. We have been trained for so long in a clinical model that is bound by skill acquisition and scopes of practice that it can be difficult to break habits, allow us to go out of our comfort zone and begin to release some of these deeply ingrained practices. I find that it helps tremendously to have information such as this to begin to build our confidence in adopting an approach that puts families first and is driven and directed by their priorities, individuality and their routines. Information such as this allows to see that this type of approach is based on evidence and frankly good sound science on child development.
As I myself began my transition to a more family- centered approach many years ago, I found myself asking were my practices at that time reflective of my core beliefs? Did I exemplify through my actions with families my confidence in their abilities to make positive changes in their children’s lives? Did I build capacities in these families? I continue to ask myself these questions as I continue to grow and refine my skills. It was wonderful to read this article and build my confidence that I am on the right track and also remind me that there is much more I can do and learn. The resources that are attached are amazing and I will certainly share them with my peers and colleagues. Keep up the amazing work! This blog is having ripple effects more than you know!
Wow, Benny, I couldn’t have gotten a better compliment! 🙂 It’s so exciting to know that this work is helping other practitioners. You are so right about providers almost having to take a leap of faith in adopting a routines-based model. For many of us, it really is a big shift and does push us beyond our comfort zone. It’s just easier to do the intervention ourselves – and that’s what most of us where trained to do. Plus, playing with babies and feeling directly responsible for their progress makes us feel good too. Shifting gears to being a coach and consultant isn’t easy but it is so effective and so rewarding when we see the family making the difference!
Thanks for sharing the reflective questions you ask yourself. I think these will be really useful to others. As you clearly know, the key to evolving your own practices is reflection. It sounds like you are doing a wonderful job of it!
I was just wondering what advice would you give or resources may you have for those who would have the objection that routines based activities may not be feasible for some children who have more profound delays?
Great question, Benny. I’ve been surprised by how often I’ve heard the same comment – that these practices won’t work for kids with significant disabilities. I think that providers will use a combination of practices, including some direct hands-on intervention to model strategies plus coaching to help the parent or caregiver practice those same strategies too. Observation of what the parent is already doing is so important too, because the research tells us that families are already quite good at adapting their routines and activities to include their children, including those with significant needs. It’s been my impression that because these children have multiple needs, we often get overwhelmed and think they need lots of special techniques and services. They do often need more than, say, a child with an expressive delay, but the intervention does not have to be completely clinical. Finding out about what interests the child, what he/she finds stimulating and what captures her attention can offer great motivators when working on key functional ability areas such as movement, communication, engagement and attention. Thinking about family routines and how to help the child participate in them is absolutely appropriate and natural, but can actually push a provider beyond the typical suggestions for toddlers. I think it’s helpful to step back and keep the child’s development in the context of his/her everyday family life. Balancing teaching the parent how to stretch, position, and engage the child with helping them find ways to weave these activities into the daily routine are the key. My advice would be to target a particular routine for each visit and see how it can be used to support the child’s development towards the IFSP outcomes. I’d love to hear other suggestions too. This sounds like a great topic for another blog article! 🙂
This is a great article. I’d LOVE to have about 3-4 more of these kinds of routines-based blogs to “spot the differences.” Such a great tool I can use with students.
And Benny, the questions you asked of yourself were fantastic!
Hmmm…good idea, Cori! I’ll see if I can pull a few more together and post them in the coming months. I love the thought of these types of posts helping students.
I found this on Pinterest and felt refreshed to read this since im an OT. I struggle with how parents and even other service providers in an EI are so stuck in this “clinic model”,bringing in piles of materials, and even bringing the kids to separate locations without involvement of family, daycare staff, or whoever else is in the natural environment. Do you recommend any literature?
Hi Lizzy – I’m glad you found the blog! Yes, One researcher who is also an OT that you might be interested in is Phillipa Campbell. She writes about participation-based early intervention. I recently presented a webinar called “Let Go of the Toy Bag and Get Off the Floor: Tips for Best Practices in Early Intervention” that you could share with your colleagues. Also, on the VA Early Intervention Professional Development Center website, you might like to visit our Implementing Supports and Services page where you’ll find lots of free resources about recommended practices. For instance, we have a set of videos all about Routines-based EI (this link will take you to the first of three videos). It can be very frustrating to be trying to use these practices and see others doing more traditional, clinical work because it can muck up the waters and be confusing for families. Keep up the good work and check out these resources. Share with your colleagues to maybe get a discussion going! 🙂