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.